Additional Revision Facts Flashcards
1
Q
Lithium in Pregnancy?
A
- Advise to stop upon becoming pregnant- Taper down over 4w- This does not prevent adverse effects.
- Discuss switching to an antipsychotic if needed (Much safer for baby).
- If lithium is continued, use as low dose as possible and drink lots of water.
- STOP lithium in labour- Cannot breastfeed baby.
2
Q
Corrected age of child development is counted back from 40 weeks!
A
E.g., social smile is normally @6w. A 32w gestation baby will therefor show a smile 14w after birth, on average.
After 2y old, this calculation is discarded.
3
Q
1st for Panic: SSRI
2nd: TCA
Abortive: Benzos
A
4
Q
Raised AFP
A
NTD
Abdominal Wall Defect
Patau’s (Cleft Palate)
Multiple Pregnancy (Raised everything).
5
Q
Nitrofurantoin in 3rd trimester
A
Haemolysis of newborn
6
Q
Potter’s Syndrome
A
Sequence of events in foetus: Kidney issue > Oligohydramnios > Pulmonary Hypolasia / Clubbed feet.
7
Q
If contraceptives are started in <5 days from period, they are all IMMEDIATELY effective.
A
Does beg the question about short cycles though- Say you had a 23 day cycle, that would imply you ovulate on day 9- which gives the COCP only 4 days to work if you took it on day 5.
8
Q
Perthe’s disease causes sclerosis of the epitheses and resorption of the femoral head.
A
So don’t confuse it with SUFE just because it says “Epitheses”.
9
Q
Fredrich-Waterhouse
A
Meningitis > Bilateral Adrenal Haemorrhage. (Salt wasting).
10
Q
Go over alpha thalassaemias.
A
11
Q
12 year olds should have vitals similar to adults
A
So a bp of 90/70 is bad.
12
Q
Pregnancy DVT - LMWH - Monitor with Anti-Xa.
A
13
Q
Umbilical fundal height at 20w
A
14
Q
HepB safe for Breastfeeding.
A
15
Q
Dilation of eye = SURGICAL cause of 3rd nerve compression: CT head.
A
16
Q
Nexplanon implant is affected by enzyme inducers (Like rifampicin)
A
17
Q
Low yield BUT; Thumb opposition is Median (The prominence) and Thumb Adduction is Ulnar.
A
18
Q
Neonatal Death: First 4w.
Puerperal Death: Maternal Death in First 6w.
A
19
Q
Terbutaline = Tocolytic
A
B-2 agonist, also used in asthma sometimes. It has tocolytic effects by causing smooth muscle relaxation.
20
Q
5years after breast-cancer cured: Return to normal screening (/3y)
A
21
Q
Apparently there are 5 (not 4) types of lacunar stroke:
A
- Sensory pure
- Motor pure
- SensoryMotor
- Ataxic hemi
- Dysarthria + Clumsy-Hand.
22
Q
Acute mania: Olanzapine.
A
23
Q
.1, .2, .3
5, 10, 15
Also good to note: Don’t subtract SHOCK boluses from deficit calculations (Think about shock boluses as correcting intraVASCULAR deficit, and the other bolus as correcting intraCELLULAR deficit)
A
<7.1 , <7.2, <7.3 pH
<5, <10, <15 HCO3
= Severe, Mod, Mild Metabolic Acidosis (/DKA).
Then K+ = 40mmol/L
24
Q
Learn the MUST questionnaire.
A
25
Learn risk factors AND list associations
26
Biliary atresia doesn't cause Kernicterus. Kernicterus requires unconjugated bilirubin. It can cause liver failure, however.
27
Key for associations (1):
Breast Cancer: +Oestrogen, -Oestrogen-Suppression.
Ovarian Cancer: +Cycles and +Oestrog
en.
Endometrial Cancer: +Unopposed Oestrogen, +Oestrogen
Cervical: Damage + Stretching + Infections to cervix (So COCP too, as this worsens thrush).
28
Key for associations (2)
Placenta Praevia: Crowding +Damage
Placental Abruption: +BP and Damage.
