OHCS Flashcards
(166 cards)
1
Q
What is the treatment for pre-eclamptic seizures?
A
ABCDE
Call for senior help
Magnesium sulfate is the evidence-based treatment for eclamptic seizures.
- 4g IV over 5-10min then 1g/h for 24hrs
- Treat further fits with 2g bolus
- Stop if RR <12, tendon reflex loss, or urine output <20mL/h)
- —Have calcium gluconate ready if RR depression
Monitor
- Catheterise for hourly urine output
- HR, BP, RR, SpO2 every 15min
- FBC, U+Es, LFTs, creatinine and clotting every 12-24hrs
This patient also needs to have her blood pressure controlled carefully and delivery expedited.
2
Q
What are the risk factors for gestational diabetes?
When do you test?
A
BMI >30
Previous baby >4.5kg
1st-degree relative diabetic
Family origin from areas of high risk
Screen (75g glucose tolerance test) at 28 weeks
-16 and 28 weeks if previous GDM.
3
Q
What tests do you carry out at the booking visit?
A
Hb, blood group and antibody screen (Rhesus)
Syphilis, rubella (+/- chickenpox) serology
HBsAg and HIV test
Sickle test depending on family origin
Hb electrophoresis
25-Hydroxyvitamin D if relevant
Take an MSU (protein; bacteria)
If from an endemic area for TB or a TB contact perform Mantoux test and CXR
Offer screening for chromosomal and structural abnormalities
4
Q
What are the risk factors for pre-eclampsia?
How do you determine who needs prophylaxis?
A
High risk:
- Previous severe or early onset pre-eclampsia (<20 weeks)
- Chronic hypertension or hypertension of previous pregnancy
- CKD
- DM
- Autoimmune (SLE, antiphospholipid, thrombophilia
Moderate risk
- 1st pregnancy
- 40 or older
- Pregnancy interval of over 10 years
- FH of pre-eclampsia
- Multiple pregnancy
- Low PAPP-A
- Uterine artery notching on doppler US at 22-24 weeks
(if 1 high risk or 2 moderate risk factors take aspirin 75mg PO OD from 12th week until delivery
5
Q
How do you manage pre-eclampsia?
A
Mild = BP 140-149/90-99 and urine PCR >30mg/mmol
- 4 hourly BP
- Check bloods 3 times per week
- Fortnightly Renal function, LFTs, FBC
- Fortnightly fetal growth scans
Moderate = BP 150-159/100-109
- Admit to hospital until delivery
- Same monitoring as above plus twice-daily CTG
- Start antihypertensives (IV labetolol (1st) PO nifedipine (2nd) or hydralazine)
Severe = >160/110 or symtpoms/signs or end organ damage
- Call for seniors
- Control BP (aim for under 150/100)
- Plan delivery in next 24-48hrs (steroids etc) if >34 weeks
Magnesium sulphate is given during labour and in first 24hrs after birth to prevent seizures.
6
Q
How do you manage preterm rupture of membranes (PROM)?
A
Admit for 48hrs (80% go into labour)
Rule out chorioamnionitis and sepsis
- Temperature
- MSU
- High vaginal swab using bivalve speculum
Give corticosteroids and erythromycin 500mg PO QDS for 10 days
If labour does not occur discharge after 48hrs and manage as out patient
- Avoid intercourse, tampons and swimming
- Weekly follow up in day unit
- Aim for induction of labour after 34 weeks if cephalic
7
Q
What is fetal fibronectin?
A
Protein not usually detected in vaginal secretions between 22 and 36 weeks.
Used to rule out preterm labour and is a bedside test
Those with +ve have 10% chance of preterm delivery and should be admitted and given corticosteroids
False +ve’s = intercourse, speculum, a significant bleeding or vaginal exam within 48hrs
8
Q
What is the definition of small for gestational age?
A
Estimated fetal weight <10th centile for their gestational age or abdominal circumference <10th centile
9
Q
What are the major and minor risk factors of small for gestational age?
A
Major
- Maternal age >40
- Smoker, Cocaine use
- Previous SGA baby
- Previous stillbirth
- Maternal/paternal SGA
- Chronic hypertension, DM, Renal impairment
- Antiphospholipid syndrome
- Pre-eclampsia
- Low PAPP-A
Minor
- Maternal age >35
- Nulliparity
- BMI <20
- IVF
- Pregnancy induced hypertension
10
Q
Which women should be assessed by serial US dopplers?
A
Women who have a major risk factor should be referred for serial ultrasound measurement of fetal size and assessment of wellbeing with umbilical artery Doppler from 26–28 weeks of pregnancy
Women who have three or more minor risk factors should be referred for uterine artery Doppler at 20–24
weeks of gestation
11
Q
What is involved in the combined test?
A
NT
Free human chorionic gonadotrophin
Pregnancy-associated plasma protein (PAPP-A)
Woman’s age
Used between 11 and 13+6 weekds
12
Q
What is involved in the quadruple test?
A
Dating scan (not NT scan) Woman's age
4 blood tests:
- Maternal AFP
- Unconjugated estriol
- free BhCG or total BhCG
- Inhibin A
Use between 15+0 weeks and 20+0 weeks
13
Q
What is chorionic villus biopsy?
A
Carried out at 10-12 weeks
Placenta is sampled by transabdominal or occasionally transcervical approach under continuous US control.
Karyotyping takes 2 days, enzyme and gene probe analysis 3 weeks, so termination for abnormality is earlier, safer, and is done before the pregnancy is apparent, compared with amniocentesis
Risks are:
-excess miscarriage rate of 1-2%, increased transmission of blood-borne viruses (HIV, hep B and C), rarely contamination by maternal cells
14
Q
What is amniocentesis?
A
Undertaken from 16 weeks onwards and involves the aspiration of fluid containing fetal cells shed from skin and gut.
A small needle is passed transabdominally under continuous US, preferably not transplacentally
Fetal loss rate is around 1% at 16 weeks gestation.
AntiD needed in all Rh -ve women
Advantages over CVS/CVB:
- Able to diagnose fetal infections such as CMV
- Excess miscarriage rate lower
Full cell culture for karyotyping may take as long as 3 weeks, but rapid results are possible within 2 days by FISH and PCR.
15
Q
How can you shorten the 3rd stage of labour and reduce the incidence of PPH?)
When is this contraindicated?
