F+C (Part 1) Flashcards
1
Q
What is your first line prescription for mild acne? Write as would be written on a prescription.
A
Isotretinoin gel 0.05%
Apply a thin layer 1-2x daily
Supply 30g
2
Q
What is your first line prescription for acne with inflammation? Write as would be written on a prescription.
A
Isotretinoin gel 0.05%
Apply a thin layer 1-2x daily
Supply 30g
Clindamycin gel 1%
Apply a thin layer, once daily
Supply 30g
3
Q
After trying isotretinoin and clindamycin a patient’s acne is still not settled. What is your next prescription for acne with inflammation? Write as would be written on a prescription.
A
Benzoyl peroxide 5% gel
Apply 1-2x daily, after washing
Supply 30g
4
Q
What is your first line prescription for chlamydia? Write as would be written on a prescription.
A
Azithromycin 500mg Tablets
Take 2 tablets immediately
Supply 2 tablets
5
Q
What is your first line prescription for vulval Candida infection? Write as would be written on a prescription.
A
Clotrimazole pessary 500mg
Insert one into the vagina, leave overnight and remove in the morning
Supply one pessary
6
Q
What is your first line emollient prescription for a patient with eczema? Write as would be written on a prescription.
A
Diprobase cream
Apply liberally, at least 3-4 times daily
Supply 500g
Note diprobase is 2/5 on emollient ladder, if needing stronger give Epaderm ointment
7
Q
What is your first line bath emollient prescription for a patient with eczema? Write as would be written on a prescription.
A
Dermol 600 Bath Emollient
Add 30ml to bath, do not use undiluted
Supply 600ml
8
Q
What is your first line steroid prescription for a patient with eczema on the face? Write as would be written on a prescription.
A
Hydrocortisone 1% cream
Apply a thin layer every 12 hours
Please supply 30g
9
Q
What is your first line steroid prescription for a patient with eczema on the trunk? Write as would be written on a prescription.
A
Eumovate 0.05% cream
Apply to affected areas, 1-2x daily
Supply 30g
Eumovate = moderate Betnovate = potent Dermovate = very potent
10
Q
What is your first line prescription for a patient with a UTI? Write as would be written on a prescription.
A
Nitrofurantoin 50mg tablets
Take one tablet, four times per day
Supply 28 tablets (7 days)
M: 7 days
F: 3 days
Pregnancy F: 7 days
Children: 7 days
11
Q
Write a prescription for mophine (10mg) for a patient to help manage their pain.
A
Morphine sulphate 10(TEN)mg tablets Take 1 (one) tablet every 4 (four) hours as required Supply 56 (fifty-six) tablets
12
Q
Name 3 causes of global developmental delay
A
Prenatal: Chromosomal disorders, alcohol or drugs in pregnancy, TORCH infection
Perinatal: Hypoxic brain injury, intraventricular haemorrhage
Postnatal: Meningitis, anoxic events, head injury
13
Q
Name three causes of an isolated motor delay (usually presenting in the first year)
A
Cerebral palsy
Congenital myopathy
Spinal cord lesion
Visual/ balance problems
14
Q
Name three causes of an isolated languagedelay (usually presenting in the second year)
A
Hearing loss
Anatomical deficit (cleft palate)
Environmental deprivation
Normal/ familial variant
15
Q
Name three differentials for a child presenting with a social delay aged 3
A
Autism
Hyperactivity
ADHD
16
Q
Give two differentials for jaundice in first 24 hours of life?
A
Haemolysis
Infection
17
Q
Give three differentials for jaundice in D2-D14 of life?
A
Physiological
Breast milk
Infection
Haemolysis
18
Q
Give three differentials for jaundice in after two weeks of age?
A
Breast milk
Infection
Hypothyroid
Biliary atresia (conjugated)
19
Q
What is the order of puberty in girls (5 steps) and normal age?
A
Age 10-14
Breast enlargement > pubic hair > arm hair > growth > periods (approx 12)
20
Q
What is the order of puberty in boys (4 steps) and normal age?
A
Age 12-16
Testicle enlargement > penis enlargement > pubic hair > growth
21
Q
Give three DDx for early puberty
A
Normal/ familial variant
Intercranial tumour
Adrenal tumour
Ovarian/ testicular tumour
22
Q
What age is classed as early puberty?
A
M < 9years
F <8 years
23
Q
Name 5 questions which should be asked as part of a constipation history? (Presenting complaint only)
A
Frequency of stools interval between stools Consistency of stool Colour Straining or pain Incontinence
24
Q
Name 3 additional questions (not presenting complaint) which should be asked in a constipation history?
A
DIET
FHx of constipation problems (50% genetic)
Stress
25
What are you 5 management steps for suspected non-accidental injury?
FBC/ clotting to exclude other disorders
Treat + investigate injury (analgesia, imaging etc)
Photography of injuries
Refer to safeguarding lead and social/ police as appropriate
Document fully (everything possible in patients words)
26
Name 5 LOC hx differentials?