Miscarriage: Clotting, structure, genes.
Pre-Eclamp: Anything causing HTN (and >10y pregnancy interval- weird).
29
USS scores for ovarian cancer:
/5
Bilateral
Multilocular
Ascites
Solid areas
Metastasis
30
1 cm Post-Men Ovarian Cysts
3 cm BrFibroAde / cm Fibroids / Cervical Ca
4 mm Endometrial Thickness
5 cm Ovarian Cysts
Cutoff for suspicion or management.
3: Cutoff for cervical cancer LLETZ vs Radical Hysterectomy - depth of invasion. Cutoff for removal of a breast fibroadenoma.
4: You can discharge home if endometrial thickness is <4mm.
5: High suspicion in Post-Men. Followup with Pre-Men.
31
4 FGMs:
Clitoridectomy, Excision (Labia), Infundibulation (Closing), Other non-medical alterations.
32
Some labour numbers:
0.5cm dilation/h in P0 & 1cm in P1+.
2nd stage: Allow 2h in P0 & 1h in P1+.
33
Meniere's Vs Vestibular Neuroma
Meniere's: Episodic. Tx: Betahistine long-term.
Neuroma: +Nerve Palsy +Absent corneal reflex. Tx: Surgery, but 75% show no growth.
34
Mechanical heart valve and pregnancy:
Stop warfarin, start Dalteparin (Not just any LMWH).
35
OGTT 8-10h Glucose. Gestation DM
>7: Insulin straight-up.
6.0-6.9 and ++Hydramnios/Somia: Insulin.
6.0-6.9: 2w lifestyle then metformin if not controlled.
36
According to NICE you don't need proteinuria to diagnose pre-eclampsia, you can also just have:
The new hypertension >20w with:
-Evidence of liver failure
-Evidence of haematological issues (-Platelets)
-Evidence of renal issues
-Eclampsia.
37
MHA Times
2: 28d
3: 6m
4: 72h
5(4): 6h (Nurse) followed by:
5(2): 72h (Doctor)
135: 24h
136: 24h
2: Recommended by 2 S12 docs.
3: Recommended by 2 S12 docs.
4: Recommended by 1 S12 doc.
The above also require an AMHP.
Note that 5s (below) can only be done on inpatients, this EXCLUDES A&E.
5(4): 1 Approved Nurse
5(2): 1 Doc of any sort.
135: Police only
136: Police only
38
Pregnancy Switchups
Carbimazole - Propylthiouracil
Propanolol - Labetolol
Warfarin - Dalteparin
Lithium - Antipsychotic
T2DM drugs - Metformin + Insulin
Levothyroxine - Up dose.
39
Additional Contraceptive Notes
EllaOne - Can't double dose
40
Annual MRI breast surveillance for women with >30% risk (FHx or genetic testing) of BRCA mutation.
Annual MammoGram for mod+ Risk of BrCa (FHx / BRCA) until 50/60/70 (depending on what the RFs are) then:
MammoGram option with 3y USS screening only to Mod+ risk and >50/60/70.
General Rule: ++BRCA = More Mammograms and ++P53 = Fewer/No Mammograms (And MRIs Instead).
41
Milk blocks iron absorption and can cause PICA.
42
Stop anti-epileptics after 2y over 2-3m.
43
Kids <3m w/Listeria meningitis: Amox for 21d AND gentamicin for 7d.
44
Croup Mx
Oral dex
If not: Inhaled Budenoside
If not: IM Dex.
45
False-Positive Sweat Test x5
Malnutrition
Oedema
Adrenal Insufficiency
G6PD
Nephrogenic DI.
46
1- Not returned to bw after 3w OR drop in 10%.
2- Drop below 2nd centile
3- Drop below 0.4 centile
4- Drop by 1cent if under 9th cent
5- Drop by 2cent if 9-91st cent.
6- Drop by 3cent if >91st cent.
2. Review by GP
3. Review by Paeds
4, 5, 6. Review by GP.
47
Reflux after 6m can be a sign of UTI in paediatrics.
Dip urine / MCS.
