Last minute wrongness Flashcards
(467 cards)
1
Q
What are symptoms of digoxin toxicity? (5)
A
- GI disturbance (N+V, abdo pain)
- Dizziness
- Confusion
- Blurry/yellow vision
- Arrhythmias
2
Q
What are possible s/e of anti-cholinergic medications?
A
- dry eyes
- constipation
- dry mouth
- urinary retention
- hypotension (postural)
- delirium
- hypothermia
3
Q
What is the definition of postural hypotension?
A
A drop over 20 mmHg in systolic BP, and over 10 mmHg diastolic
4
Q
What dementia may present with fluctuating cognition?
A
Lewy Body dementia
5
Q
What scoring system is used in grading pressure ulcer risk?
A
Waterlow score
6
Q
What medications are associated with a significant increase in mortality in dementia patients?
A
AntiPsychotics
7
Q
What validated questionnaire can be used to confirm frailty in an individual?
A
PRISMA-7
7
Q
What is a GP screening tool for dementia?
A
GPCOG
8
Q
What medications should be avoided in people with dementia?
A
Anticholingerics (TCAs, amitriptyline), Benzos, steroids
9
Q
What drug class is contraindicated for patients with Parkinsons? How might this affect delirium treatment?
A
Anti-psychotics. Instead, give benzo
10
Q
What is the first line management of acute delirium if medical interventions are required?
A
IM or oral haloperidol
11
Q
What management should be considered for patients with type 1 diabetes mellitus and a BMI >25?
A
Metformin in addition to insulin
12
Q
What additional blood tests are done within the confusion screen (other than just FBC)?
A
TSH, B12, Folate, glucose
13
Q
What is the long term prophylaxis of cluster headaches?
A
Verapamil
14
Q
What cranial nerve is responsible for the corneal reflex?
A
5
15
Q
What cranial nerve is responsible for a downward gaze and vertical diplopia?
A
CN IV
16
Q
What cranial nerve is responsible for a loss of gag reflex?
A
CN X
17
Q
In medication overuse headache, what manner should simple analgesia, triptans, and opioid analgesia be withdrawn?
A
Simple analgesia + triptans: stop abruptly
Opioid analgesia: withdraw gradually
18
Q
What is the most common complication following meningitis?
A
Sensorineural hearing loss
19
Q
What is the standard target time for thrombectomy in acute ischaemic stroke?
A
6 hours
20
Q
What is the management for a patient who presents to their GP within 7 days of a clinically suspected TIA?
A
300mg aspirin immediately + specialist review within 24 hours
21
Q
What is the next steps for bruising in a non-mobile infant?
A
Same day paediatric assessment
22
Q
What are features which should prompt admission in croup?
A
- <6 months
- known upper airway abnormalities
- frequent barking cough
- easily audible stridor at rest
- chest wall retraction (at rest)
- significant distress, agitation, or lethargy, or restlessness
- tachycardia
23
Q
What is the tx and dosage for management of croup?
A
Dexamethasone (0.15mg/kg)
24
What is the first line treatment for a breastfed baby with GORD? What is first line in a bottle fed baby?
Alginate (Gaviscon) for breast fed. Bottle fed: thickened formula
25
What are the criteria for immediate request for CT scan of the head in children?
- LOC >5 mins (witnessed)
- amnesia >5 mins
- abnormal drowsiness
- three or more discrete episodes of vomiting
- suspicion of NAI
- seizure with no hx of epilepsy
- GCS <14, or if less than <1 year <15
- sign of open or depressed skull injury
- sign of basal skill fracture
- focal neurological deficit
- dangerous mechanism of injury
26
What are the most common presentation of neonatal sepsis?
Grunting and other signs of respiratory distress
27
What rate should chest compressions be done for infants and children in paediatric BLS?
100-120/min
28
At what age do women always get a 2 week wait referral for a breast lump?
>30 years
29
What is the criteria for CT head within 1 hour in adults?
- GCS <13 on initial assessment
- GCS <15 at 2 hours post injury
- suspected open or depressed skull fracture
- any sign of basal skull fracture
- post trauma seizure
- focal neurological deficit
- more than 1 episode of vomiting
30
What are indications for a head CT within 8 hours of head injury (adults)?
- >65 years
- any hx of bleeding or clotting disorders (including anticoagulants)
- dangerous mechanism of injury
- >30 minutes amnesia of events
31
What is the most common cause of chronic pancreatitis?
Alcohol excess
32
When can the COCP be started after post partum, and why?
After 21 days due to risk of VTE. Will require additional contraception for 1st 7 days
33
When do women requires contraception after giving birth?
Day 21
34
What is the most common adverse effect of the POP?
Irregular vaginal bleeding
35
What is the requirements for expectant management of an ectopic pregnancy?
Unruptured embyro, <35mm, no heartbeat, asymptomatic, B-HCG <1000IU/L and declining
36
What is the advised management for post menopausal women with atypical endometrial hyperplasia?
Total hysterectomy with bilateral salpingo-oopherectomy, due to risk of malignant progression
37
What is the management of endometriosis?
- first line: NSAIDs/paracetamol
- 2nd line: COCP or progestogens
- 3rd line or if fertility is concerned: GnRH and surgery.
- if trying to conceive: laparoscopic excision or ablation of endometriosis plus adhesiolysis
38
What is the typical presentation of a ruptured ovarian cyst?
Sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity
39
When does HRT increase the risk of breast cancer?
When there is an added progestogen
40
What cancers does HRT increase the risk of?
Endometrial and breast
41
Which form of HRT does not increase the risk of VTE?
Transdermal
42
What medical management is given for women with hyperemesis gravidarum that have been admitted to hospital?
Normal IV saline plus added potassium
43
What is the first line management of hyperemesis gravidarum?
Anti-histamines: oral cyclizine or promethazine
44
What is the criteria for referral of N+V in pregnancy?
- continued N+V and unable to keep down any oral antiemetics
- continued N+V with ketonuria and/or weight loss greater than 5% (with tx of oral antiemetics)
45
What is the triad of hyperemesis gravidarum?
5% pre-pregnancy weight loss, dehydration, electrolyte imbalance
46
What crown rump length + no heart beat is diagnostic of a miscarriage?
Crown rump length greater than 7mm
47
What three features are needed for a diagnosis of PCOS?
- infrequent or no ovulation
- clinical or biochemical signs of hyperandrogenism (hirsutism, acne, elevated levels of total or free testosterone)
- polycystic ovaries on ultrasound (>12 follicles or increased ovarian volume >10cm3)
48
What is the most common cause of post menopausal bleeding?
Vaginal atrophy
49
What is the management for any woman with known placenta praevia who goes into labour?
Emergency c-section
50
What is the SSRIs of choice in breastfeeding women?