A
Syntometrine (ergometrine maleate 500mcg IM and oxytocin 5u IM) as the anterior shoulder is born
It can precipitate MI and is contraindicated in:
- Pre-eclampsia
- Severe hypertension
- Severe liver or renal impairment
- Severe heart disease
(if BP not measured in labour give just oxytocin)
16
Q
When do you carry out fetal blood sampling?
How do you act on result?
What if you cant do it?
A
Used to detect fatal hypoxia after abnormal CTG
-Don’t bother taking if immediate delivery required
Normal = repeat in 1h if CTG remains abnormal
- pH >7.25
- Lactate 4.1 mmol/l or below
Borderline = repeat in 30min if CTG remains abnormal
- pH 7.21-7.24
- lactate 4.2 to 4.8 mmol/l
Abnormal pH <7.2 = Immediate delivery
- pH <7.2 or
- Lactate 4.9 mmol/l or above.
If FBS fails then the baby should be delivered ASAP
17
Q
What should you advise women considering a vaginal birth after cesarean (VBAC)?
A
Risk of uterine rupture is 0.5% (1:200)
72-75% of VBACs are successful
18
Q
How do you manage shoulder dystocia?
A
Gentle downward traction fails to deliver shoulder
Call for help
CONSIDER episiotomy
-can make internal manoeuvres easier but not always necessary
Discourage pushing as this impacts the shoulders even more
Place in McRoberts (hyperflexed lithotomy) position
-Successful 90% of time
Suprapubic pressure
Enter the pelvis for internal manoeuvres
Roll mother onto all fours if this fails
LAST LINE
-Zavanelli (yeet baby back in and go for CS
19
Q
How do you investigate a mother who reports decreased foetal movements?
A
A handheld Doppler will, in most cases, confirm the presence of a fetal heartbeat. This is widely available in most settings. If the fetal heartbeat is not confirmed, then immediate referral for an ultrasound scan to assess fetal cardiac activity is required.
After viability has been confirmed, if the woman still complains of reduced fetal movement, then a CTG should be performed. If she continues to complain of reduced fetal movements, and despite having a normal CTG, then a detailed ultrasound scan should be undertaken.
20
Q
What is the most accurate test for prenatal testing of trisomies?
A
Cell-free DNA analysis
Non-invasive investigation of maternal blood
Pretty fucking amazing. Not on NHS yet
21
Q
Women with uncomplicated pregnancies should be offered induction of labour when?
A
Women with uncomplicated pregnancies should be offered induction of labour at 4 weeks. After 42 weeks, if a woman declines induction, then the health of the fetus should be monitored.
She should be offered at least twice-weekly CTG and ultrasound estimation of the maximum amniotic pool depth. These best monitor fetal distress and placental function.
22
Q
What is the classification of perineal tears?
A
● first degree: injury to the perineal skin only
● second degree: injury to the perineum involving the perineal muscles, but not the anal sphincter
● third degree: injury to the perineum involving the anal sphincter complex, consisting of the external anal sphincter (EAS) and internal anal sphincter (IAS):
● 3a: less than 50% of EAS thickness torn
● 3b: more than 50% of EAS thickness torn
● 3c: both EAS and IAS torn
● fourth degree: injury to the perineum involving the anal sphincter complex (EAS and IAS) and anal epithelium.
23
Q
What are the risk factors for perineal tears?
A
Primiparity Large baby (>4kg) Occiput posterior position Induction Epidural use Prolonged second stage Forceps use Midline episiotomy
24
Q
What drugs increase the successful rate of external cephalic version?
A
Women should be counselled that, with a trained operator, about 50% of ECV attempts will be successful.
ECV success rates are increased by the use of tocolysis. The drugs shown to be effective include ritodrine, salbutamol, and terbutaline.
25
When should triplets be delivered?
Triplet pregnancies should be offered elective delivery by Caesarean section from 35 weeks’ gestation, after a course of antenatal corticosteroids.
Seventy-five percent of triplet pregnancies will result in spontaneous labour before 35 weeks 0 days. Delivery too early puts the infants at more risk of complications so should be avoided.
26
What are the features of a clinically significant paediatric murmur?
Harsh sounding and loud
Associated with thrills
Snaps and clicks can be heard
Physiological murmurs are usually "vibratory and musical" , localised, and vary with position, respiration, and exercise
NO clubbing, NO cyanosis, NO thrills, NO rib recession, NO clicks, NO arrhythmias, normal pulses and apex, NO FTT
27
What is still's murmur?
Heard in ages 2-7
Soft systolic; vibratory, musical,”twangy”
Apex, left sternal border
Can radiate into carotids
Increases in supine position and with exercise
NO snaps or clicks,
28
What is a pulmonary outflow murmur?
Age 8-10 years
Soft systolic; vibratory
Upper left sternal border, well localised, not radiating to back
Increases in supine position, with exercise
Often children with a narrow chest,
-brings normal valve even closer to the front of the chest.
29
What is a venous hum?
Age 3-8 years
Veins bringing blood back to the heart
Soft, indistinct
Continuous murmur, sometimes with diastolic accentuation
Supraclavicular
Only audible in upright position, disappears on lying down or when turning head
-gravity etc creates the murmur
30
What are the cyanotic heart diseases?
```
TGA
Tetralogy of Fallot
Tricuspid or pulmonary atresia
total anomalous pulmonary venous return
hypoplastic left heart
truncus arteriosus
```
31
How do you manage patent ductus arteriosus?
In babies with continuous machine murmur below the left clavicle, thrill, collapsing pulse, FTT, pneumonia, loud S2
Ensure no duct dependent circulation on ECHO
Oral or IV ibuprofen early or endovascular surgery at 1yr
32
What is involved in Bishop score?
What does it tell you?
Cervical dilation (0, 1-2, 3-4)
Length of the cervix (>2, 1-2, <1)
Station of head (cm above ischial spines) (-3, -2, -1)
Cervical consistency (firm, medium, soft)
Position of cervix (Posterior, Middle, Anterior)
3 or less associated with increased rates of prolonged labour, fetal distress, and CS
-This is less in multinips
>5 is favourable
>7 induction with artificial rupture of membranes should be possible (thereby avoiding prostaglandins)
33
How do you determine mild, moderate and severe dehydration in paeds?
```
Mild dehydration (< 5%)
• No signs of cellular dehydration
```
If oral rehydration is not tolerated, a nasogastric tube is preferable to intravenous fluids
Moderate dehydration (5–10%)
• Signs of cellular dehydration (e.g. poor skin turgor)
• No signs of shock
1 Oral rehydration: trial for 6 h at 100 ml/kg
2 Intravenous therapy: if oral rehydration fails, use i.v.
therapy
Severe dehydration (> 10%)
• Clinically detectable shock with hypotension,
tachycardia, etc.