48
Meckles - Wedge
Hirsch - Swen
Malrot - Ladd's
Pyloric - Ramstd'
BilAtresia - Kasai
49
>3m Abx
Trimethoprim (Poor Swallow- No liquid).
Ceftrioxone (Billirubinaemia).
50
Atypical UTI in kids =
Abdo mass
Poor flow
Non-E. Coli
Fails to resolve in 48h
Seriously ill / Septicaemia
Creatinine raised.
51
USS on every UTI in <6m olds.
52
Gen - SV > Lav/Lem
Focal - Lam'Lev - Carb / Oxycarb
Absence - Etho > SV > Lam/Lev
Myoclon - SV > Lev
Tonic + Atonic - SV / Lam
53
Acute alcohol withdrawal - Lorazepam (Oral then, if not, IM).
54
Osteogenesis Imperfecta:
T1: Mild
T2: Most severe
T3: Moderate
T4: Moderate
Exceptions to SSRIs 1st line for depression:
-Mirtazapine for insomnia and weight-loss
-ECT for rapid response (In high risk situations)
-Antipsychotic (+Antidepressant) for psychotic depression.
55
Complex Febrile Seizure
>15m
Partial / Focal
No recovery within an hour
Occurs multiple times within same illness or 24h.
56
Extra Facts
1: Mechanism of retinopathy prem:
2: Trimethoprim can cause a rise in Creatinine
3: Women with BRCA1 mutations have what removed to prevent cancer
1:
2: But this does not reflect AKI.
3: Ovaries AND fallopian tube.
57
Benzos - Flumenazil
Serotonin - Cyproheptadine
NMS - Dantrolene + DopamineAgs
Lithium - Supportive
Paracetamol - Acetylcysteine
58
1- Complete mole:
2- Incomplete mole:
1- Monthly hCG for 6m
2- One hCG 4w later (Same as miscarriage).
59
Trinucleotide Repeats:
Fredreich's Ataxia: GAA
Huntingtons: CAG
Fragile X: CGG
Fredreich's: Gait, Arthria (Dys), Atrophy
Fragile X Cephalic Giant Gonads (CGG)
60
R.M.I for Ovarian Cancer (>250)
Score 1/3 for Pre/Post Mens
Score 0,1,3 for a USS score of 0,1,2+.
Score the same as Ca125 (If they are having a scan, it will be over 35).
USS scores:
Bilateral
Multilocular
Ascites
Solid areas
Metastasis
USS x Ca125 x Pre/Post = RMI
E.g., a 58 year old, PoMP woman comes with bloating etc. She has a Ca125 done which comes back as 42, so she has an USS- This shows bilateral enlargement of the ovaries, with simple fluid-filled cysts and no other findings.
1. What is her R.M.I?
2. What do you do?
A1: 126 (42 x 3 x 1)
A2: Don't refer, but assess other causes and followup if Sx get worse.
If USS found 2+: Refer, and 2ndry care may consider: AFP, hCG, and a CT scan.
Also note: The USS scores means that, a USS can RULE OUT ovarian cancer.
61
CIN Followups
Excision:
All 3: Test of cure in 6m.
Not-Excised:
CIN1: 6,12,24m
CIN2/3: 6,12, yearly for 10 years.
62
Neuro Scores to Learn:
AMT (Abbreviated)
MOCA (Montreal)
ACE-R (Adenbrookes)
Idea is to look at: Anteriograde memory, retrograde memory, spacial understanding, perceptive abilities, writing, reading, visuospatial abilities, language comprehension, verbal fluency, recall, attention/concentration, registration, and orientation.
AMT: 10 questions, quick one.
MOCA /30 - Animals, recall, draw clock and cube, tap on "A"s in the list, say what links two words, and link numbers. MILD COG IMPAIRMENT.
ACE-R /30 - Orientation (Where/When), remember + repeat, 100-7 etc..., Spell "world" backwards, anterograde memory (address) and retrograde (prime minister etc), Words beginning with D, then as many animals names as possible, follow 3-stage commands, write a sentence, repeat phrases, name animals shown, language comprehension, reading, copying cube and overlapping pentagon, count dots, recognise the above memory options from 3 choices.
