Core Conditions/2 Key things Flashcards

Question

CKD is graded in how many stages? what criteria is included in the final/worst stage?

Answer 1

Stages 1 to 5 Stage 5: established renal failure, eGFR <15 or on dialysis (Renal replacement therapy is required once eGFR <10)

Answer 2

1. Proteinuria >3g in 24 hours 2. Hypoalbuminemia - serum albumin <25g/L 3. Peripheral oedema (rapid and severe pitting oedema)

Answer 3

Causes: Primary = minimial change disease Secondary = diabetes/SLE/amyloid Tx: fluid restriction, diuresis (furosemide), tx underlying cause

Answer 4

1. Haematuria (macro or microscopic) 2. Oliguria 3. Proteinuria (much less than in nephrotic though) (4. Fluid retention/oedema)

Answer 5

Primary: IgA nephropathy Secondary: Post-strep, vasculitits

Answer 6

Type II hypersensitivity reaction, onset immediately (24-48 hours post-op), caused by pre-existing antibodies against donor's ABO/HLA antigens. No treatment possible, must remove graft.

Answer 7

1. Hyperacute transplant rejection: immediately post-op 2. Acute tubular necrosis of graft: first few weeks post-op 3. Acute graft failure: within 6 months post-op 4. Chronic graft failure/recurrence of original renal disease: >6 months post op 5. Post-transplant urinary leak: early post-op 6. Other: UTI, vascular thrombosis

Answer 8

Autosomal dominant: presents in adulthood, PKD1 (chromosome 16) mutation Autosomal recessive: presents antenatally, most won't live past childhood, causes Potter syndrome, liver cirrhosis, and lung hypoplasia

Answer 9

International Prostate Sx Score: 8-19 = moderately symptomatic, 20-35 = severely Bother score: impact of LUTS on QoL, score >3 requires treatment

Answer 10

1. Alpha blockers e.g. tamsulosin 2. 5-alpha reductase inhibitors e.g. finasteride (NB: must used condoms, excreted in semen)

Answer 11

1. PSA level 2. DRE: hard, craggy, asymmetrical, loss of central sulcus 3. MRI prostate: reported on Likert scale, if >3 then... 4. Prostate biopsy - transrectal USS guided or transperineal

Answer 12

1. Watchful waiting 2. External beam radiotherapy 3. Hormone therapy e.g. biclutamide (androgen receptor blocker), goserelin (GnRH agonist) 4. Surgery e.g. radical prostatectomy

Answer 13

Positive nitrates Positive leukocytes RBCs

Answer 14

Nitrofurantoin 100 mg BD PO for 3 days in women, 7 days in men or pregnant women, or… Trimethoprim 200 mg BD PO for 3 days in women, 7 days in men NB: trimethoprim is CI in the first trimester of pregnancy, and should never be co-prescribed with methotrexate NB: avoid nitrofurantoin in patients with eGFR <45, avoid in third trimester of pregnancy (risk of neonatal haemolysis)

Answer 15

- Recent hx of UTI, STI or catheter - Low grade pain (sometimes radiating to the back), fever, LUTs progressing to anuria, haematospermia - Soggy, boddy prostate on DRE

Answer 16

Ciprofloxacin, analgesia

Answer 17

Renal cell carcinoma: typically papillary, chromophone or collecting duct carcinoma

Answer 18

Roberston staging 1 to 4: 1 = renal capsule only 2 = invades perinephric fat 3 = invades renal vein/IVC/local lymph nodes 4 = invades distal viscera/distant mets (commonly lung [50%] and bone [30%])

Answer 19

Nephroblastoma: the most common renal tumour in children. Presents with abdominal mass and haematuria.

Answer 20

1. Transitional cell carcinoma (90%) - arises from exposure to aromatic amines and smoking 2. Squamous cell carcinoma - schistosomiasis (parasite), long term catheters

Answer 21

45+ years and: unexplained visible haematuria without UTI or visible haematuria persisting/recurring after successful tx for UTI 60+ years and: unexplained non-visisble haemturia and dysuria or raised WCC on blood test

Answer 22

1. Pelvicureteric junction 2. Pelvic brim 3. Vesicoureteric junction

Answer 23

non-contrast CT KUB

Answer 24

Peritoneal fluid collection between the layers of the tunica vaginalis. Presents as a painless swelling of the testicle. Transilluminates on examination. Surrounds the testis, will NOT feel seperate.

Answer 25

Primary hydrocele in a newborn: self-resolves within first few months, treat surgically if not resolved by 1-2 years Secondary: monitor/surgery depending on severity/impact, aspirate if poor surgical candidate

Answer 26

Left side because of venous drainage: left gonadal vein → left renal vein → IVC (longer course than the right gonadal vein which drains directly into the IVC ∴ varicocele is more common on the left side)

Answer 27

Benign, non-painful cystic swelling of the epididymis (lies above and behind the testis). Will transilluminate on examination and feel *seperate* to the testis.

Answer 28

Inflammation of the epididymis and testicle. 2/3rds are infective e.g. STI, UTI, mumps 1/3 are idiopathic

Answer 29

Phren's sign: elevation of the scrotum reduces the pain → likely epididymo-orchitis Reduced/absent cremasteric reflect → torsion

Answer 30

Within 4-6 hours

Answer 31

1. Youth 2. Poorly descended testis 3. Bell clapper deforminity (high attachment of the tunica vaginalis) 4. Previous torsion

Answer 32

USS doppler (will show decreased arterial flow)

Answer 33

Germ cell tumour e.g. teratoma and seminoma (therefore investigations includes urine hCG and AFP)

Answer 34

1. Family hx 2. Cryptorchidism (undescended testis, even after surgery) 3. Infertility 4. Kleinfelter's syndrome (XXY - tall, gynaecomastia, small testes)

Answer 35

Direct: enters the inguinal canal through Hesselbach's triangle (bordered by: rectus abominis, epigastric vessels, poupart's ligament), exits at the superficial ring Inirect: enters the inguinal canal at the deep/internal ring, exits at the superficial ring

Answer 36

1. Incarceration: hernia cannot be reduced, may lead to obstruction and strangulation 2. Obstruction: passage of faecal matter is blocker, presents with vomiting, abdo pain, absolute constipation 3. Strangulation: base of hernia becomes tight and blocks off blood supply → surgical emergency

Answer 37

1. Send MSU first! 2. Oral first line: cefalexin 3. IV first line: ceftrixaone Pregnant: oral cefalexin, IV cefuroxime

Answer 38

1. Tolterodine - antimuscarinic 2. Oxybutinin - antimuscarinic 3. Mirabegron - B3 receptor agonist

Answer 39

Duloxetine - causes stronger urethral contractions to increase sphincter tone

Answer 40

Urge BPH, stones, neuropathic (MS, Parkinson's)

Answer 41

Hypochloraemia - due to vomiting HCl Metabolic alkalosis - due to loss of acid (HCl) Hypokalaemia: Dehydration and sodium loss stimulates aldosterone via RAAS, Aldosterone triggers sodium to be reabsorbed from the collecting duct in exchange for potassium, Potassium is lost in the urine -> hypokalaemia

Answer 42

Normal anion gap metabolic acidosis: due to loss of HCO3- in diarrhoea

Answer 43

IgA: - Develops 1-2 days post-URTI - Young males - Macroscopic haematuria Post-strep: - Develops 1-2 weeks post-URTI - proteinuria - Low complement

Answer 44

Kidneys are resistant to ADH resulting in inadequate reabsorption of water in the collecting ducts

Answer 45

HLA-D2Q and HLA-DQ8

Answer 46

1. FBC - low Hb 2. Low B12 3. Low ferritin 4. LFTs - raised ALT 5. IgA TTG: if positive then do a duodenal biopsy via upper endoscopy whilst on a gluten containing diet, should show: increased intraepithelial WBCs, villous atrophy, crypt hyperplasia 6. Other: bone profile, vit D, stool sample

Answer 47

Dysphagia at any age >55 years old with weight loss and any of the following: upper abdo pain, dyspepsia, reflux

Answer 48

Metaplasia of normal stratified squamous epithelium of the distal oesophagus to columnar epithelium, as a result of GORD

Answer 49

Triple therapy: PPI, clarithromycin, amoxicillin

Answer 50

Gastric: mainly in elderly people on the lesser curve of the stomach Duodenal: four times more common than gastric Jejunal: associated with zollinger-ellison syndrome

Answer 51

Squamous cell: often proximal oesophagus, associated with smoking, alcohol and chronic achlasia Adenocarcinoma: often distal oesophagus, associated with GORD/Barrett's, obesity, high fat diet, incidence is rising

Answer 52

An ovarian tumour normally resulting from metstatic gastric cancer spreading via the lymphatic vessels

Answer 53

Inflammatory bowel disease limited to the colon and rectum. Continuous inflammation, affecting the superficial mucosa only. Smoking is protective.