```
Febrile convulsion (6mths-5yrs)
Seizure
Reflex anoxic seizure (in response to trigger/ bump)
Breath holding spell
Vasovagal
Arrythmia/ HOCM collapse
```
27
What are the three most common causes of cyanotic heart disease?
Transposition of great arteries (birth)
Tetrology of fallot (1-2 months)
Tricuspid atresia
28
What are the three most common causes of acyanotic heart disease?
VSD - Most common of all defects
ASD
PDA
29
Name 5 counselling points for a febrile convulsion
CAUSE - ACKNOWLEDGE DISTRESS + Reassure
Seizure management (stay out of way, call 999 if longer than 5mins or 111 before that if previous FebCons)
Take a video
1/3 will have further seizures
No evidence to suggest risk of serious illness in later life
1 in 50 epilepsy (normally 1 in 100)
Most grow out by age 5
30
Name 5 RF's for SIDS
```
Prematurity
Low birth weight
Smoking in the home
Bed sharing
Hyperthemia (overwrapping)
Sleeping prone
```
31
When is the 6 in 1 vaccine done? Name three counselling points?
At 2,3,4 months
Not a live vaccine
SE: Redness/ swelling/ bump @ injection site
Check allergies to vaccine and no current fever
32
When is the MMR vaccine given? Name three counselling points?
1yr and then 3yrs 4mths
Live vaccine
SE: Rash (6-10days), face swelling/ joint pain (2-3wks)
Can't pass contamination to others
CI: Allergy/ pregnancy/ immunocompromised
Ask for gelatin free version
33
When is the HPV vaccine given, name two counselling points
Age 12-18 (two doses 12mths apart)
Protects against 16,18 (70% cancers) and 6+11
SE: Soreness, swelling, redness on arm (settle in 3 days)
34
Name 6 symptoms of ADHD
Inattention - forgetful, careless mistakes, struggle with tasks
Hyperactivity - excessive movement, fidgeting
Impulsiveness
35
Name 3 risk factors for ADHD
Smoking/ alcohol/ drugs in pregnancy
FHx
Low birthweight
Premature
36
Name 3 management steps when counselling for ADHD
1) Parent behaviour training and pyschotherapy for child and parents
2) Plan day, clear boundaries, intervene early
3) Speak to SENCO at school for support
4) Methylphenidate (OD or 2-3x/daily)
37
Name 4 complications of down's syndrome
```
Hearing problems (70%)
Visual problems (60%)
Heart problems (50%)
Bowel/ thyroid issues
```
38
When is the combined test offered, what does it consist of?
Combined = 10-13 weeks
Nuchal translucency
+ PAPP-A (low in DS)
HCG (high in DS)
39
When is the quadruple test offered and what does it consist of?
Quad = 15-20 weeks
| BHCG (high)/ AFP (low)/ Inhibin-A (high)/ oestriol (low)
40
At what different times can CVS and amniocentesis be offered?
```
CVS = 11-13wks
Amnio = >15wks
```
41
What are the misscarriage rates for CVS and amniocentesis?
CVS- 4%
| Amnio- 1%
42
Name 5 differentials for a SOB child?
```
Croup (6mths- 6yrs, seal cough, preceeding illness)
Bronchiolitis (<1yr - cough, wheeze, fluctuating, prodromal illness)
Viral induced wheeze
Asthma
Whooping cough
Anaphylaxis
GORD (babies)
Congenital heart disease (babies)
```
43
Name 5 differentials for FTT?
```
1) Inadequate intake
GORD
Cows milk protein allergy
Coeliac
CF
Neglect
Pyloric stenosis/ IBD etc.
```
44
Name 5 lines of questioning for a FTT hx?
Pregnancy - Growth, smoking/ alcohol. illness
Post birth- Meconium, previous growth, NICU
Input- Breast/ bottle, frequency, hunger, feeding trouble?
Output - Energy, anorexia, nappies/ stools/ diarrhoea
Other - General health/ happiness
45
What questions should be asked before performing a newborn baby check (3)
Complications in labour/ pregnancy
Feeding/ latching on ok?
Passed urine and meconium?
46
What are the features of bacterial vs. viral meningitis on an LP? (2)
Bac: Raised neuts, raised opening pressure
Viral: Raised lymphs, normal opening pressure
47
Name two features of a fungal/ TB infection on an LP?
Raised lymphocytes and very raised opening pressure
48
Name 4 management points to counsel a new T1DM?
1) Education about spotting hypos (dizzy/ drowsy/ hungry/ sweaty)
2) Diabetic MDT care team
3) Insulin (injections vs pump, rapid vs. long acting)
4) Monitoring of glucose levels
5) Complications (eyes, kidney, nerves)
DIRECT TO DIABETES UK
49
Name 3 differentials for a poorly behaving child
```
ADHD
Conduct disorder (fights alot)
Oppositional defiant disorder (loser temper, argues with adults)
OCD
Autism
Attachment disorder
```
50
Name 3 features of autism?
```
Delayed speech
Impaired social interaction
Lack of awareness or interest in others
Impaired emotional ability
Repetative or compulsive behaviour
```
51
Name 5 features of psoriasis?