Sertraline or paroxetine
51
What should be given in P-PROM?
10 days erythromycin to prevent chorioamniotitis, and antenatal corticosteroids
52
What are the symptoms of mania vs hypomania?
- Mania: at least 7 days, severe functional impairment, psychotic symptoms
- Hypomania: <7 days, can be high functioning, less severe
53
What can precipitate lithium toxicity?
Dehydration, renal failure, drugs (thiazide, ACE-I, ARBs, NSAIDs, metronidazole)
54
What are the features of lithium toxicity?
Coarse tremor, hyperreflexia, acute confusion, polyuria, seizure, coma
55
What are the adverse effectsof lithium?
N+V, diarrhoea, fine tremor, nephrotoxicity (nephrogenic diabetes insipidus), hypothyroidism, ECG (t wave flattening/inversion), weight gain, idiopathic intracranial hypertension, leucocytosis, hyperparathyroidism
56
What is an advance statement?
An advance statement is a record of someone's preferences and values regarding future care if they were to become unwell and unable to make or communicate decisions about their care. An advance statement can be made verbally. It is not legally binding but must be taken into account during a best interests meeting.
57
What antibiotics lower seizure threshold?
Ciprofloxacin and other quinolones
58
What important interactions does SSRIs have?
NSAIDs (prescribe PPI), warfarin/heparin (avoid, prescribe mirtazapine), aspirin, triptans (serotonin syndrome, avoid)
59
What SSRI has the highest incidence of discontinuation symptoms?
Paroxetine
60
When stopping an SSRI, how long should the dosage be reduced over?
4 weeks, with the exception of fluoxetine
61
What are risk factors for falling in the elderly?
- Previous fall
- lower limb muscle weakness
- visual problems
- balance/gait disturbance
- polypharmacy
- incontinence
- >65
- fear of falling
- depression
- postural hypotension
- arthritis in lower limbs
- cognitive impairment
62
What medications cause postural hypotension?
Nitrates, diuretics, anticholinergics, antidepressants, b-blockers, l-dopa, ACEI
63
What brain trauma may cause fluctuating consciousness?
Sub-dural
64
What is alogia? What is it associated with?
Paucity of speech. Seen as a negative symptoms in Schizophrenia
65
What test should be done after treatment of a UTI in pregnant women?
A test of cure MSU
66
How long should a DVT be treated for in a patient with active cancer?
6 months (DOAC)
67
What are the first line abx in COPD?
Doxycycline, clarithromycin, amoxicillin
68
What is the first line treatment for heartfailure? And the 4 pillars?
1st line: beta blocker, ACE-I. 4 pillars: add mineralocorticoid (spironolactone) + SGLT-2 inhibitors
69
What are examples of SGLT-2 inhibitors?
Canagliflozin, dapagliflozin, empagliflozin
70
What are the rules for missing pills of COCP, in regards to UPSI + extra protection?
- 1 missed pill: take both, no additional contraception
- 2 missed pills -> week 1; emergency contraception if sex in pill free week or week (+7 days condoms), week 2; no emergency contraception (+7 days condoms), week 3; finish pack + omit pill free week (+7 days condoms)
71
What are possible s/e of statins, and what can be measured?
- myalgia: reported as cramps (measure serum creatinine kinase: if x5, stop statins)
- liver impairment (measure LFTs)
72
What are important contraindications to statins?
Pregnancy, macrolide antibiotics (erythromycin, clarithromycin)
73
What is the dosage of statins for primary and secondary prevention?
- primary: 20mg
- secondary: 80mg
74
What are two drugs that can be used in smoking cessation? What are their MoAs?
Varenicline (partial acetylcholine receptor agonist) and buproprion (anti depressant)
75
What smoking cessation therapy can people with epilepsy not recieve?
Buproprion: reduces seizure threshold
76
Where should pulses be checked for in paediatric BLS?
Infant: Brachial and Femoral
Child: Femoral
77
When can a child with Scarlet Fever return to school in regards to abx?
24 hours after 1st antibiotic dose
78
What prophylactic medication is often given to children with sickle cell anaemia who have had a splenectomy?
Penicillin
79
What are risk factors developmental dysplasia of the hip?
Female, breech at 36 weeks, first pregnancy, prematurity, oligohydramnios, macrosomic baby
80
What investigation is done for duodenal atresia, and what is seen?
Double bubble sign on abdominal chest xray
81
What congenital cardiac conditions are cyanotic?
Tetraology of Fallot, Transposition of the great arteries, tricuspid atresia, truncus arteriosus,
| 4T's
82
What drugs are high risk for Stevens-Johnson syndrome?
Penicillin, sulphonamides, AEDs, allopurinol, NSAIDs, COCP
83
What are indications for antibiotic prescription in otitis media?
Symptoms lasting more than 4 days or not improving, systemically unwell, immunocompromised, <2 years + bilateral, perforation or discharge
84
What is first line management of otitis media?
Amoxicillin = 1st line, if allergy given erythromycin or clarithromycin
85
What are causes of jaundice in the first 24 hours?
Rhesus haemolytic disease, G6PD deficiency, ABO incompatability, toxoplasmosis, syphilis, rubella, CMV, herpes, hepatitis
86
What are causes of prolonged jaundice?
Biliary atresia, hypothyroidism, UTI, breast milk jaundice, prematurity, TORCH infections (CMV, toxoplasmosis)
87
# Remember to consider indications for bone marrow biopsy
What are the investigations done for ITP in children?
FBC (demonstrate isolated thrombocytopenia), blood film. Do bone marrow biopsy if abnormal features (lymphadenopathy, low/high WCC, failure to respond/resolve)
88
What murmur is heard in tetralogy of fallot and why?
Ejection systolic due to pulmonary stenosis
89
What is the antidepressant of choice in depression for a patient with bipolar?
Fluoxetine
90
What is the time frame and typical symptoms of neuroleptic malignant syndrome?
Pyrexia, muscle rigidity, autonomic lability (HTN, tachycardia), agitated delirium with confusion, raised CK (can lead to AKI). Starts within hours/days
| Slower onset than serotonin syndrome
91
How long should a patient have symptoms of PTSD for a diagnosis?
1 month
92
What are adverse effects of sodium valproate?
Teratogenic (neural tube defects), nausea, weight gain, alopecia, ataxia, tremor, hepatotoxicity, pancreatitis, thrombocytopenia, hyponatraemia
93
What SSRI is proven to be safest post MI?
Sertraline
94
What SSRIs can lead to prolonged QT syndrome?
Citalopram (+ escitalopram)
95
What SSRI has a particularly increased risk of congenital malformations?
Paroxetine
96
What is the management for OCD?