63
Bradford Hill Criteria
-Strength
-Consistency
-Temporality
-Dose-Response
-Plausibility
-Reversability
-Coherence - Matches with other evidence
-Analogy - Similar to other observed mechanisms.
-Specificity - E.g, intervention is helmets, so there needs to be more reductions in head injuries compared to all cycle-accidents.
64
Screening Issues
-Anxiety for otherwise benign diseases (Breast Cancer)
-Overexposure to potentially harmful tests.
-Over-treatment that can cause harm (E.g., Abx resistance if all mothers were treated for GBS).
-
65
Wilson and Junger Screening Criteria (12):
- Important - Understood - Additional Mutations Understood - Other Prim Prevention in Place - Screening Ongoing - Economically Justified - Safe Test - Acceptable Test - Tx Cutoffs from Test - Good Treatment.
66
1- Lead time
2- Length time
1- Dx earlier, but disease has same course.
2- Milder disease is asymptomatic for longer, so more mild disease is detected on screening.
67
Primidone and Propanolol for essential tremor.
68
1. Primidone and Propanolol for essential tremor. Dopamine would not help.
2. DAT binds to dopamine
3. Fredreich's Ataxia = Dorsal Root Ganglia (Sensory Ataxia).
4. Significant vision loss in papilitis, not in papilloedema
5. MRI initial workup for vertebral pain sx.
6, Myopathy is typically asymmetrical.
7. Nerve damage: Sens Demyel > Sens Axon > Motor Demyel > Motor Axon.
8. MND = Fasciculation potentials AND abnormal motor-unit potentials. Otherwise: Benign fasciculations.
1. Alcohol and DBS may also help.
2. DAT = DopAmine Transport Scan- DAT is combined with CT so look at substantia Nigra - Cannot differentiate PD+ Diseases.
4. Both present with optic disc swelling.
69
Meconeum aspiration can cause pneumothorax.
70
Friedreich's Ataxia vs Charcot-Marie Tooth
Both autosomal recessive.
Fried: Spinocerebellar tract degen. Weakness + Hypertrophic Cardiomyopathy.
Charcot-Marie Tooth: Peripheral Nerves, so LMN (Hyporeflexia, foot drop, etc).
71
Lookup Gluten and Episodic ataxias.
20% (???) Of ataxia patients have it in England??? (?Idiopathic ataxia maybe??)
Basically seems like people noticed coeliac disease has a high correlation with idiopathic ataxia. - Also LOTS of people with severe coeliac had gait dysfunction. (Confounders??)
??Lymphocytic invasion of cerebelum.
??Peripheral lymphocytic invasion too?
Mentions the above + Dorsal Column damage.
Andigliadin Antibodies (AGAs) present?
72
Bilirubin Cutoffs
Well and not as below: Don't repeat test.
1. (2)-50:
Remeasure within 18h if RFs for Jaundice, or 24h without RFs.
2. >100 @ 0h to >350 @ 96h:
Phototherapy + Repeat measure in 4-6h. Monitor every 6-12h and stop when bilirubin reaches (2)-50.
3. >100 @ 0h to >450 @ 42h:
Exchange Transfusion
73
Breast Masses Keys:
1. Fibroadeoma: Slow-growing, firm, no other signs or vignette.
2. Fat Necrosis: TRAUMA, obese, ±large breasts.
3. Phyllodes Tumour: Fast growing, but mostly benign.
4. Intraductal Papilloma: Bloody Discharge.
5. Periductal Mastitis: Similar to other mastitis and can have blood, but not necessarily central, and highly linked to smoking.
74
Constitutional delay can be quantified by doing a wrist and hand xray.
75
Apparently COCP is less advised in epilepsy due to it's interactions with anti-epileptics. DEPO preferred.
76
All C-sections need PPIs due to risk of reflux under potential GA.
77
HIV and HepB are opposites in terms of safety in delivery vs breast-feeding; Recheck this.
78
Anti D
Only if SURGICAL ectopic or miscarriage.