Well demarcated, circular to oval
Bright red/ pink plaques
White or silvery scale
Distributed symmetrically over extensor surfaces and scalp
52
Name 3 features of eczema for a presentation?
```
Poorly demarkated
Erythematous
Dry
Lesions
Look eczematous
+/- lichenification (thickening of epidermis)
```
53
Name three causes of a microcytic anemia?
IDA
Thalassemia
Sideroblastic anaemia
54
Name thee causes of a normocytic anemia?
Anaemia of chronic disease
CKD
Haemolytic
Aplastic anaemia
55
Name 3 causes of a macrocytic anaemia?
B12/ folate deficiency (megaloblastic)
Pregnancy
Alcohol/ liver disease
Hypothyroidism
56
What treatment is given for IDA?
3 months of ferrous sulphate
| 200mg BD/TDS with review
57
What treatment is given for B12/ folate deficiency?
B12 injections (first) followed by folate supplementation
58
Name 5 symptoms of leukaemia?
```
Fatigue
Dizziness
Palpations
Bone pain
Brusing
Fever
Dysponea
```
59
What do each of the following indicate:
1) HepA IgM
2) HepA IgG
1- Current infection (IgM)
2- Past infection/ vaccination (igG)
G=Gone (infection)
60
What do each of the following indicate:
1) HBsAg
2) HBeAg
3) Anti-HBs
4) Anti-HBc
1) HBsAg = Acute disease
2) HBeAg = Marker of current infectivity
3) Anti-HBs = Immunity (vaccine or infection)
4) Anti-HBc = Previous/ current infection (IgM <6mths, IgG >6mths)
61
What do each of the following indicate?
1) Anti-HCV
2) HCV RNA
1) Anti-HCV = Current/ recovered infection
2) HCV RNA = Active infection
Only treat those with +ve HCV RNA
62
How do you manage HepA?
Rest, fluids, antiemetics
Stop alcohol and ?paracetamol
Recovery in 3-6mths
63
How do you manage HepB?
No intercourse til non-infective
Treat as HepA
If HBeAg +ve then add: Peginterferon-alfa-2a (48wks)
Symptoms should resolve in 4-8 weeks
64
What % of HepB and HepC become chronic?
```
B = 10%
C= 85% (treat same as HepB)
```
65
Name 5 counselling points for a patient with eczema?
```
Keep skin dry, nails short
Avoid temperature extremes
Avoid wearing wool or synthetics
Recognise flare ups and infection
90% grow out by adulthood
REFER TO NHS WEBSITE FOR SUPPORT
```
66
Name 5 RFs/ triggers for Psoriasis?
```
Genetic
Stress
Drugs
Low sunlight
Smoking and alcohol
```
67
Name two tools which can be used to assess severity of Psoriasis infection?
PASI - Psoriasis area severity index
| DLQI - Derm life quality index
68
Name 3 management options for psoriasis
1) Emollients
2) Vit D analogues (Dovobet also contains steroid)
3) Phototherapy/ cyclophosphamide/ methotrexate
69
You have a patient newly diagnosed with psoriasis, in addition to an emollient what should you prescribe? Write as if on an FP10 form.
Dovobet 0.05% ointment
Apply a thin layer once daily
Supply 30g
70
Name 5 things which should be asked about in an incontinence hx?
```
Primary or secondary
Triggers (cough, laugh)
Urgency
Frequency
Dysuria
Flow/ stream strength
```
PMHx (Pregnancy, childbirth)
Effects on lifestyle
71
What is first line management for stress incontinence?
Pelvic floor exercises
8 contractions TDS
Minimum of 3 months
72
What is first line management for urge incontinence?
Bladder retraining
Gradually increases intervals for minimum of 6 weeks
2) Oxybutanin
73
Name 4 differentials for incontinence
OAB/ urge
Stress
Mixed
Overflow from obstruction
74
Name 5 differentials for a breast lump
```
Breast cancer (ductal most common)
Fibroadenoma
Breast cyst
Ductal papilloma
Inflammatory breast cancer/ pagets disease (if other syx)
```
75
How does scarlet fever usually present?
Age 2-6 (4yrs most common)
Fever: typically lasts 24 to 48 hours
Malaise
Tonsillitis
'Strawberry' tongue - may just have white coat
Rash - fine punctate erythema ('pinhead') which generally appears first on the torso and spares the face. Sandpaper like appearance
Scarlet fever - S's (Sore throat, Strawberry tongue, Sandpaper rash, up to Six years + fever)
76
What identifiers should be checked on all 2ww referrals?
Name
DOB
Address
Phone number
77
What is the general Hx station structure? (7)
```
1- Open Q's
2- PC/ HPC
3- ICE
4- Differentials out and in/ screen for red flags
5- PMHx/DHx/FHx
6- Shx and support @ home
7- Summarise
```
78
What is the most common cause of spotting?
Anything with progesterone
79
What four questions should be asked in all paeds histories?