If medication required, SSRI are 1st line. 2nd line is clomipramine (TCA)
97
What PHQ-9 score divides mild and severe depression?
16
| 16: not so young, sweet + dancing queen !
98
What electrolyte disturbances are seen in refeeding syndrome?
Decreased phosphate, magnesium and potassium (U wave on ECG!)
99
What is the DSM-5 criteria for depression?
5 or more symptoms present in a 2 week period nearly every day, Must include 1 of low mood or anhedonia
100
What management should be given for women with premature rupture of membranes?
10 days of oral erythromycin, antenatal corticosteroids
101
What hormone should be measured and when for fertility?
Serum progesterone, 7 days before next menstrual period (often day 21 in a 28 day cycle)
102
What act currently dictates abortion laws?
1967 Abortion act, 1990 update
103
At what size would a fibroadenoma be excised?
3cm or more
104
What are protective factors for endometrial cancer?
Multiparity, COCP, smoking
105
What management should be taken for all women >55 years presenting with post menopausal bleeding?
Suspected cancer pathway: TVUS, and if abnormal endometrial thickness, then hysteroscopy with endometrial pipelle biopsy
106
What is normal endometrial thickness?
<4mm
107
What is the management of endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-opherectomy. High risk patients: postoperative radiotherapy
108
What is the management for dysmenorrhoea?
1st line: NSAIDs such as mefenamic acid
2nd line: COCP
109
What is the most common ovarian tumour?
Most are epithelial, and majority are serous carcinomas
110
What investigation should be carried out for all complex ovarian cysts?
Biopsied for malignancy
111
What is the commonest ovarian cyst?
Follicular
112
What is the likely dx for a woman with low grade fever, pain, and vomiting in early pregnancy, who have a palpable uterine mass?
Fibroid degeneration
113
What makes up the risk malignancy index in ovarian cancer?
US findings, menopausal status, CA125
114
Who should take high dose folic acid in pregnancy?
- obese (>30 kg/m2)
- taking AEDs
- coeliac disease
- diabetes
- partner or woman has hx of neural tube defects
115
What is the normal and increased dose of folic acid in pregnancy, and when should it be taken until?
400mcg = normal, 5mg increased dose. Take until 12 weeks
116
What are risk factors for group B streptococcus infection in pregnancy?
Prematurity, prolonged rupture of the membranes, previous sibling GBS infection, maternal pyrexa
117
What is the antibiotic choice for group b strep in pregnancy?
IV Benzypenicillin
118
Which women should be given GBS treatment in pregnancy?
- pyrexia (>38 degrees celsius) in labour
- preterm labour
- previous baby with early or late onset GBS
119
At what BP level should pregnant women be admitted?
>160/110mmHg
120
# Non pregnant, early pregnancy, late pregnancy, after childbirth
What are the cut off levels for tx for anaemia in pregnancy?
Non pregnant: 115
Early pregnancy: 110
Late pregnancy: 105
After birth: 100
121
What do the different Bishop's Scores indicate?
<5: labour unlikely to start without induction
>8: cervix is ripe
122
How does Bishops score guide two pathways of labour?
<6: vaginal prostaglandins or oral misoprostol
>6: amniotomy and IV oxytocin
123
What should be monitored for women given magnesium in pregnancy?
Urine output, reflexes, resp rate + O2 saturations. Respiratory depression can occur (give calcium gluconate)
124
What is the management of simple endometrial hyperplasia without atypia?
High dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
125
What is the age guidances for cervical screening?
- every 3 years aged 24-49
- every 5 years aged 50-64
126
What age is the cut off for premature ovarian failure?
<40 years
127
What is the classic presentation of vasa praevia?
Rupture of membranes followed immediately by (darkred) vaginal bleeding. Fetal bradycardia is seen
128
What are the features of Horner's syndrome?
Miosis (small pupil), ptosis, enopthalmos (sunken eye), anhidrosis
129
When is lumbar puncture C/I?
GCS <9, haemodynamically unstable, active seizures, post-ictal, any signs of raised ICP
130
What tumours most commonly spread to the brain?
Lung, breast, bowel, skin, kidney
131
What is the most common brain tumour in adults?
Glioblastoma
132
What is the most common primary brain tumour in children?
Pilocytic astrocytoma
133
What nerve leads to carpal tunnel syndrome?
Median nerve
134
What level is cauda equina?
L4/5 or L5/S1
135
# ABCDE
What are causes of peripheral neuropathy?
Alcohol, B12 deficiency, Cancer + CKD, Diabetes, Every Vasculitis
136
What type of anaemia is iron deficiency?
Microcytic
137
Which joints does OA typically affect?
Large joints or the small hand joints
138
What type of dementia is associated with motor neurone disease?
Frontotemporal
139
What is DKA tx?
0.9% NaCl at 10ml/kg/hour, insulin 0.1/kg/hr. When glucose is 14 mmol/l, add 10% dextrose at 125ml/kg/hr, and potassium (40mmol/l)
140
What is given for general maintenance fluids?
NaCl 0.9% with 5% dextrose and 10mml/l KCl/ 24 hours
141
How do you calculate replacement fluid?
Replacement = % dehydration * well weight (kg) * 10
142
How do you calculate % dehydration?
((well weight-ill weight)/ well weight)*100, or using mild =5%, moderate= 10%, severe =15%
143
What fluid is used for resuscitation?
0.9% NaCl 10ml/kg over 10 mins. Repeat up to 40ml/kg
144
What is seen on bacterial LP?
Turbid appearance, raised polymorphs (neutrophils), raised protein, decreased glucose
145
Which lung cancer can lead to Cushing's syndrome?
Small Cell Carcinoma
146
What is the management of a stroke patient on warfarin?
Stop warfarin, give IV vitamin K and prothrombin complex concentrate
147
What is target warfarin INR?
2.5
148
What vaccines should be given to people with heart failure?
Annual influenza vaccine, single pneumococcal
149
What is an example of a thiazide like diuretic
Metolazone, indapamide
150
What might be seen if a patient takes statins and clarithromycin at the same time?
Increased CK, can lead to AKI
151
What is Cushing's triad in a head injury?
Hypertension, bradycardia, wide pulse pressure/deep breathing
152
What does GTN do? Physiological impacts (BP/HR)
Vasodilation. Causes hypotension, tachycardia (leads to headache)
153
What is the treatment of Meniere's disease?
Buccal or IM prochlorperazine
154
What hormone does ovulation strips track?
LH levels
155
What can be done to 100% confirm a dx of angina?
CT coronary angiography
156
What is the most common cardiac change in PE?
tachycardia
157
What antibiotics interact with alcohol?
Metronidazole
158
What are signs of poor asthma control? (3)
Reduced effectiveness of bronchodilators, reduced exercise tolerance, waking up with asthma symptoms x3 weekly
159
What strains of HPV cause genital warts?