Answer 54

Truelove and Witt's severity index

Answer 55

Faecal calprotectin (>150 = IBD likely) FBC - anaemia U&E LFTs ESR & CRP - raised Gold standard diagnostic test: colonoscopy with at least 2 biopsies from 5 different sites

Answer 56

IV steroid Consider adding IV clicospoinr or infliximab Consider surgery, likelihood increased if: stool freq >8/day, pyrexia, tachycardia, dilatation, low albumin or Hb, high platelets or CRP

Answer 57

1. Topical ASA (mesalazine, sulfasalazine) 2. Still not better after 4 weeks? Oral ASA 3. Still not better? Short course of oral steroid

Answer 58

1. Topical or oral lose dose ASA (mesalazine, sulfasalazine) 2. Consider adding azathioprine or mercaptopurine if: had two or more flares in previous 12 months or remission is not maintained by ASA

Answer 59

1. toxic megacolon 2. haemorrhage (long standing anaemia) 3. VTE - acute flare causes high risk of DVT, give LMWH 4. hypokalaemia 5. colonic cancer 6. osteoporosis

Answer 60

Transmural granulomatous inflammation affecting any part of the gut from the mouth to the anus

Answer 61

1. Gold standard: endoscopy 2. Colonoscopy IF not septic/risk of perforation 3. May have barium studies to show strictures, fistulae, rose thorn ulceration

Answer 62

1. first line = prednisolone 2. may be given 5-ASA if very mild disease only in the colon 3. May be given budesonide if mild/moderate ileocaecal disease only

Answer 63

1. mild-moderate disease: azathioprine or mercaptopurine first line, methotrexate second line 2. severe disease: inflixima, adalimumab (can only be used for 12 mo at a time)

Answer 64

Examination only ever done under anaesthetic MRI Treat with oral metroniadazole & surgical 'seton' - a threat to keep the tract open, preventing premature skin closure leading to an abscess

Answer 65

First episode: oral vancomycin Life threatening: oral vancomycin and IV metronidazole

Answer 66

1. ABCDE - determine stability 2. Cannulas (2xs large bore) 3. Crystalloid fluids - IV saline 500 ml over 15 mins 4. Cross match 2 units and coagulation screen 5. Correct clotting abnormalities - give platelets if <50 x 10⁹/L, give FFP if PT more than 1.5 xs normal 6. Catheter - monitor fluid balance, aim for >30 mls/hr urine output 7. Call for help! And keep nil by mouth 8. Camera - urgent endoscopy immediately after resus, within 24 hours, then IV PPI infusion for 72 hours, oral PPI for 4-8 weeks Varices: - Terlipressin (ADH analogue) - Prophylactic co-amoxiclav to reduce risk of rebleeding - Variceal banding via OGD

Answer 67

IV PPI for 72 hours, then oral for 4-8 weeks

Answer 68

beta-blocker

Answer 69

Fever RUQ pain Jaundice = ascending cholangitis

Answer 70

Charcot's triad (fever, RUQ pain, jaundice) AND hypotension and confusion = severe ascending cholangitis, increased mortality

Answer 71

1. Normal LFTs 2. Raised infection markers (ESR, CRP) 3. USS is first line diagnostic test, if still uncertain then HIDA scan

Answer 72

RUQ pain - may radiate to the right shoulder Fever Murphy's sign Nausea & vomiting

Answer 73

RUQ pain - may radiate to the right shoulder Fever Murphy's sign Nausea & vomiting

Answer 74

1. Tender RIF 2. Low grade pyrexia 3. Positive Rosving's sign (RIF pain elicited by pressing on LIF)

Answer 75

Urine hCG USS abdo/pelvis if ?gynae Bloods: raised CRP, ESR, etc.

Answer 76

I GET SMASHED Idiopathic Gallstones Ethanol Trauma Steroid use Mumps Autoimmune Scorpion sting Hypercalcaemia & hypertriglycerideamia ERCP Drugs/medications e.g. sitagliptin, sodium valproate

Answer 77

If you have more than one severe hypoglycaemic episode in the previous 12 months you must surrender your licence while the DVLA review the situation. You can re-apply in 3 months. Severe = symptomatic hypoglycaemic episode requiring help. If you are a group 2 driver (HGV/lorry) you must notify the dval after only one severe episode.

Answer 78

Cranial: - Low after deprivation - High after ADH (because the kidneys can respond to the ADH) Nephrogenic: - Low after deprivation - Still low after ADH (kidneys can't respond to ADH) Primary polydipsia: - High after deprivation - High after ADH

Answer 79

Patient drinking excessive quantities of water. Their ADH is functionally normally.

Answer 80

Loose teeth Poor wound healing Bleeding gums, epistaxis, haematuria Malaise

Answer 81

900 mg dispersable aspirin Triptan (injection>nasal spray>tablet)

Answer 82

4 to 72 hours

Answer 83

1st line: propranolol 80-160 mg daily + avoid triggers 2nd line: topiramate

Answer 84

1. Severe unilateral pain behind the eye 2. Duration 15 mins - 3 hours 3. Sudden 'clockwork' onset

Answer 85

Acute: oxygen & triptan Prophylactic: verapamil

Answer 86

~2 seconds of stabbing pain unilaterally in trigeminal nerve distribution, face screws up with pain

Answer 87

Carbamazepine, ?surgical decompression of nerve

Answer 88

1. Age >50 2. New headache 3. Tender scalp 4. Tender temporal artery 5. Jaw claudication 6. Amaurosis fugax 7. Raised ESR 8. Often associated with polymyalgia rheumatica

Answer 89

Prednisolone immediately PO or IV methylprednisolone if visual loss present Urgent biopsy within two weeks Continue steroids for 2 years

Answer 90

1. Elderly 2. Alcoholics Trauma shears bridging veins which are more stretched and vulnerable in an atrophied brain (due to age or chronic alcohol use)

Answer 91

Fluctuating consciousness levels. Symptoms of headache and drowsiness can be present for weeks as ICP increases slowly. NB: crescent shape on CT head

Answer 92

Deteriorating consciousness level, sometimes with a lucid interval then another sudden deterioration. Associated with focal neurological signs Lemon shape on CT head

Answer 93

Trauma to the temporal bone damages the middle meningeal artery or vein

Answer 94

1. Symmetrical distal polyarthritis 2. Better with activity, worse with rest 3. Morning stiffness often present 4. Flu-like illness, muscle aches, weight loss, weakness, fatigue

Answer 95

Autoimmune condition where chronic inflammation of the synovial lining of joints, tendon sheaths and bursa causes pain, swelling and deformity. "The body's immune system normally protects you by fighting infection and other illness. RA is an autoimmune condition, where the immune system gets confused and starts attacking your own healthy joints. This causes persistent inflammation of the lining of joints and tendons, which results in pain and swelling. It normally affects small joints in your hands and feet. RA can also cause flu-like symptoms of fatigue, weight loss and muscle aches"

Answer 96

Maintenance: First line = monotherapy with methotrexate, leflunomide or sulfasalzine Second line = combine any 2 of the above drugs Third line = add a biologic (e.g. TNF-inhibitor) Flare: Short-term glucocorticoid e.g. IM methylprednisolone and short term NSAIDs e.g. ibuprofen (plus PPI cover)

Answer 97

Obesity Increasing age Occupation Trauma Female sex Family history

Answer 98

Loss of joint space Osteophytes Subarticular sclerosis (increased density of bone along the joint line) Subchondral cysts

Answer 99

A seronegative spondyloarthritis (and therefore associated with the HLA-B27 gene) that causes inflammation vertebral column and sacroiliac joints, leading to progressive fusion of the spine ("bamboo spine").