```
PIDS
P- Pregnancy/ birth
I- Immunisations
D- Development
S- Social services
```
80
What phase should you use to start any explanation station?
Intro
"It's the first time I've met you so can you bring me up to date with whats been happening so far?"
(Into brief Hx)
81
What age does coeliac disease tend to present? Name one common association?
8-24mnths (can be later if mild)
| Associated with T1DM
82
How should coeliac disease be diagnosed?
Trial gluten free diet
| No longer do jejunal biopsy
83
Name 3 red flags in a paediatric breathlessness Hx?
Apnoeic spells
Cyanosis
Exhaustion
Worsening symptoms
84
Name 3 signs of increased work of breathing to be commented on in a paeds respiratory exam?
Increased RR or tachycardia
Nasal flaring
Grunting
Retractions (under neck/ breastbone)
85
Name 4 things which should be asked for every paeds social history?
Who else is at home?
How is everyone else at home?
Does anyone smoke at home?
Nursery/ school?
86
A child presents with croup like symptoms, what is your main differential to rule out and what should you not do?
What is the causative pathogen?
Acute epiglottitis
- More sudden onset than croup and more severe, higher fever, will be very unwell, caused by HiB (normally vaccinated against)
DO NOT - examine throat
DO - admit urgently to hospital
87
How will an autosomal dominant condition show on a family tree?
Someone in every generation affected
88
How will an autosomal recessive condition show on a family tree?
Unaffected parents > affected child
89
How does an x-linked condition show on a family tree?
M to M transmission (almost exclusively)
90
What is the most common cause of bacterial meningitis if 0-3mths?
Group B Strep
91
What is the most common cause of bacterial meningitis if >3mths?
Streptococcus pneumoniae
| (2nd) Neisseria meningitides
92
What is Duchenne's muscular dystrophy? Name 3 counselling points for an explanation station?
X-linked recessive disorder (so almost only males affected)
Problem with dystrophin genes = muscle necrosis
Normally clumsy as kids, wheelchair by teens, dead by 20's
Associated with Gowers sign (too weak to get up from sitting), Pseudohypertrophy of calves
1/3 have learning difficulties
93
What diagnosis/ management is offered for Duchenne's muscular dystrophy?
Dx: Raised CK > muscle biopsy > DNA test
Physio
Supportive
Genetic counselling
NIV overnight (poor function of resp muscles)
94
What structure should be used for a diabetic pre-pregnancy counselling station?
Intro/ how can I help?
I'm not familiar with your case... brief HX
Why now/ other pregnancies/ are you already trying
Explain risks (worsen mums diabetes, baby = macrosomia, miscarriage, heart defects)
ICE
Make plan, offer short term contraception, start on folic acid
95
When doing diabetic counselling for pre-pregnancy what drug advice should be given?
Metformin (plus insulin if needs better control)
NO- Gliclazide, ACEI, statins
Start folic acid!
96
What is the bishops score, what sort of cut offs are used?
To predict whether labour will begin spontaneously
<5 = very unlikely to start
>7 = labour should commence easily
97
Name two CI to the POP?
Breast ca, undiagnosed PV bleed
98
How should patients be advised regarding taking the POP?
Take at same time every day
If miss dose, take as soon as remembered, if you miss just one day thats ok, miss 2 or more then you need to use additional protection
99
When are the POP and COCP effective from?
D1-D5 in cycle = immediate
Any other time
- POP = within 48hrs
- COCP = within one week
100
How should patients be followed up for the COCP and the POP?
Review in 3 months, then every 12 months
| BP, heigh and weight, smoking check
101
Name the structure of every contraception station? (6)
Intro- how can I help?
What contraception do they know? Considered any others? Why that one?
Short or long term/ good with tablets?
Is there anything specific you'd like to know about X?
CATHLETICS
ICE
Note doesn't protect against STI's!!!
102
Name 3 CI to having a coil inserted?
Current pelvic infection
PID < 3mths
Undiagnosed PV bleed
High STI risk (multiple partners)
103
What are the risks associated with coil insertion?
Expulsion (1 in 20 so coil check at 6 weeks)
Perforation (1 in 10000)
Bleeding
Infection
104
What history should be taken in an emergency contraception station?
Exact timing
Using any contraception at the time?
Was it consensual?
ICE
105
What 5 things should be counselled on in any emergency contraception station?
Choice of medicine and how to take (timeline)
Side effects - nausea, tiredness, headache
Was the sexual
STD risks
Signs of ectopic (abdo pain, vag bleed)
Offer long term contraception
106
What options are available for emergency contraception?
1) Copper coil (within 5 days)
2 - Levonelle (within 72hrs, start other contraception within 2 days)
3- EllaOne (within 120hrs, best options, start other contraception within 5 days)
107
Name 5 contraindications which must be checked before starting the COCP?
How are your periods?
I'll need to check a few things like your BMI (>35) and blood pressure
Smoker > 35
Migraine with aura
Hx of clots in legs or lungs (or strong FHx)
Post-natal <6weeks
Hx Breast or liver cancer
Check they are not pregnant!
108
What advice should women be given regarding taking the COCP?