6 and 11
160
What is a key differential in children who are HIV positive with lymphadenopathy?
Kaposi's sarcoma
161
When is the heel prick test done?
Days 5-9
162
What sensory region does L3 provide?
Anterior thigh
163
What is the inheritance of haemophilia A + B?
X-linked
164
At what age is Perthes observed to until surgery is performed?
6 years
165
What are risk factors for neonatal respiratory distress syndrome?
Prematurity, male sex, diabetic mother, c-section
166
When should a child with an undescended test be reviewed?
3 months
167
What is the cause of Roseola Infantum?
HHV-6
168
What height percentile means children should be reviewed by a paediatrician?
<0.4
169
What is first line investigation for queried reflux nephropathy?
Micturating cystourethrogram, DMSA scan is done later
170
What is the management for a child <3 months with a UTI?
Referral immediately to paediatrician
171
What is the management for a child under 6 months with a UTI?
- first UTI: US within 6 weeks
- recurrent or atypical: within illness US + MCUG
172
What is the management for recurrent UTIs in children (>6 months)
US within 6 weeks
173
What is the management of children with atypical UTIs (>6 months)?
US within illness
174
What is the school exclusion criteria for impetigo, and tx?
Exclude from school until lesions healed. Prescribe topical hydrogen peroxide 1%
175
What should all children with T1DM also be tested for?
Coeliac disease
176
What causes hand foot and mouth disease?
Coxscakie A16
177
What investigation is done for a newborn with queried hydrocephalus?
Ultrasound
178
What is the secondary prevention after a stroke?
Clopidogrel first line (plus dipyridamole). If Clopidogrel not regulated, then aspirin plus modified release dipyridamole
179
What is the management of myasthenia gravis?
Long acting acetylcholinesterase inhibitors: pyridostigmine. Also can add immunosuppression: prednisolone, azathioprine, cyclosporine
180
What is the management of myasthenic crisis?
Plasmanephresis, IV IG
181
What antibiotics can increase the risk of idiopathic intracranial hypertension?
Tetracyclines (doxy)
182
What is the pathophysiology of GBS?
Decreased motor nerve conduction velocity, secondary to demyelination
183
What derm findings are seen in Tuberous Sclerosis (3)
- ash-leaf spots
- shagreen patches
- subungual fibromata
184
What is seen on eye examation, neurofibromatosis vs tuberous sclerosis?
- neurofibromatosis: Iris hamartomas (Lisch nodules)
- tuberous sclerosis: retinal haemorrhage
185
What is the differences on CT in acute vs chronic subdural?
- acute: hyperdense (light)
- chronic: hypodense (dark)
186
What is seen on CT in alzheimers?
Atrophy of cortex + hippocampus
187
What nerve palsy might be seen in raised ICP?
3rd nerve palsy
188
What is first line management for essential tremor?
Propanolol
189
What is the cause of upper bitemporal hemianopia?
Pituitary tumour
190
What is the cause of lower bitemporal hemianopia?
Craniopharyngioma
191
What is seen on neurological examination in B12 deficiency?
Dorsal column affected first: loss of proprioception and vibration sense
192
If a patient is B12 and folate deficient, which should be treated first and why?
Treat B12 deficiency first to avoid precipitating subacute combined degeneration of the cord
193
What is the triad of Vestibular Schwannoma?
Vertigo, hearing loss, tinnitus
194
What imaging is done for diffuse axonal injury?
MRI
195
What is the management of a brain abscess?
3rd generation cephalosporin + metronidazole. Can add dexamethasone if oedema
196
Which reflex is bicep, and which triceps?
Bicep: C5/6
Tricep: C7/8
197
What is Todd's paresis?
Post ictal weakness seen after a frontal lobe seizure
198
What is the stopping regime for AEDs?
Stop if seizure free for >2 years, and stop over 2-3 months
199
What are contraindications to thrombolysis?
Previous intracranial haemorrhage, intracranial neoplasm, SAH, LP within 7 days, active bleeding, pregnancy, uncontrolled HTN
200
What neurological condition is associated with small cell carcinoma?
Lambert-Eaton Syndrome
201
What are first line treatment of neuropathic pain, and an important regime note?
Amitriptyline, duloxetine, gabapentin, pregabalin. Must be given as monotherapy. Tramadol can be used as rescue therapy
202
What is the drug class of oxybutynin?
Anti-muscarinic
203
What is polypharmacy?
A patient taking 5 or more medications daily
204
What must be ruled out as causes of seizures?
Hypoglycaemia and hypoxia
205
What HTN drug MUST be stopped immediately in pregnancy?
ACE-I
206
What are risk factors for gestational diabetes?
BMI >30kg/m2, previous macrosomic baby, previous gestational diabetes, first degree relative with diabetes, family origin with high prevalence
207
What symptoms in early pregnancy would justify an assessment at early pregnancy assessment service?
Pain and abdo tenderness, pelvic tenderness, cervical motion tenderness, bleeding
208
What is the first line management of a woman reporting reduced fetal movements in pregnancy?
- first line: hand held doppler
- if no heartbeat: immediate ultrasound
- if heartbeat: CTG used for at least 20 mins to exclude fetal compromise
209
What is the cutoff for a 'macrosomic' baby?
4.5kg
210
When can same-day delivery be done for pre-eclampsia?
After 34 weeks
211
What are the minimum requirements for managing an ectopic surgically?
>35mm or B-hCG over 5000IU/L
212
What is the pearl index of pregnancy?
The number of pregnancies that would be seen if 100 women used that method for a year
213
What is the test of cure pathway in cervical screening?
individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community
214
What is the management of x1 and x2 inadequate cervical screenings?
x1: repeat at 3 months. x2: colposcopy
215
What is the most common treatment of CIN?
LLETz (large loop excision of transformation zone)
216
What is the management of vasomotor symptoms of menopause?
SSRIs
| Fluoxetine for Flushes
217
What is the time frame for various contraceptives to become effective?
- Instant: IUD
- 2 days: POP
- 7 days: IUS, COCP, injection, implant, IUS
218
What can epidural do to a womans blood pressure?
Decrease
219
When does POP count as a missed dose?
12 hours
220
How long does methotrexate needs to be stopped before pregnancy?
6 months in MEN AND WOMEN
221
When is placenta praevia classically diagnosed, and what follow up would this trigger?
Dx at 20 week scan, rescan at 32 and 36 weeks
222
What causes the whirlpool sign?
Ovarian torsion
223
What is the management of PPH?
- ABCDE
- massage fundus
- oxytocin + prostaglandins + ergometrine
- tamponade with balloon
- B-lynch suture
- sub/total hyesterectomy
224
What cancers does COCP increase and decrease the risk of?