• Intravenous therapy required
34
How do you treat severe dehydration in paeds?
1 Treat shock: use 20 ml/kg 0.9% saline
2 Rehydration: with 0.9% saline/dextrose
(NB if plasma Na+ is high, rehydrate over 48 h. If Na+ is low or normal, rehydrate over 24 h)
a Treat fluid deficit:
Estimated percentage dehydration × weight in kg
b Plus maintenance:
• 100 ml/kg for first 10 kg
• 50 ml/kg for next 10 kg
• 20 ml/kg per kg for rest of weight
c Plus ongoing losses (e.g. vomiting, diarrhoea, etc.)
35
How does a normal babies weight change in the first couple of weeks?
Babies can lose up to 10% of their birthweight in the first week but should have regained their birthweight by 2 weeks of age.
This can worry parents so good to know and reassure them.
36
What is the risk with any congenital heart lesions?
increased risk of bacterial endocarditis
Need to treat even if they are well
37
What babies classically still get rickets?
This is especially common in African-Caribbean and South Asian children in the UK who are breastfed for a prolonged period.
This is because dark-skinned people absorb less sunlight and there is less conversion of 7-dehydrocholesterol to previtamin D3. This results in even lower levels of vitamin D in breast milk.
38
What should always be considered in acutely unwell asthmatic patients who deteriorate suddenly?
Pneumothorax
39
What are the investigations for rickets?
Serum calcium, phosphate, alkaline phosphatase, and serum 25-OHD, which is the most robust marker for vitamin D status
Haemoglobin levels should also be measured because iron deficiency anaemia frequently coexists with rickets
Parathyroid hormone concentrations are typically elevated in neonates and young infants with vitamin D deficiency but may be within the reference range.
If there is diagnostic uncertainty—because of atypical clinical manifestations, a lack of risk factors, atypical biochemistry, focal pain, or asymmetrical deformity—then radiographs should be arranged to confirm rickets
X-ray shows widened, frayed, and cupped metaphyses. These changes are typical of rickets and are usually combined with osteopenia.
40
What testicular size indicates the start of puberty?
4mL
41
What is the first step in neonatal rescus?
In all cases whether intervention is required or not, dry the term or near-term infant, remove the wet towels, and cover the infant with dry towels.
Significantly preterm infants (<32 weeks) are best placed, without drying, into polyethylene wrapping under a radiant heater.
In infants of all gestations, the head should be covered with an appropriately sized hat.
The temperature must be actively maintained between 36.5°C and 37.5°C after birth unless a decision has been taken to start therapeutic hypothermia.
42
Where are hypospadias and epispadias located
Penis like dolphin
DORSUM (dorsal fin) -> epispadia
ventral -> hypospadia
(AVOID circumcision -> need foreskin for any future procedures)
43
In any child with a fever you should check urine dip for UTI.
When do you send urine for culture?
in infants and children who are suspected to have acute pyelonephritis/upper UTI
in infants and children with a high to intermediate risk of serious illness
in infants under 3 months
in infants and children with a positive result for leukocyte esterase or nitrite
in infants and children with recurrent UTI
in infants and children with an infection that does not respond to treatment within 24–48 hours, if no sample has already been sent
when clinical symptoms and dipstick tests do not correlate.
44
What are the criteria for an atypical UTI in paeds?
seriously ill, poor urine flow, abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to treatment with suitable antibiotics within 48 hours, infection with non-E. coli organism
45
When do you perform an ultrasound scan in kids after UTI?
Atypical UTI (US during the acute episode)
For infants younger than 6 months with first-time UTI that responds to treatment, ultrasound should be carried out within 6 weeks of the UTI
For infants and children aged 6 months and older with first-time UTI that responds to treatment, routine ultrasound is not recommended unless the infant or child has atypical UTI
Infants and children who have had a lower UTI should undergo ultrasound (within 6 weeks) only if they are younger than 6 months or have had recurrent infections.
46
What are the features of tuberous sclerosis?
MRI scan shows subependymal nodules in the left ventricle. This, combined with seizures and hypopigmented skin lesions, is strongly suggestive of tuberous sclerosis.
47
How should the growth pattern of SGA babies differ to normal babies once they are born?
Catch-up growth for weight in early childhood is a risk factor for future obesity. Babies who are born small for gestational age are advised to gain weight at a slower rate than babies born at a ‘normal’ weight—no more than 100 g per week for the first few months, rather than 180–200 g per week.
48
What is the prognosis of Minimal Change Glomerulonephritis?
95% respond to steroids
70% relapse at some point however long term outlook is good
49
What do hyphae on microscopy indicate?
Candid or "thrush"
May also show mycelia or spores
50
What are the CSF features of bacterial meningitis?
Appearance: Cloudy and turbid
Opening pressure: Elevated (>25 cm H₂O)
WBC: Elevated >100 cell/µL (primarily polymorphonuclear leukocytes (>90%))
Glucose level: Low (<40% of serum glucose)
Protein level: Elevated (>50 mg/dL)
51
What are the CSF features of viral meningitis?
Appearance: Clear
Opening pressure: Normal or elevated
WBC: Elevated (50 – 1000 cells/µL, primarily lymphocytes, can be PMN early on)
Glucose level: Normal (>60% serum glucose however may be low in HSV infection)
Protein level: Elevated (>50 mg/dL)
52
What are the CSF features of fungal meningitis?
Appearance: Clear or cloudy
Opening pressure: Elevated
WBC: Elevated (10 – 500 cells/µL)
Glucose level: Low
Protein level: Elevated
53
What are the features of tuberculous meningitis?
Appearance: Opaque, if left to settle it forms a fibrin web
Opening pressure: Elevated
WBC: Elevated (10 – 1000 cells/µL, Early PMNs then mononuclears)
Glucose level: Low
Protein level: Elevated (1-5 g/L)
54
What is the treatment for gonnorhoea?
When antimicrobial susceptibility is not known prior to treatment:
-Ceftriaxone 1g intramuscularly as a single dose (Grade 1C)
When antimicrobial susceptibility is known prior to treatment:
-Ciprofloxacin 500mg orally as a single dose (Grade 1A)
55
How do you diagnose gonorrhoea microscopically?
Microscopy of Gram-stained genital specimens allows direct visualisation of N. gonorrhoeae as monomorphic Gram-negative diplococci within polymorphonuclear leukocytes.