Answer 100

Commonly affects young men (late teens/early 20s) Gradual onset over >3 months Low back pain Sacroiliac/buttock pain Pain worse at rest, improves with movement Morning stiffness lasts >30 mins

Answer 101

Psoriatic arthritis Reactive arthritis Ankylosing spondylitis HLA-B27

Answer 102

Gonorrhoea

Answer 103

Type 1 diabetes Rheumatoid arthritis

Answer 104

reactivation of TB - get a chest XR before starting!

Answer 105

No bacterial growth Needle shaped monosodium urate crystals Negatively bifringent of polarised light

Answer 106

No bacterial growth Rhomboid shaped calcium pyrophosphate crystals Positively bifringent of polarised light

Answer 107

1. NSAIDs 2. Colchicine (NB: diarrhoea is a common SE) 3. Steroids

Answer 108

osteopenia = -1 to -2.5 osteoporosis = less than -2.5

Answer 109

A tool to predict the risk of a fragility fracture over the next 10 years

Answer 110

Inflammatory condition causing pain and stiffness in the shoulders, pelvic girdle and neck. Strongly associated with GCA/temporal arteritis.

Answer 111

Typically affects white women aged >50, symptoms should be persistent for at least 2 weeks: 1. Bilateral shoulder pain (may radiate to elbows) 2. Bilateral pelvic girdle pain 3. Pain is worse with movement 4. Pain interferes with sleep 5. Morning stiffness lasting at least 45 minutes

Answer 112

Start with prednisolone 15 mg OD, if no response after 1 week consider an alternative diagnosis. Should see a 70% improvement in symptoms after 3-4 weeks, then can start a reducing regimen.

Answer 113

Autoimmune destruction/damage of nicotinic ACh receptors on the post-synaptic side of neuromuscular junctions - involves both T and B cells

Answer 114

1. Increasing and relapsing muscle fatigue 2. Ptosis (often bilateral) 3. Myasthenic snarl (can be elicited by asking patient to count up to 50 then smile) 4. Diplopia 5. Normal tendon reflexes

Answer 115

1. Reversible ACh inhibitors e.g. pyridostigmine 2. Immunosuppression with prednisolone 3. Thymectomy 4. +/- monoclonal antibodies e.g. rituximab

Answer 116

FEV1 - variable FVC - decreased FEV1/FVC - increased = restrictive

Answer 117

1. >50 years old 2. Insidious onset of SOB 3. Dry cough 4. Bibasal fine end-inspiratory crackles 5. Finger clubbing

Answer 118

Bilateral interstitial shadowing = typically small, irregular, peripheral opacities that initially have a ground glass appearance and will progress to a honeycomb appearance

Answer 119

1. Pirfenidone 2. Nintendabin

Answer 120

Anterior: Outer thigh = L2 Inner thigh = L3 Inner calf = L4 Outer calf & foot = L5 Posterior: Bum = S5, S4, S3 Hamstrings to mid calf = S2 Lower calf, ankle, sole of foot & pinky toe = S1

Answer 121

Those with recurrent DVT or PE currently receiving anticoagulation

Answer 122

Withold 1 or 2 doses of warfarin Reduce subsequent maintenance dose

Answer 123

Stop warfarin Give IV vitK Restart when INR <5

Answer 124

Stop warfarin Give vit K (IV if bleeding, oral if not) Restart when INR <5

Answer 125

Stop warfarin Give IV vit K Give dried prothrombin complex (or FFP if unavailable)

Answer 126

Primarily clinical diagnosis without imaging. Useful supporting blood tests include: ↑amylase, ↑lipase, ↑WCC, ↑LDH

Answer 127

↑WCC > 16 = severe disease ↑LDH >350 = severe disease Low calcium = severe disease Amylase does NOT correlate with severity of disease

Answer 128

AKI with disproportionately raised creatinine Raised creatinine kinase - at least 5 times the upper limit of normal (>10,000) Myoglobinuria Hypocalcaemia raised phosphate Typically following a prolonged epileptic seizure or a fall with a long lie

Answer 129

1. close monitoring of CVS risk factors 2. annual cervical smear (increased risk of HPV and cervical cancer) 3. Up to date vaccinations (avoid live vaccines)

Answer 130

1. Toxoplasmosis infection → mutliple lesions on head CT, with ring/nodular enhancement, Thalium SPECT negative 2. Primary CNS lymphoma → single lesion, solid/homongenous enhancement, Thalium SPECT positive, associated with EBV 3. Progressive mutlifocal leukoencephalopathy (PML) → widespread demylination due to infection of oligodendrocytes by JC virus 4. Encephalitis → due to CMV or HIV itself, oedematous brain on CT 5. Cryptococcus → fungal infection stains with india ink, CT shows meningeal enhancement and cerebral oedema

Answer 131

1. cryptosporidium - an intracellular protozoa, most common 2. mycobacterium avium intracellulare - atypical, only in individuals with CD4 <50

Answer 132

CD4 <200 cells/mm³

Answer 133

50-100 copies/ml

Answer 134

Initial seroconversion flu-like illness in the first few weeks of infection Asymptomatic period Progression to immunodeficiency presenting with opportunistic infections and AIDS defining illnesses

Answer 135

1. Kaposi's sarcoma - tumours appear as purple patches/nodules on the skin, associated with human herpes virus 8 2. Pneumocystis jirovecii pneumonia - stains with silver 3. Cytomegalovirus infecition 4. Candidiasis 5. Lymphomas 6. TB

Answer 136

Ptosis, down and out gaze, fixed dilated pupil

Answer 137

Impaired downwards gaze, vertical diplopia

Answer 138

Impaired abduction, horizotal diplopia

Answer 139

Towards the lesion

Answer 140

When the iris bulges forwards, sealing off the trabecular meshwork from the anterior chamber and preventing the drainage of aqueous humour. Leads to increasing intra-ocular pressure, particularly in the posterior chamber. Will cause optic nerve damage and permanent vision loss if not urgently treated.

Answer 141

1. Severely painful and red eye 2. Blurred vision 3. Halos around light 4. Headache 5. N&V

Answer 142

Red eye Hazy cornea Fixed and dilated pupil Firm eyeball on palpation Decreased acuity

Answer 143

Pilocarpine Acetazolamide Glycerol/mannitol Timolol Dorzolamide Brimonidine

Answer 144

In open angle glaucoma resistance in the trabecular meshwork increases slowly, slowly making it more difficult for aqueous humour to leave the eye and increasing intraocular pressure.

Answer 145

Gradual closing in of peripheral vision leading to tunnel vision. Gradual onset of fluctuating pain, headaches, blurred vision and halos appearing around lights (particularly at night time).

Answer 146

1. goldmann applanation tonometry to check intraocular pressure 2. fundoscopy to check for optic disc cupping and optic nerve health 3. visual field assessment to check for peripheral vision loss

Answer 147

Prostaglandin analogue eye drops e.g. latanoprost SE: eyelash growth, eyelid pigmentation, iris browning

Answer 148

A normal optic disc has a small indent in the center, usually less than half the size of the disc. Optic cupping occurs when increased pressure (e.g. in glaucoma) in the eye causes this indent to become wider and deeper. An optic cup >0.5 times the size of the disc is abnormal.