Take at same time every day
Take for 21 days then 7 day break (can get dummy pill packs)
If miss dose, take as soon as remembered, if you miss just one day thats ok, miss 2 or more then you need to use additional protection for one week
109
Name 4 hormonal side effects of the pills, which pill tends to have worst SE's?
Weight gain, acne, mood changes, headache < long term
Breast tenderness and intermittent bleeding < tends to resolve in 3 months
COCP tends to be worse
110
COCP increases your risk of (A) and decreases risk of (B)
A- Breast and VTE/ HTN
| B - Endometrial and ovarian
111
How should an ectopic pregnancy be explained to a patient?
Intro- How can I help?
SPIKES
(What, why, consequences, management)
- Don't forget to say risk of death!
112
What are the three management options for ectopic?
Low risk - Expectant (HcG <200, mass <3cm)
Med risk- Single dose IM methotrexate
- Do HCG on D4 and D7 (15% decrease)
High risk- Salpingectomy
113
What 4 factors should a patient about to undergo a salpingectomy be counselled on?
```
GA and laproscopic
ICE - find out specific concerns
No decreased risk of fertility
Can try again straight away
10% risk of future ectopic so needs USS @7wks
```
If no other tube/ other fertility reasons can consider salpingectomy
114
Name 5 symptoms of menopause?
```
Hot flushes
Night sweats
Vaginal dryness
Poor sleep
Low mood/ anxiety
Low sex drive
No periods (for 12 months)
```
115
What are the different types of HRT and when should each be prescribed?
Cyclical - If LMP <1yr ago
Continuous - If LMP >1yr ago, or 2yrs if premature failure
Oestrogen only - Given only to those who don't have a uterus!
116
What modes can HRT be delivered by? (3)
Patch, tablet, cream, pessaries etc.
117
Name 6 contraceptive options?
```
Mirena coil
Copper coil
COCP
POP
Implant - lasts 3 years
Weekly patch
Depot injection - 3 monthly
Condoms
```
118
What are the three most common post-partum mental health conditions, when do they each occur?
```
Baby blues (60%) : D3-D7 - Support + reassure
Post-natal depression (10%) : 1-3mths - S+R, CBT, sertraline if severe (safe for breastfeed)
Puerperal pyschosis (0.1%) : 2-3wks : Admit to hospital, 20% chance of reoccurance
```
119
What are your top 5 differentials for menorrhagia?
```
Dysfunctional uterine bleed (60%)
Fibroids - look for urine/ constipation symptoms
Cervical or endometrial polyps
Bleeding disorders i.e. Von Willibrands
Thyroid disease
```
120
What 5 questions should be asked about all bleeding from the vagina in PC/HPC?
```
Timing
- Onset (acute of gradual + when)
- Duration (intermittent or continuous)
- Progression
Bleed
- Amount
- Clots
- Pain
- Urinary or bowel symptoms
```
121
What are the first three lines of treatment for fibroids?
1) COCP/ transexamic/ mefanamic
> If no success then TVUS
2) GnRH agonist (leuprolein)
3) Myomectomy
122
Which 7 areas should be covered in an infertility hx?
How long trying? Reassure 80% in one year, 90% in 2 years
Takes two to make a baby so need to ask about you and your partner - do either have children already?
Intercourse (How often/ methods/ contraception)
Gynae Hx (MOSC)
Medical Hx (Bleeding, pain, dysparenunia - PCOS and endometriosis symptoms)
Weight/ smoking/ alcohol
123
What does the acronym PISS WARD F stand for?
```
P- pre existing medical conditions
I- Intercourse (frequency, method)
S- Smoking
S- Smears
W - Weight
A - Alcohol
R - Rubella
D - Drugs
F - Folic Acid (400mcg)
```
124
Name 5 differentials for infertility?
```
Unknown cause (25%)
Ovarian - an-ovulation i.e. PCOS, prem ovarian failure
Tubal/ uterine disoders - PID/ endometriosis
Male factor
```
125
Name 5 risk factors for miscarriage?
```
20% of all pregnancies!
Previous miscarriage
Alcohol
Drugs
Smoking
Diabetes
Increase age
```
126
What investigations should be done for all miscarriages?
TVUS + hcG (confirm if complete or incomplete)
| - Rule out ectopic
127
What are the management options of an incomplete miscarriage? (4)
Bereavement counselling!!!
1) Expectant - preg test in 3 weeks
2) Medical - mifepristone + mifeprostol 48hrs later as pessary
3) Surgical - under LA, tube hoover into cervix
128
What acronym is used to remember gynae histories?
```
MOSC
M- Menstrual (LMP plus details)
O- Obstetric
S - Sexual
C - Contraception + cervical smear
```
129
What acronym is used to remember obs histories?
```
WIMPP
W- Weeks, first baby?
I - Issues (Apppointments, scans, health)
M - Movements (refer at 24 wks)
P - Previous pregnancies (+outcomes)
P - PMHx/DHx/SHx
```
130
What acronym is used to remember sexual histories?
```
SEX CASP
S- Sexually active?