56
What is the gold standard specimen for chlamydia diagnosis in women?
Vulvo-vaginal swabs
| first, catch urine for men
57
What is Mycoplasma Genitalium?
Mycoplasma genitalium (MGen) is emerging as a significant sexually transmitted pathogen and coinfection rates of 3%-15% with chlamydia have been reported
58
What is the first line treatment for chlamydia?
Doxycycline 100mg bd for 7 days is now recommended as first line treatment for uncomplicated urogenital, pharyngeal and rectal chlamydia infections, with test of cure (TOC) for diagnosed rectal infections.
REMEMBER:
- Doxycycline contraindicated in pregnancy!
- Azythromycin 1g
59
How do you treat C. glabrata?
This is the other cause of thrush
Topical nystatin or 7-14 day course of an imidazole
60
List the types of ovarian tumours
Functional cysts
- Enlarged or persistent follicular or corpus luteum
- Extremely common (normal if <5cm)
- If <5cm usually resolve over 2-3 cycles
Endometriomas
-Chocolate cysts
Serous cystadenomas
- Commonest in women aged 30-40 years
- About 30% are bilateral and about 30% are malignant
Mucinous cystadenomas
- The commonest large ovarian tumours, may become enormous
- Filled with mucinous material and rupture (may cause pseudomyxoma peritonei)
- Commonest in 30-50 age group
- About 5% malignant
- Occur with GI tumours (remove appendix)
Fibromas
- Associated with Meigs' syndrome (pleural effusion (usually right sided) + ascites + benign tumour
- Includes: thecoma, cystadenoma, granulosa cell tumour
Teratomas
-Arise from primitive germ cells
Other germ cell tumours
- All malignant and rare
- Non gestational choriocarcinomas (secrete hCG)
- Ectodermal sinus tumours (yolk sac tumours - secrete a-fetoprotein)
- Dysgerminomas
Sec-cord tumours
- Rare (usually low grade malignancy
- Arise from cortical mesenchyme
- Granulosa-cell and theca-cell tumours produce oestrogen and may present with precocious puberty, menstrual problems, or postmenopausal bleeding
61
What LH:FSH ratio is characteristic for PCOS?
"Reversed LH:FSH ratio of around 3:1"
62
What is the most sensitive biochemical test for PCOS?
High free androgen index (testosterone: sex hormone binding globulin ratio)
63
What are the 4 stages of syphilis?
● Primary: characterized by painless ulcers, called chancres, at the site of infection. They may not be noticed. Chancres occur about 3 weeks after infection
● Secondary: occurs 2–10 weeks after the chancres appear. Symptoms include a rash, mouth ulcers, lymphadenopathy, fever, and myalgia
● Latent: occurs months to years after the initial infection if it goes untreated and it is usually asymptomatic, but the infection remains in the body
- Early latent = proven under 2 years infection
- Late latent = over 2 years
● Tertiary: occurs years after the initial infection in a minority of people and can affect almost any part of the body.
64
What investigations do you do in paracetamol overdose?
Serum paracetamol concentration at 4 or more hours, with venous gas, U+Es, FBC, LFTs and clotting
65
When can you give activated charcoal in paracetamol poisoning?
If presenting <1h, and >150mg/kg of tablets ingested and no contra-indication (e.g. vomiting; decreased GCS), give activated charcoal
66
What is an obsession?
An obsession is a stereotyped, purposeless word, idea, or phrase that comes into the mind and that originates from the person, rather than from outside. The patient realizes that it is not true.
67
What are common side effects of SSRIs?
Nausea
GI upset
Restlessness
Insomnia
(Citalopram and prolonged QTc)
68
How do you assess acute mania?
Mania can be caused by:
- Medications (steroids, illicit substances (amphetamines, cocaine), antidepressants)
- Physical (infections, stroke, neoplasm, epilepsy, MS, hyperthyroidism
Ask about: infections, drug use, and past or family history of psych problems
Investigations you must do:
-CT head, EEG, screen for drugs/ toxins
Assess: psychotic symptoms, cycling speed, suicide risk
69
How do you treat acute mania?
Moderate/ severe mania:
- Any second generation antipsychotic
- Valproate semisodium (Depakote)
70
Name some first, second and third-generation antipsychotics
First-generation:
- Chlorpromazine
- Haloperidol
Second-generation:
- Amisulpride
- Olanzapine
- Quetiapine
- Risperidone
- Zotepine
Third generation:
-Aripiprazole
71
What are Schneider's 1st rank symptoms?
Auditory hallucinations:
- Hearing thoughts spoken aloud
- Hearing voices referring to himself / herself, made in the third person
- Auditory hallucinations in the form of a commentary
Thought withdrawal, insertion and interruption
Thought broadcasting
Somatic hallucinations
Delusional perception
Feelings or actions experienced as made or influenced by external agents
72
What are the two types of emotionally unstable personality disorder?
What are the features of them?
There are two types of emotionally unstable personality disorder—borderline and impulsive. In the borderline type, the person tends to form intense relationships and have rapid fluctuations in mood, with impulsivity, disturbed self-image, recurrent self-harm, and chronic feelings of emptiness.
73
What is the most effective CBT for anxiety?
Anxiety management training
(Behavioral therapy with graded exposure to anxiety-provoking stimuli may be useful in some specific cases. Paroxetine (an SSRI) can help to treat social anxiety, but non-pharmacological measures should be tried first.)
74
What are the features of autism?
● impaired communication: in the most severe cases, there is no language at all, no imaginative play, and echolalia (repeating other people’s words)
● impaired social interaction (e.g. not responding to other people’s emotions)
● restricted, repetitive, and stereotyped patterns of movement, behaviours, and interests (e.g. liking rigid routines and becoming upset when these do not occur, enjoying activities such as lining toys up or spinning wheels repeatedly)
● onset before the age of 3 years.
75
When can you start clozapine treatment?
Offer clozapine to people with schizophrenia whose illness has not responded adequately to treatment despite the sequential use of adequate doses of at least 2 different antipsychotic drugs.
At least 1 of the drugs should be a non-clozapine second-generation antipsychotic
76
What is the medical treatment for alzheimer's?
1. The three AChE inhibitors donepezil, galantamine and rivastigmine as monotherapies are recommended as options for managing mild to moderate Alzheimer's disease
2. Memantine monotherapy is recommended as an option for managing Alzheimer's disease for people with:
moderate Alzheimer's disease who are intolerant of or have a contraindication to AChE inhibitors or
severe Alzheimer's disease.