Answer 149

IV or PO methylprednisolone 500 mg/day over 4 hours PPI cover

Answer 150

Autoimmune mediated inflammation of the nervous tissue of the brain and spinal cord, causing loss of the myelin sheath

Answer 151

1. Optic neuritis 2. Internuclear ophthalmoplegia (lesion in the medial longitudinal fasciculus causing impaired adduction in one eye, and horizontal nystagmus in the other) 3. Lhermitte's sign (electric shock) 4. Uhthoff's sign (symptoms worsen with rise in body temp) 5. Sensory or cerebellar ataxia (positive Rhomberg's test) 6. Numbness and paraesthesia 7. Trigeminal neuralgia 8. Incontinence 9. Limb paralysis, foot drop 10. Bell's palsy (drooping of one side of the face) 11. Horner's syndrome (ptosis, miosis, anhidrosis)

Answer 152

Loratadine

Answer 153

Inflammation of the optic nerve leading to subacute vision loss occuring over hours to days, mainly affects younger people (<30), usually unilateral and often recurrent.

Answer 154

1. Decreased visual acuity and colour vision (unilateral) 2. Pain on eye movement (→ retrobulbar optic neuritis) 3. RAPD 4. Optic disc may look normal (→retrobulbar optic neuritis), or swollen

Answer 155

1. Silver wiring/copper wiring (thickened walls of arterioles) 2. Arteriovenous nipping (thickened arterioles compress veins where they cross) 3. Cotton wool spots (ischeamia and infarction damages nerve fibres) 4. Hard exudates (damaged vessels leak lipids) 5. Retinal haemorrhages 6. Papilloedema

Answer 156

Acromioclavicular joint arthritis

Answer 157

Supraspinatus tendinopathy

Answer 158

Rotator cuff tear Fracture Shoulder dislocation

Answer 159

Supraspinatus - arm abduction Infraspinatus - arm external rotation Teres minor - arm external rotation Subscapularis - arm internal rotation

Answer 160

Supraspinatus tendinopathy Glenohumeral arthritis Acromioclavicular arthritis

Answer 161

Adhesive capsulitis: inflammation and fibrosis of the shoulder joint capsule leading to adhesions that limit the ROM Can be primary (spontaneous) or secondary (following trauma, surgery or immobilisation) Has three phases: painful (worse at night), stiff, thaw - can last up to 3 years

Answer 162

Arterial: - Deep - Smaller - Less likely to bleed - More painful - Painful on raising, less painful on lowering Venous: - More superficial - Larger with sloping/irregular borders - More likely to bleed - Less painful - Painful on lowering, less painful on raising

Answer 163

Refer to tissue viability and pain specialists Tx can involve debridement, compression, dressing, abx if indicated, analgesia Pentoxifylline can aide healing

Answer 164

A squamous cell carcinoma in situ, arising from the outer layers of the epidermis and has a low risk of progressing to an invasive SCC Commonly presents in older women with a fixed, well-defined, non-itchy patch

Answer 165

Squamous cell carcinoma RF: sun exposure, immunosuppression, chronic inflammation (leg ulcers)

Answer 166

Basal cell carcinoma

Answer 167

Shiny, pearly nodule with rolled edge Telangiectasia (irregular blood vessels across surface) Transluscent (minimal keratin) Slow growing

Answer 168

1. Superficial spreading - most common, 70% of cases 2. Nodular - second most common 3. Lentigo maligna - less common 4. Acral lentiginous - rarest

Answer 169

1. Superficial spreading - affects the arms, legs, back and chest of younger people 2. Nodular - middle aged people, affects sun exposred areas 3. Lentigo maligna - older people with chronic sun exposure 4. Acral lentiginous - nails, palms or soles of feet in people with darker skin pigmentation

Answer 170

Major 1. Change in size 2. Change in shape 3. Change in colour Minor 1. Diameter ≥ 7mm 2. Inflammation 3. Oozing or bleeding 4. Altered sensation

Answer 171

2 x serum sodium + serum glucose + serum urea (all in mmol/L)

Answer 172

Meticillin resistance = resistance to beta-lactam antibiotics which includes penecillins, cephalosporins and carbapenems

Answer 173

A glycopeptide antibiotic - works by inhibiting cell wall synthesis

Answer 174

Stop and rest Use spray as prescribed, wait 5 mins Still in pain? Readminister, wait 5 mins Still in pain? Readminister, wait 5 mins Still in pain? Call an abulance (don't wait more than 15 mins to call)

Answer 175

A thrombus from an atherosclerotic plaque blocks a coronary artery resulting in: unstable angina, a STEMI or an NSTEMI

Answer 176

Aspirin 75 mg Another antiplatelet e.g. clopidogrel for up to 12 months ACEi Atenolol or another beta-blocker Atorvastatin (or another statin) (Aldosterone antagonist for those which clinical HF, initiated within 3-4 days of MI, preferable after ACEi is started)

Answer 177

Trop (normal) ECG (no pathological changes) Further investigations such as echo, cxr, CT coronary angiogram

Answer 178

ABC High flow O2 if hypoxic and not CI Morphine 5-10mg IV and cyclizine 50mg IV GTN spray/tablet Aspirin 300 mg Ticargrelor PCI if available within 2 hours of presentation, thrombolysis if not Transfer to CCU

Answer 179

Primarily in the anterior leads: V3 and V4 Can also affect septal leads (V1, V2) and lateral leads (V5, V6, I, aVL), making it an extensive anterior STEMI May also be seen with classic tombstone shape formed by elevated J point and T wave with significant ST elevation = Left anterior descending artery

Answer 180

Used to assess for the need for PCI in an NSTEMI Gives a 6 month risk of death or repeat MI after an NSTEMI 5-10% → consider PCI within 4 days of admission

Answer 181

Beta blocker Aspirin Ticagrelor 180 mg stat (or clopidogrel 300mg) Morphine and cyclizine Anticoagulant - LMWH or fonaparinux Nitrates O2 if hypoxic Prepare to transfer to CCU

Answer 182

A localised immune response 2-3 weeks after an MI, causing pericarditis

Answer 183

Pleuritic chest pain Low grade fever Pericardial rub on auscultation

Answer 184

Pericardial effusion Pleural effusions - transudative (watery) Cardiac tamponade

Answer 185

Ix: ECG (global ST elevation, T wave inversion), echo (pericardial effusion), raised inflammatory markers Tx: NSAIDs, steroids, pericardiocentesis

Answer 186

Raised JVP Ankle oedema Hepatomegaly (smooth, tender, firm, pulsatile liver edge)

Answer 187

NT-pro-BNP >2000 = urgent referral to be seen within 2 weeks 400-2000 = referral to be seen within 6 weeks

Answer 188

ACEi - improves ventricular function, reduces mortality (switch to ARB if not tolerated) BB - decreases HR, myocardial oxygen demand and RAAS activation Add a loop diuretic if fluid overloaded Add of low dose aldosterone antagonist if sx are continuing despire ACEi, BB and diuretic Still sx? get specialist advice

Answer 189

1. Details - age, name, DOB 2. RIPE: - Rotation - Inspiration = 5-6 anterior ribs, 8-10 posterior ribs - Projection = AP or PA? - Exposure = left hemidiaphragm visible, vertebrae visible behind heart 3. Airway: trachea (central, deviated?), carina, right and left main bronchi, hilum 4. Breathing: lung markings, pleura 5. Cardiac: heart size, major vessels (aortic knob) 6. Diaphragm: right side higher than left, costophrenic angles 7. Extras: NG, PICC, ECG electrodes, chest drain, sternotomy clips

Answer 190

H.influenzae

Answer 191

Large round well-circumscribed masses seen on chest xray, indicative of metastases from renal cell carcinoma (and choriocarcinoma or endometrial cancer)