Ex- Partners (number and M/F)
C - Condoms and contraception
A - Activites (Vag, oral, anal)
S - STI's
P - Paid for/ same sex/ abroad (high risks)
```
131
Name 5 risk factors for prematurity?
Before:
Multiple pregnancy/ Overweight/ Diabetes/ Fertility Tx
During:
Infection/ Pre-eclampsia / Polyhydramnious /Placenta praevia
132
What is the structure of all obstetric stations which require an explanation? (4)
Intro + how can I help?
I'm not familiar with your case... how's pregnancy been so far... Brief Obs Hx (WIMPP) including PMHx etc.
SPIKES for topic explanation
Summary, their choice, give leaflet
133
What risks regarding prematurity should parents be counselled on?
May need to go to NICU
Need help with breathing/ feeding/ staying warm
Born after 28weeks (80% survive)
Increased risk future birth of prem
134
How should you counsel a woman regarding breast screening (structure)?
How can I help?
Any specific concerns?
Explain pro's and con's
Explain process
135
Name 4 risk factors for developing candidasis?
Diabetes
Pregnancy
DHx - Antibiotics/ steroids
Immunosuppresion
136
What are your top 5 differentials for a post-coital bleed?
```
Infection
Cervical ectropion (Increased risk with COCP)
Atrophic
Cervical/ endometrial polyp
Cervical cancer
Trauma
```
137
What are your top 5 differentials for intermenstrual bleeds?
```
Idiopathic (50%)
Hormonal (increased risk if on pill)
Polyps
PID (pain/ dysparenunia)
Fibroids
```
138
What management steps do you undertake for a vaginal bleed - including referal? (5)
Refer (over 45, mass, abnormal cervix, high cancer risk)
Examination
Pregnancy test, swabs for STI's
FBC and TFTs, clotting
TVUS
139
What acronym is used to interpret a CTG?
DR C BRAVADO
Dr- Define risk (Diabetes, HTN, multip, previous etc.)
C- Contractions (in 10 mins)
Bra- Baseline rate (110-160)
V - Variability (Normal 5-25)
A- Accelerations (normal)
D- Decelerations (variable are normal if <90mins)
O - Overall (reassuring, non-reassuring or abnormal)
140
Name three causes of a fetal tachycardia on a CTG?
Fetal hypoxia
Chorioamnionitis
Fetal or maternal anaemia
141
Name three causes of a fetal bradycardia on a CTG?
Cord compression
Cord prolapse
Epidural
142
Name the most common cause of late deceleration's on a CTG?
Fetal hypoxia and acidosis
| Can be from Pre-eclampsia or maternal hypotension
143
How do you investigate late deceleration s on an CTG?
Do FBS
| If acidosis then do c-section
144
What are the key steps in a vasectomy explanation station? (7)
Intro - how can I help?
History- Why now, previous children, brief PMHx
Options- how much do you know? Others considered?
Concerns
Explain procedure
Empathy, give time to make decision
S: Leaflet
145
A patient asks you to explain a vasectomy to him, name 5 points you'd counsel on?
Done under LA as a day case
Will still ejaculate as normal
Test 12 wees post-procedure to check effectiveness
1 in 2000 failure rate (very small)
Very small risks of bleeding and infection with procedure
Make sure they've thought it through and won't regret it! Reversal is not always available on the NHS and success rates aren't great
146
Name 5 parts of a primary ammenorrhoea Hx?
```
(No menses by 14)
Other secondary sexual characteristics
Family menses timing
HPC: Pain (cyclical), discharge
PMHx, DHx (contraception)
SHx (Eating, stress, exercise)
```
147
A 16 year old girl presents with primary ammenorrhoea, what's the most likely cause and how should she be counselled?
Likely constitutional delay
- Periods are last thing to develop
If all other secondary sexual characteristics are normal then reassure.
148
What are your top three differentials for primary ammenorrhoea?
Consitutional delay
Imperforate hymen
Hyperprolactinemia (hypothyroid/ pituitary tumour)
149
What investigations (4) would you do for primary ammenorrhoea?
HcG (rule out pregnancy)
FSH/ LH < pituitary tumour causing hyperprolactinaemia
TFT < hypothyroid
Prolactin
150
What are your top 5 differentials for a secondary ammenorrhoea?
Pregnancy, lactation < Always rule this out!
Menopause or premature ovarian failure
PCOS (acne, alopecia, obesity) < very high LH
Post-contraception
Thyroid disease < weight gain, lethargic, constipation
Weight loss/ cushings < Low BMI
151
What investigations (4) would you do for secondary ammenorrhoea?
1) HcG < rule out pregnancy
2) FSH+LH < Raised if POM, low if hypothalamic cause
3) Prolactin < raised if pituitary tumour
4) TFT < hypothyroid
152
Name 4 lines of management options for endometriosis?