-Treatment should be under the conditions specified in recommendation 4 below.
3. For people with an established diagnosis of Alzheimer's disease who are already taking an AChE inhibitor:
- consider memantine in addition to an AChE inhibitor if they have moderate disease
- offer memantine in addition to an AChE inhibitor if they have severe disease.
77
What eye defect occurs in giant cell arteritis causing loss of vision?
The posterior ciliary arteries may be affected by the arteritis, resulting in an anterior ischaemic optic neuropathy causing dramatic visual loss and a swollen disc with flame-shaped haemorrhages.
78
How does preseptal cellulitis differ from orbital cellullitis?
Orbital cellulitis differs from preseptal cellulitis, as congestion from orbital spread results in chemosis, proptosis, and restriction of eye movement, in addition to eyelid involvement.
79
What is the treatment for orbital cellulitis?
This is an emergency, requiring urgent intravenous antibiotics and possible drainage of any sinus abscess.
80
What percentage of anterior scleritis is associated with an underlying autoimmune condition?
Nearly 50%
81
What does pinhole testing do when checking visual acuity?
Pinhole use focuses light entering the eye, so it can compensate for refractive errors (up to several dioptres) or conditions that cause glare such as cataract. Visual acuity improvement with pinhole testing, therefore, implies a refractive problem, rather than an organic problem.
82
How important are AF and hypertension as risk factors for stroke?
AF increases risk of stroke 480%
| Hypertension increases risk 140%
83
What is the current immunisation schedule for HPV?
There are hundreds of HPVs, of which types 16 and 18 cause 70% of HPV-related cervical cancers. HPV types 6 and 11 are associated with genital warts.
In the UK, two vaccines are currently used.
-Cervarix immunises against types 16 and 18, and Gardasil immunizes against types 6, 11, 16 and 18.
The current programme schedule involves 3 doses given at 0, 1-2, and 6 months.
Any women under 18 with unknown or incomplete immunization status should complete the course. Those from overseas who are not protected should be offered protection.
84
Who should receive the pneumococcal vaccine?
Infants (PCV13 vaccine)
-8 weeks, 16 weeks and after 1st birthday
Those over 65 (PCV23 vaccine)
Those in high-risk group (PCV23)
- Asplenia or disorders of the spleen (Coeliac, Sickle cell)
- Chronic resp disease (not asthma)
- Chronic heart disease (IHD etc)
- CKD
- Chronic liver disease
- Diabetes (on insulin or oral hypglycaemics)
- Immunosuppression
- Cochlear implants
- CSF leaks (trauma, surgery, any shunts)
85
When does the health visitor take over from the midwife?
When baby is 10 days old
86
What are the diagnostic criteria for Anorexia nervosa?
Weight <85% of predicted (taking into account height, sex and ethnicity) or BMI 17.5 or below
Intense fear of gaining weight, or becoming fat, with persistent behaviour that interferes with weight gain
Feeling fat when thin
87
What is the SCOFF questionaire?
>2 yeses indicates a likely anorexia nervosa or bulimia
Do you ever make youself SICK because you feel too full?
Do you worry you've lost CONTROL over eating?
Have you recently lost more than ONE stone in 3 months?
Do you believe you are FAT when others say you are thin?
Does FOOD dominate your life?
88
What antibiotics do you use for UTI in pregnancy?
As first choice antibiotic consider prescribing:
-Nitrofurantoin (avoid at term) 100mg modified-release twice a day for 7 days if eGFR ≥45ml/minute.
As second-choice (no improvement in lower UTI symptoms on first-choice taken for at least 48 hours or when first-choice not suitable) consider prescribing:
- Amoxicillin (only if culture results available and susceptible) 500mg three times a day for 7 days.
- Cefalexin 500mg twice a day for 7 days.
For alternative second-choices discuss with local microbiologist.
89
What contraceptive method is the best for young people?
Long-acting is clearly best in young people so that they actually take the stuff
However, there are some concerns about the effect of progesterone-only injections (Depo-provera) on bone mineral density and the UKMEC category of the IUS and IUD is 2 for women under the age of 20 years, meaning they may not be the best choice
The progesterone-only implant (Nexplanon) is therefore the LARC of choice is young people
-It contains 68mg of etonogestrel.
90
When should people get STI testing after unprotected sexual intercourse?
Should be advised to get tested 2 and 12 weeks after episode
91
When should you consider referral for children with bronchiolitis?
Respiratory rate of over 60 breaths/minute.
Difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume).
Clinical dehydration (indicated by reduced skin turgor and/or a capillary refill time of more than three seconds, and/or dry mucous membranes, and/or reduced urine output). (5-10% dehydration)
Factors that should lower the threshold for hospital admission include:
- Chronic lung disease (including bronchopulmonary dysplasia).
- Haemodynamically significant congenital heart disease.
- Neuromuscular disorders.
- Immunodeficiency.
- Age under three months.
- The infant having been born prematurely, particularly before 32 gestational weeks.
Factors that might affect a carer's ability to look after a child with bronchiolitis, such as adverse social circumstances, or concerns about the skill and confidence of the carer in looking after a child with bronchiolitis at home, or the carer being able to spot red flag symptoms.
Longer distance to healthcare in case of deterioration.
92
What are the contraindications to the COCP?
Breastfeeding <6 weeks postpartum (after that should be fine)
Non-breastfeeding <6 weeks postpartum (unless after the first 3 weeks and no risk factors)
Smokers 35 or older (unless they haven't smoked in over 1 year)
BMI 35 or larger
Complicated organ transplant (graft failure, rejection etc)
Multiple risk factors for CVD (such as smoking, diabetes, hypertension, obesity and dyslipidaemias)
Hypertension, AF, bacterial endocarditis, pulmonary hypertension, impaired cardiac function (cardiomyopathy)
History of VTE, current VTE, or family history of VTE in first-degree relative <45
Known thrombotic mutation (Factor V leiden etc)
Migraine with aura
BRCA mutation or past history of breast cancer, or undiagnosed breast lump/ symptoms
93
What are the contraindications for the copper coil/ LNG-IUS?
Insertion between 48 hrs and 4 weeks (put coil in straight away or 1 month after birth)
Postpartum sepsis
Unexplained vaginal bleeding
Gestational trophoblastic disease w/ persistently elevated levels of hCG levels or malignant disease
Cervical cancer awaiting treatment
Endometrial cancer
Disordered uterine cavity (abnormality to shape etc)
Current pelvic inflammatory disease or any STIs
(must test prior to insertion)
Pregnancy
(must test prior to insertion)
94
What are the 3 types of oral contraceptive pill?