Answer 192

Leads I, aVL, V5, V6 Circumflex artery and left coronary artery (i.e. the left atrium and the posterior aspect of the left ventricle)

Answer 193

V3 and V4 Left anterior descending and left coronary artery (i.e. the anterior aspect of the left ventricle and septum)

Answer 194

I, III, aVF Right coronary artery (supplies the right atrium and right ventricle)

Answer 195

300 / n of large squares in an r-r interval

Answer 196

1 small square = 0.04 seconds 1 large square = 0.2 seconds

Answer 197

PR = 3-5 small squares QRS < 3 small squares QT ~0.42 seconds

Answer 198

Rheumatic fever heart disease Digoxin toxicity

Answer 199

Rotterdam criteria 2 out of 3 of: 1) Polycystic ovaries (12 or more peripheral follicles or increased ovarian volume >10cm3 2) Oligo-ovulation or anovulation 3) Clinical/biochemical signs of hyperandrogenism

Answer 200

1. Endometrial cancer 2. Diabetes 3. Stroke/TIA 4. Obstructive sleep apnoea

Answer 201

Painful peroids with no underlying pelvic pathology

Answer 202

Symptoms: 1. Pelvic or low abdo pain 2. Abnormal vaginal discharge 3. Abnormal bleeding (intermenstrual, post-coital) 4. Pain during sex (dyspareunia) 5. Fever 6. Dysuria Examination: 1. Pelvic tenderness 2. Cervical motion tenderness (cervical excitation) 3. Inflamed cervix (cervicitis) 4. Purulent discharge

Answer 203

Most common: chlamydia Most severe: gonorrhoea

Answer 204

IM ceftriaxone 1g STAT and doxycycline 100mg PO for 14 days and metronidazole 400 mg BD PO for 14 days

Answer 205

Small cyst = should resolve in three cycles 50-70 mm = require yearly monitoring 50-100 mm and persistent or haemorrhagic = require surgical removal

Answer 206

Ordinarily the corpus luteum should breakdown when pregnancy doesn't occur, however it can fill with fluid/blood forming a cyst Clomifene use

Answer 207

Ectopic endometrial tissue outside the uterus, possibly caused by retrograde menstruation A lump of endometrial tissue = endometrioma Endometrioma in the ovaries = chocolate cyst Adenomyosis = endometrial tissue within the myometrium (muscular layer of the uterus) (NB: causes a raised CA125)

Answer 208

Dyspareunia Dysmenorrhoea Cyclical pelvic pain (or continuous for >6 months) Subfertility Cyclical associated symptoms e.g. urinary and bowel symptoms

Answer 209

Benign tumours of the smooth muscle of the uterus, sensitive to oestrogen

Answer 210

1. Heavy/prolonged menstruation 2. Pain (worse during menstruation) 3. Bloating 4. Urinary/bowel symptoms 5. Deep dyspareunia 6. Reduced fertility 7. +/- palaable pelvic mass on bimanual examination

Answer 211

1. Heavy menstrual bleeding → IDA 2. Red degeneration → ischaemia, infarction and necrosis of the fibroid causing severe abdo pain, low-grade fever, tachycardia and vomiting (occurs most frequently with larger fibroids during the second or thrid trimester of pregnancy) 3. Torsion of the fibroid → usually affects pedunculated fibroids 4. Malignant change → leiomyosarcoma (very rare <1%) 5. Urinary outflow obstruction and UTIs 6. Pregnancy complications e.g. miscarrigae, premature labour, obstructive delivery 7. Reduced fertility

Answer 212

Menopause: amenorrhea for >1 year, occurs on average at 51 years old Premature menopause = <40 years (results from premature ovarian insufficiency) Early menopause = <45 years

Answer 213

1. VTE (particularly with oral HRT) (2-3xs increased risk) 2. Ischaemic stroke and coronary artery disease (with long term use in older women) 3. Breast cancer (*combined* HRT) 4. Endometrial cancer (risk reduced by adding progesterone)

Answer 214

1. Reduced vasomotor symptoms (hot flushes, night sweats) 2. Improved symptoms such as: low mood, decreased libido, poor sleep 3. Decreased risk of osteoporosis

Answer 215

Cyclical: early or pre-menopause/still having periods Continuous: menopause (>12 months without periods)

Answer 216

ONLY if a patient has had a hysterectomy (with uterus removal!)

Answer 217

Total: womb and cervix removed Subtotal: cervix left in place Total with bilateral salpino-oopherectomy: womb, cervic, fallopian tubes and ovaria removed Radical: womb and surrounding tissues are all removed including fallopian tubes, part of the vagina, ovaria, lymph glands and fatty tissue THINK: subtotal hysterectomy = must carry on having cervical smears

Answer 218

1. The development of follicle declines 2. Oestrogen production decreases, progesterone levels are low 3. LH and FSH increase 4. Ovulation doesn't occur 5. Endometrium doesn't develop 6. Menstruation stops

Answer 219

Hot flushes Emotional lability Vaginal dryness and atrophy Reduced libido Irregular periods Premenstrual syndrome Joint pains

Answer 220

You need effective contraception for: - 2 years after the last menstrual period if <50 years olds - 1 year after the last menstrual period if >50

Answer 221

If >13 years old with no features of secondary sexual development OR some features but no progression for over 2 years

Answer 222

No menstruation for more than 3 months after previous regular menstruation OR previous infrequent/irregular periods and no periods for 6-12 months

Answer 223

Raised FSH (>40), two samples taken >4 weeks apart Low oestradiol

Answer 224

Symptoms during the luteal phase, should resolve once menstruation begins. Ask them to keep a symptom diary. Give a GnRH analogue to halt the cycle and see if symptoms resolve.

Answer 225

1. Ovarian fibroma (benign ovarian tumour) 2. Pleural effusion 3. Ascites Typically occurs in older women, requires surgical removal of the fibroma

Answer 226

Current or previous breast cancer Any oestrogen-sensitive cancer Undiagnosed vaginal bleeding Untreated endometrial hyperplasia

Answer 227

Deficiency of LH and FSH leading to a deficiency of testosterone and oestrogen

Answer 228

Gonads fail to respond to stimulation from gonadotrophins (LH and FSH) leading to a deficiency of testosterone and oestrogen. The lack of negative feedback causes the anterior pituitary to produce increasing amounts of LH and FSH

Answer 229

Abnormal functioning of the hypothalamus or pituitary, this could be caused by: - Previous damage/surgery - Growth hormone insufficiency - Hypothyroidism - Kallman syndrome - Excessive dieting or exercise

Answer 230

post-menopausal bleeding OR >55 with unexplained discharge or visible haematuria and raised platelets, anaemia or raised glucose levels

Answer 231

endometrial thickness >4mm in a post-menopausal woman

Answer 232

Anything that increases exposure to unopposed oestrogen: - obesity (adipose tissue releases oestrogen) - PCOS (anovulation) - Tamoxifen - No or fewer pregnancies - Earlier onset of menstruation

Answer 233

Normally, when ovulation occurs, a corpus luteum is formed in the ovaries from the ruputred follicle that released the egg. It is the corpus luteum that produces progesterone, providing endometrial protection during the luteal phase of the cycle. PCOS can cause anovulation and therefore the corpus luteum doesn't develop, and progesterone isn't produced → exposure to unopposed oestrogen To reduce this risk people with PCOS should be given the COCP or the mirena coil or cyclical progestogens.