1) Do nothing (30% get better, 40% get worse)
2) Paracetamol, NSAIDS, codiene
3) COCP or mirena coil
4) INVESTIGATE < DIAGNOSTIC LAPROSCOPY (see and treat approach)
5) Hysterectomy
153
What are the complications of a see and treat laproscopy for endometriosis? (4)
General anaesthetic
Adhesions in pelvis (stuck together can cause problems)
Infection
50% reoccurance in 5 years
154
Name 5 symptoms of endometriosis?
```
Cyclical pain and other pain
Dysparenuina
Heavy periods
Pain after going to the the toilet
Sickness, constipation, diarrhoea
Problems getting pregnant
```
155
Name two protective/ relieving factors for endometriosis?
Multiparity
| COCP
156
What are the Rotterdam criteria?
Diagnosis of PCOS needs 2/3
1- Oligomenorrhoea (<9/yr)
2- Polycystic ovaries (>12 follicles or >10cm3)
3- Clinical/ biochemical hyperandrogenism (alopecia, acne, hirsutism)
157
What are your firstline investigations if suspecting PCOS?
Pelvic US (for cysts)
Gonadotrophins (FSH/ LH) < normal in PCOS, however very very high can indicate PremOvarianFailure
TFT (exclude thyroid cause)
Glucose tolerance test (assess insulin resistance)
158
How should PCOS be managed? (6)
Advise on complications (weight, CHD, infertility, cancer, T2DM) - can't be cured but tx symptoms
1) COCP or IUS (reduce risk endometrial cancer)
2) Orlistat (help weight loss)
3) Metformin (if insulin resistance problems)
4) Co-cyprindol (for hirsuitism or acne)
5) Clomifene (for fertility)
159
Name 5 complications of PCOS?
```
Weight gain (dyslipidaemia)
T2DM (insulin resistance)
Endometrial cancer (lack of bleeds)
CVD (due to weight, sugars etc.)
Infertility
```
160
What are the four most common causes of PPH (in order)?
Tone - uterine atony
Tissue - retained placenta
Trauma - eg. from operative delivery
Thrombin - Coagulopathies
161
Namw 5 risk factors for PPH?
```
Previous PPH
Placenta praevia (12x)
Retained placenta (4x)
Episiotomy/ operative delivery
Multiple pregnancy
Induction of Labour
Big baby/ obese mother
Fibroids
```
162
Name 4 complications of PPH
```
Hypovolemic shock
AKI
DIC
Sepsis
Death
```
163
What are your 7 management steps of a PPH
1) ABCDE + emergency button to get team in
2) Uterine rub
3) Bimanual compression
4) Oxytocin/ ergometrine
5) Misoprostol or carboprost
6) Ballon tamponade/ suturing in theatre
7) Bilateral uterine artery ligation/ hysterectomy
164
What questions should be asked about in a PMB hx?
O- When did it start?
C - Heavy/ light
R
A - Pain, dryness, dysparenunia, Postcoital bleed,
T- Has it happened before? Getting better or worse?
MOSC - RF's (early menarche, nulliparious, late menopause)
- RF's not in MOSC (PCOS etc.)
165
What are your top 5 differentials for a PMB?
```
Atrophic vaginitis
HRT use
Endometrial hyperplasia
Endometrical ca
Cervical cancer
Cervical/ endometrial polyp
```
50% are idiopathic!
166
What percentage of women will experience a PMB, what percentage of these are cancer?
Up-to 10% all women experience PMB
Of these 1 in 10 will be endometrial cancer
(This should be explained when doing the 2ww)
167
What is the first line treatment for endometrial cancer?
Hysterectomy with bilateral salpingoophrectomy
+/- radio/chemo is stage II/III/IV
(if fertility needed then do surgical excision and progesterone tx)
168
Name 5 risk factors for endometrial cancer
```
Increasing age
Early menarche
Late menopause
Nulliparity
Late age of first child
Bottle feeding
Diabetes
PCOS
Tamoxifen use
```
169
How should a woman be counselled for Hysterectomy with bilateral salpingoophrectomy?
Removal of womb, ovaries, fallopian tubes and cervix
Need GA
5 days in hospital, 6-8 weeks recovery time
Risk: Bleeding, infection, damage to bladder or bowel
WILL go through menopause if hasn't already
170
What symptoms are common with fibroids?
Heavy periods
Abdo pain
Increased wind and constipation
Pain during sex
171
What are you first three management steps for fibroids?
1) Nothing - will improve during menopause so can leave
2) COCP, transexamic or mefanamic acid
3) Leuprorelin or mifepristone
4) Myomectomy or hysterectomy
172
Name 3 complications of fibroids in pregnancy?
IUGR
PPH
Prematurity
173
What are fibroids, what age do the affect and what do they normally grow in response to?
Non-cancerous growths of muscle/ fiberous tissue
Affect 15-50 (Rf's all oestrogen exposure)
Grow in response to oestrogen
174
What are polyps and what symptoms do they cause?
Overgrowth of the womb, most not cancerous but can become precancerous then cancerous
Syx: Heavy bleeding, irregular bleeding, IMB, PMB
175
How are polyps investigated and treated?
I: Hysteroscopy
Tx: Hysteroscopy under LA or GA
176
What are the 5 steps to conducting a home birth counselling station?