MONOPHASIC
Identical pills are taken every day for 21 days, followed by a 7 day gap. This is repeated in a 28 day cycle. The gap allows a withdrawal of hormones that leads to a normal menstrual period.
Microgynon: ethinylestradiol and levonorgestrel
Yasmine: ethanol estradiol and drospirenone
E.G. Yasmine, Microgynon, Cilest, Marvelon.
PHASIC
Similar to monophasic: one pill per day for 21 days, followed by a 7 day gap. The difference is that the pills contain varying amounts of hormone, to closer match the normal changes in hormones over the menstrual cycle, therefore the correct pills need to be taken at the correct time (in order).
E.G. Logynon
EVERY DAY
These are monophasic pills, but the pack contains 7 inactive (sugar) pills, making it easier for women to keep track of their pill by simply taking them in order every day.
E.G. Microgynon ED
95
What are the common side effects of the COCP? What are the risks you have to make women aware of?
Common Side Effects (usually improve over time)
- Breakthrough bleeding / spotting
- Headaches / migraines
- Breast tenderness
- Changes to libido
- Improving / worsening acne
Risks
- Hypertension
- Thrombosis (DVT / PE / acute coronary syndrome / stroke)
- Increased risk of breast cancer (however the pill reduces the risk of endometrial, ovarian and colon cancer)
96
Women who miss one COCP should just take the dose ASAP even if it means taking 2 at the same time. No other precautions needed.
What do they do if they miss more than one pill?
Take the most recent missed pill as soon as possible (even if two at the same time).
They need additional contraception (i.e. condoms) or abstinence until they have taken the pill again for 7 days straight (although this is theoretically not required if missed between day 8-21 of the pack and otherwise compliant).
If day 1-7 of the packet then they need emergency contraception if they have had unprotected sex
If day 8-14 of the pack (and day 1-7 was fully compliant) then no emergency contraception is required
If day 15-21 of the pack (and day 1-14 was fully compliant) then no emergency contraception but they should go back to back with their next pack of pills and not take the pill free period.
97
What are the two types of POP?
When do they need to be taken each day?
This is especially common in African-Caribbean and South Asian children in the UK who are breastfed for a prolonged period.
This is because dark-skinned people absorb less sunlight and there is less conversion of 7-dehydrocholesterol to previtamin D3. This results in even lower levels of vitamin D in breast milk.
98
What are the side effects of the POP?
```
Irregular bleeding (40%) or amenorrhea (20%)
Breast tenderness
Headache
Change in libido
Acne
```
99
What are the downsides to intrauterine devices/ systems (copper coil and mirena)?
Copper coil:
-Can increase periods and cause intermenstrual bleeding (often settles over time and can make periods lighter long term).
Mirena:
- Can cause spotting or irregular bleeding
- Alternative contraception is required for 7 days.
Both:
- Rarely causes uterine perforation or pelvic inflammatory disease on insertion
- Increases risk of ectopic pregnancies
- There is a small risk of uterine perforation during insertion of intrauterine devices.
- Intrauterine devices can occasionally fall out.
100
What are the side effects and risks of Depo-provera?
Common side effects
- Amenorrhea (periods can get lighter or stop altogether).
- Irregular bleeding / spotting
- Weight gain (no other contraceptive methods have a proven association with weight gain)
- Acne
Risks
-Osteoporosis
101
Technically when do women not require contraception after pregnancy?
Women do not need contraception until 21 days after birth
Lactational amenorrhea (full breastfeeding without periods) is 98% effective as contraception up to 6 months
102
How do you manage neonates exposed to VZV?
Neonates with significant exposure to chickenpox or shingles should receive ZIG as soon as possible.
103
When do you need to carry out a pelvic examination for menorrhagia?
The National Institute for Health and Care Excellence (NICE) has provided guidelines on the management of heavy periods. These suggest that in simple heavy menstrual bleeding, the only investigation required is a full blood count to rule out anaemia. A pelvic examination is only required if a structural or histological abnormality is suspected or an intrauterine device is being considered.
104
How do you manage a presentation of TIA?
A TIA is defined as stroke symptoms and signs that resolve within 24 hours.
Patients who present with a TIA need to be assessed to determine whether they are at high or low risk, using the validated ABCD2 (Age, Blood pressure, Clinical features, Duration of symptoms, and Diabetes) tool.
A patient with an ABCD2 score higher than 4 is at high risk and should have specialist assessment and investigations, such as cholesterol and carotid Dopplers, within 24 hours.
Patients with a score of 3 or less or who present more than 1 week after the event should have specialist assessment and investigation within 1 week.
All patients should be started on 300 mg aspirin unless this is contraindicated.
105
What is the eGFR cut off for use of SGLT2 inhibitor?
SGLT2 inhibitors are not licensed for initiation with a GFR less than 60.
106
When is pioglitazone contraindicated?
```
heart failure or history of heart failure
hepatic impairment
diabetic ketoacidosis
current, or a history of, bladder cancer
uninvestigated macroscopic haematuria.
```
107
What are the options for type 2 diabetes not controlled on metformin alone?
metformin and a DPP-4 inhibitor or
metformin and pioglitazone or
metformin and a sulfonylurea
108
How common are laryngeal nerve palsies in laryngeal cancer?
About one-third of recurrent laryngeal nerve palsies are caused by cancers, and 40% of these are in the larynx. The risk is increased in smokers. The left recurrent laryngeal nerve has a long course and loops down under the arch of the aorta in the chest, so it may be affected in malignant tumours of the mediastinum.
109
How can ear discharges help to localize problems?
Otitis externa produces a scanty discharge, as there are no mucinous glands
o Blood can result from trauma to the canal and liquid wax can sometimes leak out
Mucous discharges are almost always due to middle ear disease
o Serosanguinous discharge suggests a granular mucosa of chronic otitis media
o An offensive discharge suggests cholesteatoma
110
How do you tell if a fluid is CSF?
CSF otorrhoea/ leaks should be suspected if you see a halo sign on filter paper, or glucose is increased on dipstick
B2 (tau) transferrin testing can be used to confirm the diagnosis
111
What are the common causes of BPPV?
Idiopathic
| Any trauma to the head
112
Temporal bone fractures commonly cause what symptoms?
Temporal bone fracture causes severe dizziness, often associated with facial nerve palsy and hearing loss.