Increase: breast + cervical
Decrease: ovarian + endometrial
225
What Edinburgh post natal depression score indicates management needed?
>13: CBT
226
What scan results + b-HCG levels indicate an ectopic?
b-HCG >1500 and unseen on ultrasound
227
What is the most common cause of encephalitis?
HSV-1
228
What does radial nerve palsy cause?
Wrist drop
229
When is booking clinic?
10 weeks
230
When is the dating scan?
10-13+6 weeks
231
When is anomaly scan?
18-20+6 weeks
232
What are risks of long lie after a fall?
Pressure ulcers, dehydration, rhabdomyolysis, hypothermia
233
What investigations does NICE suggest for all frail adults?
'Turn 180 degrees' test and 'timed up and go' test
234
What cognition test is often used in GP?
6-CIT
235
What is drug management for PTSD?
SSRI or venlafaxine
236
How long is drug detox in the community vs in hospital?
Community: 12 weeks, Inpatient: 4 weeks
237
When should blood tests be done upon starting Clozapine?
1 blood test weekly for 18 weeks, then fortnightly until a year
238
When should lithium levels be check after dose change?
Weekly until stable
239
When stable, how often should lithium levels be checked?
Every 3 months, including renal and thyroid function
240
What levels might be raised in blood tests DKA?
Creatinine and sodium
241
How can gastric and duodenal ulcers be differentiated?
Gastric ulcers: worsened by eating, duodenal: worsened by hunger
242
What is the management of fibroids <3cm?
Same as heavy bleeding pathway
Requires contraception: IUS (1st line), COCP
No contraception: mefanamic acid or TXA (start on first day of period)
243
What can shrink fibroids prior to surgery?
GnRH agonists
244
What surgery can be done to improve fertility for someone with fibroids?
Myomectomy
245
When is a membrane sweep done?
Done at 40 weeks if nulliparous, or 41 if parous
246
What drug is contraindicated in post partum haemorrhage if a woman is asthmatic?
Carboprost
247
What is the primary monitoring concern for SSRIs?
Sodium
248
What is monitored on SNRIs?
Blood pressure: can cause hypertension
249
What should be monitored on clozapine?
WCC + constipation
250
What should be monitored annually for antipsychotics?
BMI + prolactin + HbA1c + FBC + U+Es + LFTs + pulse/BP + ECG
251
What is first line management of GAD?
Sertraline
252
What is second line management for GAD?
Second SSRI or SNRI
253
What is the main worrying electrolyte abnormality if a patient after a long lie has rhabdomyolysis?
Hyperkalaemia from the muscle breakdown
254
What are the main causes of infectious exacerbation of cystic fibrosis?
S.aureus, P.aeuroginosa, H,influenzae
255
What investigation is done for all patients presenting with AKI?
Urinalysis: if no abnormalities, then abdominal ultrasound
256
What are 4 important drugs that have nephrotoxic potential?
ACE-I, ARBs, diuretics, NSAIDs
257
What are the risk factors for osteoporosis?
SHATTERED: steroids, hyperthyroidism, alcohol/smoking, thin (BMI <22), testosterone deficiency, early menopause, renal/liver failure, erosive/inflammatory bone disease, diet (low calcium)
258
What DEXA score indicates osteoporosis?
<2.5
259
What strains of HPV increase risk of cervical cancer?
16, 18, 33
260
What must the crown rump length be to identify a viable pregnancy?
<7mm
261
What is the medical management of miscarriage?
Vaginal misoprostol
| MISO because MISOerable
262
What is the management of tardive dyskinesia?
Tetrabenzene
263
What is the management for acute dystonic reactions?
Procyclidine
264
What is section 135 vs 136?
135: police from home, 136: police from public
265
What is section 5(4) and how long does it last?
Nurse hold for 6 hours
266
What is section 5(2) and how long does it last?
Doctors hold for 72 hours
267
What is the criteria for malignant HTN?
>180/120 mmHg AND retinal haemorrhage/ papilloedema/life threatening symptoms/symptoms of phaeochromocytoma
268
What are the 4 layers of Seedhouses' Ethical Grid?
External considerations, core rationale, deontological layer, consequential layer
| Want to install a DECC in my HOUSE
269
What are the 4 quadrants?
Medical interventions, patient preferences, contextual features, QoL
| My Patient's Quality Care
270
What is the most specific/sensitive marker of rheumatoid arthritis?
Anti-CCP Ab
271
What deformities are associated with RA?
Z-shaped thumb deformity, swan neck deformity, ulnar deviation, boutonierre's
272
What symptoms are associated with Edward's?
Micrognathia (small jaw), low set ears, rockerbottom feet, overlapping fingers
273
What are causes of fetal hydrops?
Severe anaemia (B19, a-thalassaemia, haemorrhage, ABO/Rh incompatability), chromosomal, cardiac issues, chorioangioma, parvovirus
274
What is reassuring baseline + variability in CTG monitoring?
Baseline: 110-160
Variability: 5-25 BPM
275
What is abnormal baseline and variability in CTG monitoring?
Baseline: <100 or >180
Variability: <5 for 50 mins, >25 for 25 mins
276
What are the 4 types of deceleration?
Prolonged, early, late, variable
277
What decelerations indicate umbilical cord compression?
- prolonged: 2-10 minutes, drop 15 BPM
- variable: unrelated to contractions
278
What decelerations indicate hypoxia of the fetus?
Late deceleration after contraction
279
# 6 steps
What is the sequalae of induction of labour?
Membrane sweep -> vaginal prostaglandins (E2) -> oral prostaglandins (misoprostol) -> oxytocin IV -> amniotomy (break waters) -> cervical ripening balloon
280
What is given to paracetamol overdose + over what time?
Acetylcysteine: infused over 1 hour
281
When should a child with otitis media be referred to ENT? (3)
>6 episodes in 12 months, persistent effusion >3 months bilaterally, or >6 months unilaterally
282
What makes up the FEVERPain score?
- fever in past 24 hours
- absence of cough/coryza
- symptoms <3 days
- purulent tonsils
- inflamed tonsils
283
Why should amoxicillin be avoided in tonsilitis?
Can lead to widespread maculopapular rash
284
What is the score interpretation for the FEVERPain score?
0-1: no abx
2-3: delayed prescription
4-5: phenoxymethicillin
285
What is red flags for paediatric constipation?
>48 hours passing meconium, present from birth, ribbon stools, distension
286
What is the difference between HSP and ITP?
HSP has more systemic symptoms: fever, abdo pain, polyarthritis, kidney involvement
287
What conditions may cause a pan-systolic murmur?
VSD, mitral regurgitation, tricuspid regurgitation
288
What conditions may cause a ejection systolic murmur?