Answer 234

1. DM2 2. hereditary nonpolyposis colorectal cancer or Lynch syndrome

Answer 235

A biopsy done as outpatient using a speculum and a thin tube (pipelle). It is highly sensitive for endometrial cancer. Other investigations for endometrial cancer: TVUSS for endometrial thickness (>4mm post-menopause is abnormal) Hysteroscopy with endometrial biopsy

Answer 236

1. BRCA1, BRCA2 2. obesity 3. recurrent clomifene 4. smoking 5. increased number of ovulations: early menarche, late menopause, no pregnancies (∴ anything that reduces lifetime number of ovulations reduces risk e.g. COCP, breastfeeding, pregnancy) Peak incidence is as 60 years old

Answer 237

Used to estimate risk of an ovarian mass being malignant, includes: - Menopausal status - USS findings - CA125 level

Answer 238

Benign ovarian tumours arising from the germ cells. Contain various tissue types: skin, teeth, hair, bone. Particularly associated with ovarian torsion. Ix: - Raised alpha-fetoprotein - Raised hCG

Answer 239

Signet ring cells (Krukenberg = ovarian tumour metstasied to somewhere else)

Answer 240

Very non-specific ∴ often found very late, more than 70% have spread beyond the pelvis at diagnosis. - Abdo bloating - Early satiety - Pelvic pain - Urinary symptoms (freq, urge) - Weight loss - Abdo/pelvic mass - Ascites

Answer 241

Immediate 2ww if you find any one of: - Ascites - Pelvic mass (unless clearly fibroids) - Abdominal mass Get a CA125 first then 2ww if >50 and presenting with: - New change in bowel habit/IBS - Abdominal bloating - Weight loss - Early satiety - Pelvic pain - Urinary freq or urgency

Answer 242

Epithelial cell ovarian cancer Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy

Answer 243

Squamous cell carcinoma

Answer 244

Every 3 years for 25-49 year olds Every 5 years for 50-64 year olds

Answer 245

HPV 6 and 11 = warts HPV 16 and 18 = cancer (cervical and 80% of anal cancer)

Answer 246

Anything that increases your risk of catching HPV: - Early sexual activity - Increased n of sexual partners - Sexual partners who have had more partners - Not using condoms Non-engagement with cervical screening HIV (need yearly smears) COCP use for >5 years Family hx Smoking

Answer 247

usually asymptomatic, may have non-specific symptoms e.g. post-coital bleeding, red-brown discharge, purulent discharge

Answer 248

Cervical ulceration, inflammation, bleeding or a visible tumour. Urgent cancer referral for colposcopy.

Answer 249

The grading system for the level of dysplasia (pre-malignant change) in the cells of the cervix. Diagnosed on colposcopy: CIN I = mild CIN II = moderate, likely to progress if untreated CIN III = severe, very likely to progress if untreated

Answer 250

Smear results = cytology & HPV status: - Inadequate sample → repeat in 3 months - HPV neg. → continue normal screening - HPV pos. with normal cytology → repeat HPV test in 12 months - HPV pos. with abnormal cytology (dyskaryosis) → refer for colposcopy

Answer 251

squamous cell carcinoma

Answer 252

>75 years old Immunosuppression HPV infection Lichen sclerosis

Answer 253

Irregular mass Fungating lesion Ulceration Bleeding

Answer 254

No, you must be at least 12 weeks post-partum

Answer 255

Cervical ectropion

Answer 256

Vaginal atrophy

Answer 257

Follicular phase: days 1 to 14 - LH and FSH stimulate follicles to develop - Follicles produce oestrogen - Oestrogen causes a drop in LH and FSH - Drop in LH and FSH causes follicles to die, except for one dominant follicle - Dominant follicle secretes lots of oestrogen - High oestrogen causes a surge of LH and FSH - Surge of LH and FSH causes follicle to rupture and release the oocyte = OVULATION Luteal phase: days 14 to 28 - Remainder of the empty dominant follicle forms the corpus luteum - Corpus luteum produces lots of progesterone (and some inhibin) - Progesterone and inhibin suppress LH and FSH release, oestrogen continues to fall Meanwhile...days 0 to 5 in the cervix, the old endometrium is shed = menses Days 5 onwards = proliferation of the endometrium, growth of spiral arteries, consistency of the cervical mucus changes

Answer 258

An X-linked recessive condition where a genetically male child (46XY) has end-organ resistance to testosterone causing them to have a female phenotype. Features: - Primary amenohorrea - Undescended testes causing groin swellings

Answer 259

1. Gonadal dysgenesis (e.g. Turner's syndrome) = most common 2. Testicular feminisation 3. Congenital malformation of the genital tract 4. Functional hypothalamic amenorrhoea e.g. secondary to anorexia 5. Congenital adrenal hyperplasia 6. Imperforate hymen

Answer 260

1. Hypothalamic amenorrhea (secondary to stress, excessive exercise) 2. PCOS 3. Hyperprolactinaemia 4. Premature ovarian failure 5. thyrotoxicosis* (*hypothyroidism can also cause amenorrhea) 6. Sheehan's syndrome 7. Asherman's syndrome

Answer 261

TVUSS shows 'string of pearl' appearance

Answer 262

High testosterone High LH Normal FSH Low progesterone Low SHBG (sex hormone binding globulin)

Answer 263

A complication of PID; inflammation of the liver capsule leads to adhesions between the liver and peritoneum. Px: Right upper quadrant pain, shoulder tip pain.

Answer 264

Ovarian fibroid

Answer 265

cephalosporins

Answer 266

Can stain the baby's teeth and cause skeletal developement problems

Answer 267

Start with least invasive and work up: - Bladder training - Anticholinergic = oxybutinin - Mirabegron - botox injection

Answer 268

Chronic urinary retention due to obstruction, results in incontinence without the urge to pass urine. Causes include: fibroids, pelvic tumours, anticholinergics, neuro conditions (MS)

Answer 269

Constipation, urinary retention, palpable lumb in the vagina

Answer 270

Anyone who has been trying to conceive for 1 year with frequent UPSI (every 2-3 days) Anyone who has been trying to conceive for 6 months with frequent UPSI, if: the woman is ≥36 or there is a known cause of infertility or there is a hx of predisposing factors

Answer 271

Male: - Semen analysi (sperm count, motility, morphology, vitality, concentration, volume) - Chlamydia screening Female: - Mid-luteal progesterone (~day 21) to assess if ovulation is occuring - FSH and LH levels to assess ovarian function (poor ovarian function → high FSH and LH) - Chlamydia screening

Answer 272

Anything that slows the passage of the ovum! 1. Smoking 2. PID 3. Prior fallopian tube surgery 4. IVF 5. Early first sexual intercourse (<18) 6. Age >35 at presentation 7. Black ethnicity 8. Endometriosis 9. Progesterone-only pill

Answer 273

TVUSS: blob/bagel/tubal ring sign i.e. a mass in the fallopian tube containing an empty gestational sac

Answer 274

A pregnancy implanted outside the uterus, most commonly in the fallopian tube

Answer 275

Offer surgical tx if: in significant pain, adenxal mass>35mm, fetal heartbeat present, hCG>1500 Medical tx: single dose *methotrexate* Make sure to advise avoiding getting pregnant for the next 3 months! And that there may be no bleeding as the tissue can be resorbed by the body Surgical tx is laparoscopic salpingectomy, unless there is high risl of infertility in which case you can consider laproscopic salpingotomy

Answer 276

Measure bHCG at baseline Repeat after 48 hour Doubly = intrauterine Rising but not doubling = ectopic Falling by half or more = miscarriage

Answer 277

Medical abortion: mifepristone, then misoprostol 1-2 days later Surgical up to 14 weeks: mifepristone, misoprostol, osmotic dilatations and suction Surgical at 14-21 weeks: cervical dilation and evacuation with forceps Don't forget to give anti-D if rhesus neg and over 10 weeks

Answer 278

Fetal pole present when gestation sac reaches 25mm Fetal heartbeat present what CR length reaches 7mm

Answer 279

<6 weeks = expectant management, await miscarriage (as long as there is no pain, RF or Cx) and repeat pregnancy test in 7-10 days Medical: vaginal or oral misoprostol Surgical: misoprostol and vacuum aspiration

Answer 280

3+ consecutive miscarriages

Answer 281

Complete: empty oocyte lacking maternal genes is fertilised (karyotype 46) - requires surgical evacuation Incomplete: oocyte is fertilised by two sperm, three sets of chromosomes (karyotype 69) - requires medical termination

Answer 282

1. Passing grape liek vesicles 2. Hyperemesis gravidarum 3. Hyperthyroidism 4. Vaginal bleeding 5. Large for gestation uterus 6. VERY high bHCG

Answer 283

snow storm appearance

Answer 284

1. Asian ethnicity 2. Blood group A 3. Low protein, low carotene, low folic acid diet 4. Prev molar pregnancy 5. Extreme maternal age

Answer 285

11 to 14 weeks

Answer 286

First line and most accurate screening test, involves USS and bloods. Looks for high risk of Down's, Edward's, or Patau's. High risk is shown by: nuchal translucency >6mm, high beta-hcg, low PAPPA (pregnancy associated plasma protein) If risk if >1 in 150, offer further testing (CVS or amniocentesis).