113
How can hypothyroidism affect voice?
Hypothyroidism can cause oedema of the vocal cords, and therefore hoarseness.
Thyroid dysfunction can also cause hoarseness due to pressure from a goitre.
The list of causes of hoarseness is long, and therefore you need to look out for other clues in the history and examination
114
How is the ear typically displaced in mastoiditis?
Inferior and laterally
115
What is a sanguineous discharge from the ear indicative of?
Bloody discharge indicates a squamous cell carcinoma. The tumour tissue is friable and can bleed easily on contact.
116
What is a glomus tumour?
A glomus tumour, or non-chromaffin paraganglioma, is a rare vascular benign tumour that arises from the glomus body (a small collection of paraganglionic tissue). These tumours often occur in the middle ear.
Because of blood flow, the tinnitus is pulsatile. A mass may also be felt in the ear. Glomus tumours can also occur in the carotid body but would not give these symptoms.
117
How can rheumatoid arthritis affect the voice?
The cricoarytenoid joints rotate with the vocal cords, so arthritis here causing stiffness can affect the pitch and tone of the voice. This has been reported in 17–70% of patients with rheumatoid arthritis, and airway obstruction by swelling is a rare, but serious, complication.
118
What lump does an atypical mycobacterium infection cause?
The characteristic appearance of this infection is an enlarging, nontender, violaceous mass. It does not disappear following antibiotic use. It is rare but should be considered.
119
What investigation is gold standard for a suspected inhaled foreign body in children?
Microlaryngoscopy and bronchoscopy
120
What is the treatment for seborrhoeic dermatitis of the beard or scalp?
Ketoconazole 2% shampoo (twice a week for 4 weeks, then once every 1-2 weeks for maintenance) or selenium sulphide shampoo (twice a week for 2 weeks [contraindicated in pregnancy])
If the person has severe itching of the scalp:
-Consider co-prescribing a short course (maximum 4 weeks of treatment) of a topical corticosteroid scalp application such as betamethasone valerate 0.1% or mometasone furoate 0.1% once a day.
Other medicated shampoos such as zinc pyrithione, coal tar, or salicylic acid can be used, if ketoconazole or selenium sulphide are not appropriate or acceptable to the person
121
How do you treat seborrhoeic dermatitis of the skin or face?
For adults, treat seborrhoeic dermatitis of the face and body with:
-Ketoconazole 2% cream (once or twice a day) or another imidazole cream (clotrimazole or miconazole) for at least 4 weeks. An antifungal shampoo such as ketoconazole 2% can be used as body wash.
Advise the person that once they feel symptoms are under control, ketoconazole cream can be used less frequently (for example twice a week, once a week, once every other week) to prevent recurrence.
Consider adding in a mildly potent topical corticosteroid such as hydrocortisone 0.5% or hydrocortisone 1% for flares to help settle inflammation.
-Mild topical corticosteroids should only be used short-term (one to two weeks — consider the potential for adverse effects (for example thinning of the skin).
122
How do you differentiate psoriasis and lichen planus?
The extensor aspects of the elbows are involved—a classic site for psoriasis. The additional information of the nails and scalp gives the final clue of psoriasis and should always form part of the examination of the dermatology patient. Lichen planus (LP) can affect the nails, from dystrophy to total nail destruction, which is different from pitting. LP can, in addition, also affect the scalp with a form of scarring alopecia, which is quite different from the thick scale of scalp psoriasis. LP and psoriasis both koebnerize, but LP classically affects the volar aspect of the wrist and can also affect mucosal surfaces.
123
What are the two Hutchinson's signs?
Of the nose
-Predicts ocular involvement in herpes zoster
Of the nail
-subungal melanoma where the lesion spreads beyond the nail to involve any surrounding skin.
124
What is Auspitz sign?
The Auspitz sign is small areas of bleeding when removing scale from plaques, which may indicate psoriasis.
125
How do you differentiate bullous pemphigoid and pemphigus vulgaris?
Pemphigus vulgaris
- Eroded areas from superficial blisters that have burst (Nikolski's sign)
- The skin around the eroded areas is normal (in contrast, in bullous pemphigoid, it is erythematous).
- Erosions on mucosal surfaces further support the diagnosis of pemphigus vulgaris.
126
What is the treatment ladder for acne?
Mild-moderate
- A topical retinoid (e.g. adapalene alone or in combination with benzoyl peroxide. Retinoids are contraindicated in pregnancy and breastfeeding.
- A topical antibiotic (for example clindamycin 1%) — antibiotics should always be prescribed in combination with benzoyl peroxide to prevent development of bacterial resistance.
- Azelaic acid 20%.
Consider adding an oral antibiotic such as lymecycline or doxycycline (for a maximum of 3 months).
-A topical retinoid or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing.
COCP may be used in women
Oral isotretinoin last line
127
What are the side effects of isotretinoin?
Dry skin and lips
Photosensitivity of skin to sunlight
Strongly teratogenic (harmful to the fetus during pregnancy) and patients should be careful to use contraception and must stop isotretinoin for at least a month before becoming pregnant.
Depression, anxiety, aggression and suicidal ideation.
-Patients should be screened for mental health issues prior to starting treatment.
Rarely Stevens-Johnson syndrome and Toxic Epidermal Necrolysis
128
What is Lupus Vulgaris?
Lupus vulgaris is cutaneous tuberculosis
| -has a very distinctive appearance.
129
How do you differentiate pityriasis alba and vitiligo?
The patches have an indistinct border and are hypopigmented (not sharp-edged and depigmented, as would be seen in vitiligo).
This is pityriasis alba, which occurs on the faces of children with atopic eczema. It improves with treatment with emollients and mild topical corticosteroid creams.
130
What is melasma?
What is the treatment?
The safest treatment is to advise the daily use of sunblock. Sunshine makes this condition worse.
Some women develop melasma while pregnant or when taking the oral contraceptive pill.
131
What kind of drug is atropine?
anticholinergic
132
What is the proper name for a trauma mask?
Face mask with non-rebreather valve and reservoir bag
133
How do you confirm oesophageal intubation?
Oesophageal intubation could be confirmed by auscultating over the stomach and hearing air entry when hand-ventilating the patient.
134
What are the types of blood you can use in emergency?
Fully cross-matched blood, which usually takes up to 45 minutes to become available. This blood will be thoroughly matched for the patient’s blood group (A, B, AB, or O), rhesus D status (negative or positive), and the rarer antibodies/antigens.