Intro
1) Why do they want this and ICE
2) Take brief medical Hx (determine risk)
3) Explain it's their choice, however you are there to advise
4) Discuss pro's and con's
5) Offer options (middle ground = midwife led unit)
177
What are the pros (1) and cons (3) of a home birth?
Pro- More relaxing for mother
Con-
1) Can't access drugs/ equipment if something goes wrong
2) Can't have epidural if wants one
3) Can't always get a doctor to you in time if needing help
(Birth centre compromise)
178
What are the 5 steps to conducting a breech counselling station?
Intro
1) What do they know so far (P)
2) ICE - what do they want to know
3) Explain breech and draw picture
4) Explain risks
5) Explain options (ECV-50% work so C-section is backup)
6) Ask mum what she'd like to do
179
What is the management of a breech presentation for which ECV is failed at 38 weeks?
Deliver by c-section at 39 weeks
180
Name three counselling points for an ECV
Takes 15mins, some drugs to soften uterus
Very safe, rare complication PROM, abruption or badycardia - baby monitored all the way through
Stay for an hour or so to be monitored, return in one week to double check
50% success rate
181
Name 2 risks of a breech delivery?
Cord prolapse
= Oxygen not delivered
= cerebral palsy, death
Risks of damaging mum (trauma)
182
What order should a breast vs. bottle counselling station be done in?
1) Intro
2) Thoughts on preference? Heard from other mums? Why?
3) It's always your choice but I can talk you through pro's and cons
4) Any specific questions?
5) Pros vs. cons
6) Their decision
183
Name 3 pro's for bottle feeding over breast?
More convenient - anyone can feed
Need feeding less often
Medically might not be able to produce enough
184
Name 5 pro's for breast feeding over bottle
WHO and NHS advised (exclusive to 6mths, ween at 1yr)
All nutrients needed - less likely to have diarrhoea
Cheaper
Better for babies immune system
Can prevent asthma, allergies and obesity
Helps mum and baby bond
Helps mum lose weight
Reduces mums chance of some cancers
185
How should pre-eclampsia be managed?
Admit all women with pre-eclampsia
1) Start labetalol
2) If severe risk start magnesium sulfate
3) Three times weekly bloods (looking for HELLP) and 4x daily BP's
Only definitive Tx is delivery, do any time after 37 weeks (give steroids if doing early or to mums likely to delivery early)
186
Name 5 risk factors for pre-eclampsia. What action should be taken if risk factors are present?
```
Previous pre-eclampsia
Family hx
Diabetes
Kidney disease
Obesity
Over 40
Lupus
```
If >2 RF's then give Aspirin from 12weeks
187
How many pregnancies are affected by pre-eclampsia?
1 in 20
| 1 in 100 severely
188
Name 4 complications of pre-eclampsia?
Eclampsia (seizures > give magnesium sulphate)
HELLP (haemolysis, elevated liver, low platelets)
Increased risk of stroke, liver and renal disease
Inreased risk of pre-term labour and stillbirth
189
What is hyperemesis gravidarum?
70% of women experience morning sickeness. For 1% this is very severe and called HG
190
Name 3 symptoms of hyperemesis gravidarum?
```
N+V (some upto 50x/day)
Low BP (postural hypotension especially)
Dehydration
Ketosis
Weight loss
```
191
How do you manage HELLP syndrome?
1) IV labetolol
2) Magnesium sulphate
3) IV dexamethosone
192
When do morning sickness and HG typically resolve by?
Morning sickness resolves by 14weeks
HG by 20 weeks although can continue to term
193
Name some complications for mum and baby of hyperemesis gravidarum
```
Doesn't harm baby!
Maternal weight loss may lead to small baby
Maternal depression
Maternal exhaustion
Likely to reoccur in future pregnancies
```
194
How is hyperemesis gravidarum treated? (6)
R- Refer if severe dehydration or ketosis
C - Advice on diet
M- Cyclizine or promethasine for sickness
+ Thiamine, LMWH and fluid/ nutrition support
2nd line - add steroids
195
What is TV and what is your first line treatment for?
```
Trichomonas vaginalis (parasite)
Causes smelly, yellow/green, frothy discharge
Tx: Metronidazole
```
196
What is BV and what is the first line treatment?
```
Bacterial vaginosis (not STI)
Fishy, thin white discharge
Tx: 7 days of oral metronidazole
```
197
What sort of bacteria is gonorrhoea? What is the incubation period and the first line tx?
Gram negative diplococci
2-5 days incubation period
Ceftriazone 500mg IM and azithromycin stat (also helps cover co-existing chlamydia)
198
How is herpes treated?
Oral acyclovir
199
What structure should be used for a vaginal discharge hx?
COCP-DBT
(Colour, odour, consistency, pain, duration, blood, timing)
Plus MOSC (menstrual, obs, sexual, contraception)
200
What are the steps to reporting a chest x-ray?
Patient details (Name, date)
Quality (Projection, exposure, inspiration, rotation)
Obvious abnormality
ABCDE
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