Answer 287

Maternal blood test performed between 14 and 20 weeks. Includes bHCG, AFP and serum oestriol. High risk of Down's = high beta-HCG, low AFP, low oestriol

Answer 288

Any pregnancy with a risk of Down's >1 in 150. USS guided biopsy of placental tissue for karyotyping, must be done before 15 weeks. Risk of miscarriage is thought to be ~1 in 200.

Answer 289

Aspiration of amniotic fluid to sample fetal cells for karyotypic. Done at 15-20 weeks. 1 in 100 miscarry.

Answer 290

Fetal DNA fragments are checked from a maternal blood test. Not a definitive test but does give a good indication of whether a fetus is affected by Down's .

Answer 291

Up to 4 weeks

Answer 292

1. Placental abruption 2. Placenta praevia 3. Vasa praevia 4. Local anteparum haemorrhagee.g. varicose veins, vaginal lacerations, cervical ectropian

Answer 293

Minor = <500ml Major = 500-1000ml Massive = >1000ml or signs of shock

Answer 294

1. 2 large grey cannulas 2. Cross match 4 units of blood 3. Blood tests - FBC, U&E, coag screen, LFTs 4. CTG monitoring 5. Fluids 6. Escalate quickly!

Answer 295

1. Woody abdomen 2. Sudden onset severe continuous abdo pain 3. Dark vaginal bleeding 4. Shock (inconsistent with external loss) 5. CTG abnormalities

Answer 296

1. Pre-eclampsia 2. Multiple pregnancy 3. Fetal growth restriction 4. Mutligravida 5. Trauma 6. Increased maternal age 7. Smoking 8. Cocaine or amphetamine use 9. Bleeding early in pregnancy 10. Previous placental abruption

Answer 297

ANY sign of fetal distress → CAT1 c-section >36 weeks → deliver baby ASAP <36 weeks → monitor, give corticosteroids, plan delivery AND address blood loss, do they need fluids/resus etc.

Answer 298

Booking clinic: Hb >110 28 weeks: Hb >105 Post partum: Hb>100

Answer 299

Low MCV = IDA High = B12 or folate deficiency Normal = physiological anaemia due to increased plasma volume in pregnancy

Answer 300

When the placenta implants deeper, through/past the endometrium, making it difficult to separate and deliver in the third stage of labour. Found antenatally on USS or during a PPH

Answer 301

1. prev c-section 2. prev uterine surgery 3. increased maternal age 4. IVF

Answer 302

Hysterectomy, uterus preserving surgery or expectant management (leave to resorb - very risky)

Answer 303

Fetal vessels are exposed, outside the protection of the umbilical cord or placental. Instead they travel through the chorioamniotic membranes and across the internal cervical os.

Answer 304

plan for c-section at 34-36 weeks, give corticosteroids. at32+ weeks remember digital vaginal exam is CI!

Answer 305

Placenta lying wholly or partially in the lower uterine segment. Seen on routine USS in week 20, confirmed with TVUSS

Answer 306

No pain Abnormal lie/high head Profuse red bleeding

Answer 307

TVUSS at 32 and 36 weeks Corticosteroidsat 34-35+6 weeks Planned c-section at 36-37 weeks

Answer 308

8-12 weeks Hep B Syphillis Chlamydia BP BMI Urine dip (asymptomatic bacteuria? culture, confirm sensitivities, give abx)

Answer 309

10-14 weeks Accurate gestational age is calculated from the crown rump length Multiple pregnancies are identified

Answer 310

18 to 20 weeks USS identifies any anomalies such as heart conditions

Answer 311

OGTT done at booking clinic for women with previous gestational diabetes, done at 24-28 weeks for those with risk factors or suggestive features (e.g. large for dates, polyhydramnios, glucosuria): Fasting glucose >5.6, Then asked to drink a 75g glucose drink, 2 hour glucose >7.8

Answer 312

Education on monitoring blood sugars (four times a day). Serial growth scans every 4 weeks from week 28 to 36 Fasting glucose less than 7: start with 2 weeks of exercise/lifestyle changes Fasting glucose more than 7: start insulin +/- metformin

Answer 313

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

Answer 314

1. BMI > 30 2. Prev macrosomic baby weighing 4.5kg or more 3. Prev gestational diabetes 4. Family origin with high prevalance of diabetes (south Asian, black Caribbean, Middle Eastern)

Answer 315

Metformin can be continued. Oral hypoglycaemics must be stopped e.g. glicazide Glibenclamdide (sulfonylurea) can be continued.

Answer 316

Hypertension and one of: - Proteinuria (P:C>30, A:C>8) -Placental dysfunction - End organ dysfunction

Answer 317

Pre-eclampsia is defined by systolic BP >140 mm Hg or diastolic BP >90 mm Hg in the second half of pregnancy, with ≥1+ proteinuria on reagent stick testing. 1. Headache 2. Visual disturbance 3. N&V 4. Abdo pain 5. Oedema 6. Reduced urine output 7. Brisk reflexes 8. Raised AST and ALT 9. HELLP syndrome

Answer 318

1. Intrauterine growth restriction 2. placental abruption 3. Pre-term labour 4. Seizures 5. HELLP (haemolysis, elevated liver enzymes, low platelets) 6. Renal failure

Answer 319

1. High risk women given 75mg OD aspirin from 12 weeks 2. Antihypertensive medication: 1st line = labetalol 2nd line = nifedipine 3rd line = methyldopa 3. IV magnesium sulphate during labour and for 24 hours after to prevent seizures 4. Deliver by 37 weeks, stay for observation after birth in case of seizures

Answer 320

Haemolysis, Elevated Liver enzymes, Low Platelets - a combination of features that occurs as a complication from pre-eclampsia

Answer 321

first line = IV magnesium sulphate 2nd line = diazepam

Answer 322

Reduced outflow of bile acids from the liver. Caused by increased oestrogen and progesterone in later pregnancy (28 weeks+)

Answer 323

Raised ALT, AST, GGT and bile acids Ursodeoxycholic acid

Answer 324

1. >5% weight loss 2. Dehydration 3. Electrolyte imbalance

Answer 325

PUQE score: <7 mild, 7-12 moderate, >12 severe (pregnancy unique quantification of emesis)

Answer 326

1. Prochlorperazine 2. Cyclizine 3. Ondansetron 4. Metoclopramide

Answer 327

Panbrinex (vit c and b) fluid resus anti-emetic don't forget to r/o other causes of vomiting e.g. gastritis, apendicitis

Answer 328

IV benzylpenicillin before labour

Answer 329

Pregnant women with GBS on vaginal swab or bacteruria AND anyone who previously had a baby with GBS

Answer 330

Monoamniotic: elective c-section at 32-33+6 weeks Diamniotic: first baby might be able to deliver vaginally, second needs c-section

Answer 331

Twins sharing a placenta, recipient twin receives. the majority of the blood supply whilst donor twin is starved. Donor: anaemia, oligohydramnios, growth restriction Recipient: fluid overload, heart failure, polyhydramnios

Answer 332

Because a UTI increases the risk of pre-term delivery

Answer 333

7 days of antibiotics: - Nitrofurantoin (not in the third trimester though!) - Amoxicillin (if sensitivites are known) - Cefalexin (safe in all stages of pregnancy)

Answer 334

Fetus below the 10th centile for their gestational age, USS is used to measure estimated fetal weight (EFW) and fetal abdominal circumference.