Aortic stenosis, pulmonary stenosis, Turners syndrome (bicuspid aortic valve)
289
What is the most common congenital cardiac cause of heart failure?
Ventricular Septal Defect
290
What procedure is done for Hirschsprung disease?
Swenson procedure
291
What procedure is done for Biliary Atresia?
Kasai Portoenterotomy
292
What is the treatment of minimal change disease?
High dose prednisolone for 4 weeks
293
What is the management of obstetric cholestasis?
Ursodeoxycholic acid
294
What is the dosage of adrenaline in anaphylaxis?
- <6 months: 100-150mg
- 6 months- 1 year: 150mg
- 1-12 years: 300mg
- adult: 500mg
295
What enzyme can be measured to determine true anaphylaxis?
Serum tryptase
296
What are signs of alcohol dependence?
- drink = PRiority
- COmpulsion to drink
- STereotyped drinking
- TOlerance
- RElief from drinking
- WIthdrawal symptoms
- Rapid REinstatement after stopping
| PR COST TO REWIRE
297
What are the key features of serotonin syndrome?
Neuromuscular hyperactivity (tremor, hyper reflx, rigid), autonomic dysfunction (tachycardia, diarrhoea, shivering), altered mental state
298
What is 2nd line tx of ADHD?
Lisdexamfetamine
299
When should a child be admitted for IV fluids after gastroenteritis?
If in clinical shock
300
What is the management of viral wheeze?
Salbutamol inhaler with spacer
301
What hormone levels are seen in premature ovarian failure?
Raised FSH + LH, low oestradiol
302
What nerves are affected in Erb's palsy?
C5-C6
303
What cervical length indicates risk of preterm labour?
<25mm
304
What are the two options of prophylaxis of preterm labour?
1. Vaginal progesterone (1st line)
2. Cervical cerclage if previous premature birth of cervical trauma (such as cone biopsy)
| Between16 and 24 weeks if cervical length <25mm on TVUS
305
What can be tested to diagnose P-PROM?
Insulin like growth factor binding protein-1 and placental alpha-microglobulin-1 (PAMG-1)
306
How is preterm labour with intact membranes diagnosed?
- <30 weeks: clinical diagnosis
- >30 weeks: TVUS, if cervical length <15mm, then dx. Can also check if raised fetal fibronectin levels
307
What drug can be used to stop labour? Between what weeks is it used?
Tocolysis with nifedpine, between 24 and 35 weeks
308
When is IV magnesium sulphate given for neuroprotection?
If preterm labour <34 weeks
309
When are antenatal steroids used (gestation wise)?
<36 weeks
310
What are risk factors for placenta praevia?
Previous c-section, previous pregnancy with it, smoking, increased maternal age, assisted reproduction, structural abnormalities
311
What hallucinations are seen in delirium tremens?
Lilliputian (little people)
312
What is the major cause of hyperandrogenism in post menopausal women?
Ovarian hyperthecosis (why old women get hairy chins!)
313
What score can be calculated to decide if someone can detox from alcohol in the community?
AUDIT score
314
What is the management for c.diff?
10 days vancomycin
315
What causes syphilis, and what shape is it?
Treponema Pallidum, Spirochaetae
316
What antibodies are raised in primary biliary cholangitis?
Anti mitochondrial antibodies
317
What classifies a UC flare up as 'severe'?
>6 stools/day with blood
318
What is the sick day rules for steroids?
Double all steroids except for fludrocortisone
319
When are sick day rules for steroids used?
When a patient is systemically unwell, for example with a temperature or D+V
320
When should a child with bronch be immediately referred?
Apnoea, looks severly unwell, severe respiratory distress (>70 RR), central cyanosis
321
When should O2 be given in bronch?
<92%
322
How are patients in an acute asthma attack monitored?
Peak flow and oximetry
323
When is oxygen given in an asthma attack, and what levels are you aiming for?
Give if <94%, aim for 94-98%
324
What is first line treatment of acute asthma attack + dosage?
Nebulised salbutamol in an oxygen driven inhaler, up to x10 puffs
325
Which children should go to hospital for asthma exacerbation?
All life threatening/severe
326
Which inhaler is preventer, and which reliever?
Preventer: brown, ICS
Reliever: blue, salbutamol
327
When does the dosage of levonorgestrel need to be changed?
If BMI >26 then double the dose
328
When should an ambulance be called in febrile seizures?
If >5 minutes
329
What assessments should children have after seizure?
Specialist assessment within 2 weeks of first seizure with a paediatric neurologist. Should have EEG + MRI + ECG
330
What is the rules for driving after a TIA?
No driving for a month. If multiple TIAs, then 3 months
331
What is the first step of newborn resus?
x5 inflation breaths
332
Who should be screened for DDH?
+ve FHx for hip problems, breech presentation at or after 36 weeks, multiple pregnancy
333
What is the first line management after 4 months in DDH?
xray
334
What causes a ipsilateral field defect?
Optic nerve lesion
335
What is seen with the pupil on a surgical 3rd nerve palsy?
Dilated (indicates compression)
336
What lobe is Broca's in?
Frontal
337
What lobe is Wernicke's in?
Temporal
338
What area of a stroke is associated with contralateral homonymous hemianopia? Where is the lesion?
MCA (in tract, after the chiasm)
339
What are the symptoms of a PCA stroke?
Contralateral homoymous hemianopia with macular sparing. Visual agonisa
340
What type of stroke is most associated with aphasia?
MCA
341
How can you differentia PICA and AICA strokes?
- both have vertigo, vomiting, dysphagia, ipsilateral facial pain + temp loss, and contralateral limb pain + temp loss
- AICA also has facial paralysis and deafness
342
How is MS dx?
MRI with contrast (to view the demyelinating lesions)
343
What are the UKMEC levels, and what do they mean?
- UKMEC1: no restriction
- UKMEC2: advantages >disadvantages
- UKMEC3: disadvantages>advantages
- UKMEC4: unacceptable risk
344
What is the treatment of myoclonic seizures?
Men: sodium valproate
Females: levetiracetam
345
What is the treatment of tonic/atonic seizures?
Males: sodium valproate
Females: lamotrigine
346
What AED may worsen absence seizures?
Carbamazepine
347
What is the tx for spasticity?
Baclofen (GABA-B receptor agonist which acts as a muscle relaxant)
348
How might foetal alcohol syndrome affect head size?
Can lead to microcephaly
349
What is the description of an ataxic gait?
Wide based gait with loss of heel toe walking
350
What is the psychological intervention in OCD?
CBT + ERP (exposure and response prevention)
351
Which antipsychotics are most likely to cause acute dystonic reaction?
First gen antipsychotics: haloperidol, chlorpromazine
352
What specific S/e can anti-psychotics increase the risk of in elderly people?