For all termination >10w.
79
SUFE: Reduced Flex + Internal (Imagine the position of someone slipping on bannana)
TRansient Synovitis: Think about someone trying to get traction with their leg; It's extended and internal.
Perthes': All around the ERTH; every direction, reduced ROM.
80
Water break + temp - Cultures then Abx
81
sHLH (Secondary Haemophagocytic Lymphohistiocytosis) = "Cytokine Storm" associated with Covid19;
Anakinra subcut as some treatment (IL1 blocker).
82
Long-term NSAIDs should not be stopped as there is no clear link between them and increased risk of, or more severe, Covid19. Also, acute NSAIDs do not prevent or improve course of Covid19 infection.
83
Vaccine:
Pfizer/Moderna: mRNA
AstraZeneca: Adenovirus vector
VTE, Bell's Palsy, Myo/EndoCarditis, Gullian Barre is a notable rare side-effect of the vaccines.
84
Apparently for Kawasaki you DO need a long fever followed by 4/5 of the CRASH symptoms.
85
Labrythitis vs Vestibular Neuritis
Both can occur following infection.
Vestibular Neuritis: Only balance
Labyrinthitis: Balance, tinnitus, hearing.
Both resolve, both can have balance issues treated with antihistamines.
86
Posterior Reversible Encephalopathy Syndrome (PRES)
-Headaches
-Seizures
-Visual changes
-Link with: Autoimmune conditions, Transplantation, and Kidney dysfunction.
-Tx: Treat seizures, remove stimulant (normally, a immunosuppressive agent).
87
Rett's Vs Reye's
Rett's: MECP2 Gene, Neurological, mostly in females, Seizures, Intelectual disability, Hypotonia, SLEEP disturbances. DYSPRAXIA of the hand. GSfDx: Genetic Test.
Reye's: Preceding Viral Illness OR Aspirin, Encephalopathy, FATTY LIVER (GSfDx: Biopsy), Hypoglycaemia.
88
LGV Vs Syphilis
Both have painless penile ulcers.
LGV: Might mention HIV. Lymph-nodes are PAINFUL.
Syphilis: Lymph-nodes painless.
89
HHVs:
1: Oral Ulcers.
2: Genital Ulcers.
3: Chicken Pox / Shingles.
4: EBV / Mononucleosis / Glandular.
5: CMV / Mononucleosis / Glandular.
6: Roseola Infantum (/6th Disease).
7: Pityriasis Rosacea.
8: Kaposi's Sarcoma.
90
USS UTIs if:
-Under 6m (6w after infection).
-Recurrent Under 6m (During).
-Recurrent Over 6m (6w after).
DMSA If:
-Under 3y +Recurrent/Atyp (4-6m later)
-Over 3y +Recurrent
Recurrent =
-2+ Pyelonephritis
-1 + 1 - Pyelo + LUTI.
-3+ LUTI.
Atypical =
-Not E.Coli
-Sepsis
-Mass
-++CK
-No response to tx.
91
Public Health Additional Stuff:
HARK For domestic abuse:
Harm, Afraid, Rape, Kick (Hurt).
Opioid RFs: Co-Habitant, Young, Unemployed, White, Bad health, Smoker. (NOT: Gender, Alcohol, Education).
92
Geriatric Giants (Is and Ms)
-Instability
-Immobility
-Incontinence
-Intelectual Impairment
OR
-Mind
-Mobility
-Medications
-Multi-Complexity
-Matters Most
93
Chorionic Villous Sample 11-13
Amniocentesis 15-20w
NIPT up-to 21+6w
94
Alcohol Questionnaires.
CAGE - Screening
AUDIT - Identifying
SAD-Q - Dependence
FAST - Screening
APQ - Problems with
CIWA - Withdrawal
Can refer to:
Sydney Street Clinic
AA
95
Smoking Cessation Drugs
1. Bupropion
2. Varenicline
3. Nicotine Replacement Therapy
1. Antidepressant with nicotine-receptor properties.
2. Nicotine Receptor Agonist
3. Duh