Answer 335

Estimated fetal weight > 90th centile

Answer 336

1. Birth injury 2. Neonatal hypoglycaemia 3. Obesity 4. DM2 5. Shoulder dystocia at birth

Answer 337

1. PPH 2. Perineal tear 3. Instrumental or c-section delivery

Answer 338

1. small for gestational age 2. oligohydramnios 3. abnormal doppler 4. reduced fetal movement 5. abnormal CTG

Answer 339

Bishop score > 8 predicts successful induction

Answer 340

1. Membrane sweep - used from 40 weeks 2. Vaginal prostaglandin E2 - done in hospital 3. Cervical ripening balloon - used when prostaglandins are not preferred e.g. in a woman with a previous c-section or multiparous 4. Artificial rupture of membranes with IV oxytocin - used if prostaglandins haven't worked or are CI

Answer 341

When the amniotic sac ruptures more than 18 hours before delivery

Answer 342

When the amniotic sac ruptures before the onset of labour and before 37 weeks gestation

Answer 343

Check vaginal fluid*, high IGFB-1 and high PAMG-1 indicate waters have broken *pooling of amniotic fluid in the posterior vaginal vault indicates rupture of membranes

Answer 344

Erythromycin 250mg QDS for 10 days/until delivery, induction from 34 weeks

Answer 345

Abnormal lie after 37 weeks

Answer 346

Nulliparity Prolonged pregnancy Cephalic position

Answer 347

Definitive treatment is an emergency c-section! In the interim you can: - Position Mum in on all fours (draws the baby away from the cord) - Physically push the baby off the cord - Give a tocolytic to minimise contractions

Answer 348

Premature labour Multiple pregnancy Placenta praevia Pelvic deformities

Answer 349

Offer ECV at 36 weeks (27 weeks if multiparous) ECV: - Give tocolytic - Do ECV under doppler USS - Check CTG - Give anti-D if rhesus negative

Answer 350

Baby born before 37 weeks

Answer 351

<30 weeks = clinical assessment >30 weeks = check TVUSS to assess cervical length, if <15 mm treat as preterm labour

Answer 352

The "glue" between the chorion and uterus, found in the vagina during labour. Can be checked to establish if patient is in preterm labour. FF < 50 ng/ml = preterm labour is unlikely

Answer 353

Vaginal progesterone via gel or pessary. Offered to women with a cervical length less than 25 mm on TVUSS between 16 and 24 weeks. Cervical cerclage: a stitch in the cervix to support and keep it closed. Offered to women with a cervical length less than 25 mm on TVUSS between 16 and 24 weeks AND who have had a previous premature birth or cervical trauma (colposcopy or cone biopsy)

Answer 354

Given IV to the mother to protect the baby's brain during premature delivery. Given within 24 hours of delivery in preterm babies of less than 34 weeks gestation. Given IV to the mother to treat/prevent seizures in pre-eclampsia.

Answer 355

When the baby's anterior shoulder gets stuck behind the pubic symphysis during labour

Answer 356

Damage to the brachial plexus resulting. in 'waiter's tip' = adducted, internally rotate arm, pronated forearm Complication of shoulder dystocia

Answer 357

Episiotomy McRoberts manoeuvre Pressure to the anterior shoulder by pressing on the suprapubic region of the abdomen Rubins manoeuvre Wood's screw manoeuvre Zavanelli manoever

Answer 358

Difficulty delivering the face and head, unable to deliver the shoulders. Failure of restitution: the head remains face down and doesn't turn sideways as expected. Turtle-neck sign - head delivers then retracts back in again.

Answer 359

1st: superficial injury 2nd: includes perineal muscles but does not affect anal sphincter 3rd: - A = includes <50% of the external anal sphincer - B = includes >50% - C = includes both sphincters 4th: includes rectal mucosa & sphincters

Answer 360

3rd or 4th

Answer 361

1. Tone - uterine atony is the most common cause 2. Tissue - retained placenta 3. Trauma - e.g. perineal tear 4. Thrombin - bleeding disorder

Answer 362

Oxytocin Ergometrine Carboprost IM (caution in asthmatics) Misoprostol Tranexamic acid

Answer 363

Rub the uterus Catheterise to empty the bladder

Answer 364

Intrauterine balloon tamponade = first line for uterine atony B lynch suture Uterine artery ligation Hysterectomy

Answer 365

FORCEPS: Fully dialted OA/OP Ruptured membranes Cephalic Engaged Pain relief given Sphincter (bladder empty and catheteristed)

Answer 366

Cephalohematoma (ventouse) Facial nerve palsy (forceps) Subgaleal haemorrhage Intracrainal haemorrhage Skull fracture Spinal cord injury

Answer 367

Terbutaline

Answer 368

Power (strength of contractions) Passenger (size, attitude, lie, presentation) Passage

Answer 369

less than 2cm dilation in 4 hours, or slowing of progress in a multiparous woman

Answer 370

Active pushing lasting over 2 hours (nuliparous) or 1 hour (multiparous)

Answer 371

>30 mins with active management, >60 mins with physiological management

Answer 372

1: threat to life, deliver within 30 minutes 2: urgent, deliver within 75 minutes 3: required but stable 4: elective

Answer 373

1. skin 2. subcutaneous tissue 3. rectus sheath 4. rectus abdominismuscle (separated vertically along the linea alba) 5. parietal peritoneum 6. vesicouterine peritoneum 7. uterus 8. amniotic sac

Answer 374

Temp >38 in the first 14 days post-partum, caused by endometriosis (most common), UTI, wound infection, mastitis or VTE. If suspected, immediately refer to hospital for abx.

Answer 375

Edinburgh scale

Answer 376

Sertraline or paroextine

Answer 377

Post labour psychosis, develops within the first 2 weeks, affects 1 in 1000 deliveries

Answer 378

1. Latent phase: 0 to 3cm dilation, progressing 0.5cm/hour, irregular contractions 2. Active phase: 4 to 7 cm dilation, progressing 1 cm/hr (0.5 if 1st baby), regular contractions 3. Transition phase: dilation 7 to 10 cm, 1cm progress/hr, strong and regular contractions

Answer 379

1 hour of passive descent (don't push, helps baby to settle further down) Active pushing: 2 hours max if 1st labour, 1 hour max if 2nd+ labour

Answer 380

Delivery of the cord Cord traction if delayed Manual removal in theatre if traction doesn't work

Answer 381

McRobert's: pull knees into chest Rubin's: reach into vagina, press on anterior shoulder Wood screw's: reach introvagina, press on posterior shoulder Zanelli: push head back in, do emergency c-section

Answer 382

1. Direction of the baby: transverse, oblique, longitudinal 2. Which part is closest to the pelvic inlet? e.g. cephalic, breech 3. Orientation of the head, determined by the occiput, OA is ideal 4. Degree of flexion of the head

Answer 383

Primary = High PTH, High Calcium Caused by a parathyroid tumour. Excessive PTH secretion, excessive resorption from calcium from the bones, kidneys and gut. Secondary = High PTH, Low/normal Calcium Vitamin D deficiency or CKD means that the kidneys and gut cannot absorb enough calcium. Persistent low calcium detected by the parathyroid gland causes more and more PTH to be secreted. Eventually causes parathyroid gland hyperplasia. Tertiary = High PTH, High Calcium Once you fix the underlying cause of secondary hyperparathyroidism, the hyperplased glands continue to secrete too much PTH.