Stroke/VTE events
353
Which antipsychotic particularly reduces seizure threshold?
Clozapine
354
What antipsychotic best manages negative symptoms of schizophrenia?
Clozapine
355
What is the management of otitis externa?
Topical antibiotic or combined topical antibiotic with a steroid
356
What is the pathophysiology of pyloric stenosis?
Hypertrophy of the pyloric sphincter, resulting in narrowing of the pyloric canal
357
What deficiency is CAH linked to?
21-hydroxylase enzyme
358
What is the inheritance of CAH?
Recessive
359
What hormone changes are seen in CAH?
- low aldosterone
- low cortisol (high glucose)
- high testosterone
360
What is the presentation of CAH?
'Virilised genitalia'. Poor feeding, vomiting, dehydration, arrhythmias. Will make a female patient more female. There will also be skin pigmentation (melanocyte simulating hormone released alongside cortisol)
361
What is a risk for a patient with a atrial septal defect that has a DVT?
Could travel up to the brain and cause a stroke
362
What are the features of PDA? (5)
- left subclavicular thrill
- continous machinery murmur
- large volume, bounding, collapsing pulse
- wide pulse pressure
- heaving apex beat
363
What heart condition might lead to a murmur heard infraclavicularly and sub-scapularly?
Coartication of the aorta
364
What is the exclusion criteria for measles?
4 days from rash onset
365
What is the exclusion criteria for rubella?
5 days after rash onset
366
Who should notifiable diseases be reported to?
'Proper Officer' at the Local Health Protection Team. They then tell the Health Protection Agency
367
What is the inheritance of Duchenne's?
X-linked
368
What is the pathophysiology of Duchennes?
Dystrophin (protein) is absent, which is required for muscle architecture. Muscle is lost and replaced by adipose tissue
369
What medical intervention can slow progression of Duchennes?
Steroids
370
What heart condition is linked to Duchennes?
Cardiomyopathy
371
When should physiological jaundice resolve in a term/pre-term baby?
Term: 14 days
Pre-Term: 21 days
372
What are the main 2 tx options for neonates with jaundice?
Phototherapy, blood transfusion
373
What is the 'male Turner's'?
Noonans
374
What cardiac compx are associated with Noonans?
Pulmonary valve stenosis, hypertrophic cardiomyopathy
375
What cardiac issues does Williams syndrome cause?
Supravalvular aortic stenosis
376
What cardiac conditions are associated with Downs?
Endocardial cushion defect, VSD, tetralogy of Fallot
377
What are the features of congenital rubella?
- sensorineural deafness
- congenital cataracts
- heart disease
-growth retardation
- purpuric skin lesions
- microphthalmia
378
How is vesicoureteric reflux diagnosed?
Micturating cystourethrogram
379
What is 'toddler's fracture'?
Spiral fracture of the tibia
380
When should a child with a limp be referred urgently?
- fever
- <3
- suspect NAI
- >9 with potential SFE
381
What screening programmes are there in pregnancy?
- infectious diseases (HepB, HIV, syphilis)
- sickle cell + thalassaemia
- Fetal anomaly (Down's, Edwards, Pataus)
382
What screening programmes are there in newborn babies?
- NIPE
- newborn hearing screening programme
- newborn blood spot screening programme (SCD, CF, phenylketonuria, hypothyroidism)
383
What screening programmes are there in adults?
1. AAA
2. Bowel
3. Breast
4. Cervical
5. Diabetic Eye
384
How many screening programmes are there in the UK?
11
385
What ages is the NHS breast cancer screening programme offered between?
50-70 years
386
How often do women recieve breast cancer screening?
Every 3 years
387
What is the imaging of choice in children older than 6 months if recurrent UTI?
DMSA (if <3 months, can do MCUG aswell)
388
What is the bowel screening programme?
FIT screening every 2 years to men and women aged 60-74 years
389
What is the screening programme for AAA?
Single abdominal ultrasound for men >65
390
What is diabetic eye screening?
All diabetics invited for eye screening, if >12 years. Every 2 years
391
What HbA1c is diagnosed of diabetes?
48 mmol/mol (and 7 fasting, and 11 random)
392
What are the features of West Syndrome?
- 'Salaam' attacks: flexion of the head, trunk, arms. Followed by extension of arms
- progressive mental handiscap
- EEG: hypsarrhythmia
393
What is are the risk factors (5) and protective factor (1) for hyperemesis?
Increase:
-multiple pregnancies
- trophoblastic disease
- nulliparity
- obesity
- FHx/PMHx
Decrease:
- smoking
394
What are inflation breaths in neonatal resus?
5 breaths of air via facemask
395
What is Asherman's syndrome?
Intrauterine adhesions, commonly following D+C
396
What are the paediatric dose for low, moderate and high dose ICS?
- low: <=200 mg
- moderate: 200-400mg
- high: >400mg
OF BUDESONIDE or EQUIVALENT
397
How many weeks after a TOP should there be a negative test?
4 weeks, though women should do a multi-level pregnancy test at 2 weeks
398
What type of insulin is used to treat gestational diabetes?
Short acting insulin
399
What is the definition of menorrhagia?
An amount that the woman considers to be excessive. Old definition= >80 ml per menses
400
What is the relationship between long term atypical antipsychotics and polyuria/polydipsia?
Long term atypical antipsychotics can lead to the development of glucose dysregulation and diabetes
401
What is the mechanism of action of metformin in PCOS?
Increases peripheral insulin sensitivity
402
What is the test for degenerative cervical myelopathy done during examination?
Hoffman's
403
What is the investigation of degenerative cervical myelopathy?
MRI of the cervical spine
404
What is the management of degenerative cervical myelopathy?
Urgent surgical review
405
When can contraception be restarted after use of levonorgestrel or ulipristal?
- levonorgestrel: immediately
- ullipristal: 5 days
406
What method of hearing testing is used for screening newborns?
Otoacoustic emissions
407
What hearing test is done if otoacoustic emission test is abnormal?
Auditory brainstem response test
408
What hearing test is done at school entry in the UK?
Pure tone audiometry
409
According to Schneider's first rank symptoms, what features of voices indicate a dx of schizophrenia?
Hearing own thoughts spoken aloud, running commentary, auditory third person hallucinations
410
What can cause a rise in urea and creatinine?
Dehydration, kidney failure, if the patient is making a lot of new protein (anabolic), or breaking down a lot of protein.
411
What is the definition of osteoporosis?
Presence of bone mineral density (BMD) of less than 2.5 standard deviations (SD) below the young adult mean density
412
What investigations should be done after a fall? (3 categories)
1. Bedside test: blood pressure (lying and standing), blood glucose, urine dip, ECG
2. Bloods: FBC, U+Es, LFTs, bone profile
3. Imaging: xray of chest/injured limbs, CT head, ECHO
413
What does a bone profile blood test consist of?
Serum phosphate, albumin, ALP, calcium (total and adjusted)
414
What results are seen in a bone profile in osteoporosis?
Everything normal
415
What value on the sweat test indicates cystic fibrosis?
>60 mEq/l
416
What are differentials for abdominal distension in children?
Intra-abdominal mass, Kwashiokor, food intolerance, coeliac, intestinal obstruction, constipation + impaction
417
What is seen on microscopy in minimal change disease?
Loss of podocyte foot processes, abnormality may not be seen
418
Name 3 causes of nephritic syndrome?
IgA nephropathy, Good pastures, HSP, post streptococcal glomerulonephritis, SLE, HUS
419
Name 3 causes of nephrotic syndrome?
Diabetes, infection, minimal change disease
420
Why are patients with nephrotic syndrome more likely to develop a VTE?
- hypercoaguability: increased fibrinogen and hyperlipidaemia
- loss of antithrombin
421
When would you refer to nephrology in AKI? (paeds+adults?)
- hx of renal transplant
- unknown AKI cause
- inadequate tx response
- AKI complications: significant electrolyte abnormalities
- stage 3
- CKD 4 or 5
422
What LFTs are seen in alcoholics?
- raised AST and ALT
- AST:ALT ratio >1.5
- raised GGT
- raised ALP
423
What are risk factors for reduced fetal movements (8)?
- posture
- distraction (just notice them less)
- placental position
- medication (alcohol, opiates, benzos)
- fetal position
- body habitus
- amniotic fluid volume (oligo and polyhydramnios)
- SGA
424
What is the recommendation for delivery for women with type 1 or 2 diabetes (+ no other complications)?
Induced labour or (if indicated) c-section between 37-38+6
425
How long after a membrane sweep should a woman go into labour?
48 hours
426
What is the next step if there is a negative spirometry result, and still high clinical suspicion of asthma?
Fractional exhaled nitric oxide (FeNO) test
427
What requirements should be met for discharge after an acute asthma attack?
Peak Expiratory Flow should be >75% of best or predicted. For paeds, also SpO2 >92% on air, stable on 4-hourly bronchodilators
428
What drugs may be used in the tx of neuroleptic malignant syndrome?
Bromocriptine (dopamine agonist) and dantrolene (treats spasticity). Can also use benzos to control agitation (lorazepam)
429
What is neurological investigation is done in myasthenia gravis, and what is the finding?
Single fibre electromyography: fibres don't respond to nerve stimulation
430
What are 5 symptoms of MND?
- mixture of lower motor neuron and upper motor neurone signs
- fasciculations
- absence of sensory pain
- wasting of small hand muscles + calves
- asymmetric limb weakness
431
What is the type of MND with the worst prognosis?
Progressive bulbar palsy
432
What drug is used in the tx of MND?
Riluzole
433
What is a characteristic feature of guillain barre syndrome?
Progressive, symmetrical weakness of the limbs. Ascending, with reduced reflexes
434
What is Tinel's test?
Tapping causes paraesthesia (carpal tunnel)
435
What are causes of carpal tunnel?
Idiopathic, rheumatoid arthritis, pregnancy, oedema (eg, heart failure)
436
What is the conservative management of carpal tunnel syndrome?
Corticosteroid injection, wrist splints at night
437
What must be monitored in GBS, and how often?
Respiratory function, using FVC. Should be checked every 4 hours.
438
What are unique side effects of the depot injection?
Weight gain and osteoporosis
439
What cells are affected in MS?
Oligodendrocytes
440
What is the acute tx for kawasaki?
IVIG and high dose aspirin
441
What emergency tx may be given in croup before escalation to ICU?
High flow oxygen, nebulised adrenaline
442
What are signs of decompensated congenital heart disease?
Poor feeding, dyspnoea, tachycardia, weak pulse, cold peripheries, engorged neck veins
443
What are risk factors for surfactant deficient lung disease?
Male sex, diabetic mother, c-section, second born of twins, premature
444
What is the definition of cerebral palsy?
A chronic disorder of movement and posture due to non-progressive brain abnormalities occurring before the brain is fully developed
445
What are the 4 classifications of cerebral palsy?
Spastic (most common), dyskinetic, ataxic, mixed
446
What is the treatment of cerebral palsy?
- MDT
- diazepam
- baclofen (for spasticity)
- orthopaedic surgery
447
What is felt on examination in intussusception?
Sausage shaped abdominal mass
448
What are the three possible treatment options for intussusception?
1. air reduction (first line)
2. barium enema
3. laparotomy
449
What is the investigation for cauda equina?
Urgent MRI
450
What is the management of hypercalcaemia?
- rehydration with normal saline
- bisphosphonates + calcitonin
451
What are features of thought disorder in schizophrenia? (3)
Knight's move, neologisms, odd logic
452
What is the definition a delusion?
A firmly held false belief that is outside of normal social and cultural ideas
453
What is the MoA of anti-psychotics?
Dopamine antagonists
454
What electrolyte disturbances are seen in refeeding syndrome, and which is hallmark?
All low; hallmark is hypophosphataemia, which may lead to cardiac issues
455
What is the cause of roseola infantum?
HHV-6
456
What is the cause of Erythema infectiosum?
Parvovirus B19 (slapped cheek syndrome)
457
What are risk factors for placental abruption?
Maternal hypertension, maternal smoking, maternal trauma, increasing maternal age, multiparity, fetal growth restriction, previous abruption
458
What are hCG levels in downs vs edwards vs pataus?
- increased in Downs
- decreased in Patau and Edwards
459
What are the risks of gestational diabetes?
Congenital abnormalities, preterm labour, foetal lung maturity is worse, macrosomia (increased risk of shoulder dystocia), sudden fetal death
460
What is the definition of pre-eclampsia?
New onset blood pressure >140/90 mmHg after 20 weeks of pregnancy, and proteinuria and/or other organ involvement
461
What is the 5 components of the Bishop score
1. cervical dilatation
2. station of the fetal head
3. position of the cervix
4. effacement of the cervix
5. consistency of the cervix
462
What are the most common causes of meningitis?
Neisseria meningitidis, S.pneumoniae
463
What is the leading cause of death in GBS?
PE: therefore, need VTE prophylaxis
464
What are common triggers of GBS?
Campylobacter jejuni, CMV, EBC
465
What is the tx of pneumonia in children? (1st line, 2nd line, if mycoplasma suspected, if with influenza)
- 1st line: amoxicillin
- 2nd line: add macrolides
- Mycoplasma: macrolifes
- Influenca: co-amoxiclav
466