Type-specific blood takes about 20 minutes to become available and is matched for blood group and rhesus D status, but not for the rarer antibodies/antigens.
Group O rhesus-negative blood (universal donor blood) should be available immediately in most clinical areas but carries the risk of the patient raising antibodies to the rarer antigens, which can cause problems with future blood transfusions. The decision as to which blood to request will depend upon the level of clinical urgency.
135
What are the main causes of heat loss during surgery?
Radiation accounts for approximately 40% of the heat lost from the body. In addition, convection (30%), respiration (including humidification) (20%), and conduction (10%) are all important, and their relative contributions vary, depending on the environment. Space blankets are designed to reduce heat loss from radiation.
136
What increases the risk of a sickle cell crisis during surgery?
Use of a tourniquet is associated with precipitation of sickle cell crisis. If a tourniquet must be used, the limb should be thoroughly exsanguinated prior to inflation.
IV fluid therapy, opioid analgesia, oxygen therapy, and prophylactic antibiotics can all be utilized to decrease the risk
137
What is the clinical criteria for pre-eclampsia?
This condition is diagnosed after 20 weeks’ gestation when there is:
- hypertension (systolic blood pressure greater than 140 mmHg and/or diastolic blood pressure greater than 90 mmHg) or
- a rise in systolic blood pressure of more than 30 mmHg or
- a rise in diastolic blood pressure of more than 15 mmHg, compared with the booking blood pressure,
AND
Greater than 300 mg/dL per 24 hours of protein in the urine (in practical terms, more than 2+ on urinalysis).
138
How is the parkland formula?
Parkland formula: for the first 24 hours after the burn, give 4 mL/kg per % BSA burn of Hartmann’s solution. Give half of this volume in the first 8 hours after the burn, and the other half in the next 16 hours.
139
Where do the majority of organ donations come from?
Does a patient have to be on the donor register?
What if the next of kin doesn't want organs donated?
The majority of organ donations in the UK occur from heart-beating donors. The use of non-heart-beating donors is increasing in the UK but is still relatively uncommon.
A patient does not have to be registered on the organ donor register to donate organs, but if they expressed the view that they would not want to donate organs during life, this decision is usually honoured.
If a patient expressed the view that they wanted to donate their organs, but their living next of kin were against organ donation, it is unlikely that organs would be taken.
140
What drug is used as an anti-emetic during surgery?
Dexamethasone (a corticosteroid) is commonly used as an anti-emetic. It is usually given intra-operatively, as it is associated with unpleasant side-effects when given to patients who are awake.
141
What drugs are used in palliative care to prevent secretions?
Anticholinergic drugs (e.g. hyoscine) are routinely used for their antisialagogue effect, particularly in the palliative care setting. Acetylcholine is the neurotransmitter at muscarinic receptors of the parasympathetic nervous system, responsible for control of secretions. Therefore, anticholinergic drugs will block this pathway.
142
What is Fox's sign?
Discolouration of the inguinal crease
Another sign of retroperitoneal haemorrhage along with Cullen's sign = periumbilical
Grey-Turner's sign = on the flanks
143
When do you use anti-retrovirals for bell's palsy?
When it is ramsay hunt syndrome
Treat with aciclovir
144
What are the features of brown-sequard syndrome?
An injury causing a hemisection of the cord will lead to loss of motor function, proprioception, and fine touch on the same side as those fibres have already crossed at a higher level.
However, the contralateral pain and temperature sensation is affected for areas below the level, as they cross at the spinal cord itself.
145
What are the mucopolysaccaridoses (MPS)?
Mucopolysaccaridosis (MPS) includes Hurler’s and Hunter’s syndrome
These cause a build up of large sugar molecules – mucopolysaccharides, now known as glycosaminoglycans (GAGs) – in tissues in the body dur to an enzyme deficiency
MPS 1 = Hurler’s = autosomal recessive
MPS 2 = Hunter’s = X-linked
Symptoms are progressive and range in severity
Severe forms present in the first year of life with features due to tissue build up
- Organomegaly, skeletal deformity, coarse facial features and macroglossia, hernias, cardiomyopathy.
Poor feeding is likely due to large tongue, bulbar dysfunction, and spiration.
Urine testing is a useful part of a metabolic work up in children when an inborn error of metabolism is suspected
Excess GAGs will leak out of the urine giving a clue to the diagnosis
146
What should all patients with rheumatoid arthritis have pre-op?
Any patients with rheumatoid arthritis should have anteroposterior and lateral radiographs of the cervical spine done pre-op because of intubation challenges
147
What are the risk factors for developmental dysplasia of the hip?
- female gender
- first born
- foot first (breech)
- family history
- further bony abnormalities (e.g. talipes equinovarus)
148
What are the causes of a +ve Trendelenburg test?
It is caused by weak abductor muscles, a dislocated hip, or the absence of a stable fulcrum.
149
When should antibiotic prophylaxis be given during surgery?
● clean surgery involving the placement of a prosthesis or implant
● clean-contaminated surgery
● contaminated surgery.
150
What are the features of a club foot?
A full club foot involves the ankle (talus) and foot (pes), and is equinus (the heel is elevated like that of a horse) and cavus (with an exaggerated arch). It is varus (turned inward) and adducted (moved towards the midline). It cannot be moved through the normal range of movements, and the Achilles tendon is tight and the calf muscle shortened.
151
What is the nerve root for the long thoracic nerve?
Serratus anterior
C5, C6, C7 raise your arms up to heaven
152
What does the musculocutaneous nerve supply?
BBC
Biceps
Brachialis
Coracobrachialis
153
What are the superficial forarm flexors?
Players Follow Pimps For Fun
```
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis
```
154
What muscles does the radial nerve supply?
BREAST
```
BrachioRadialis
Extensors
Anconeus
Supinator
Triceps
```
155
What are the 3 hand deformities from nerve injuries?
DR CUMA
Drop wrist = Radial nerve
Claw hand = Ulnar nerve
Median nerve = Ape hand
156
What are the borders of the femoral triangle?
So I May Always Love Surgery
Superior (Inguinal),
Medial (Adductor longus)
Lateral (Sartorius)
157
What are the external hip rotators?
Pretty Girls Often Grow Old Quickly
```
Piriformis
Gemellus Superior
Obturator internus
Gemellus inferior
Obturator externus
Quadratus feoris
```
158
What are the foot everters and inverters?
Everters = pErineus longus/ brEvis/ tErtius
Inverters = tIbialis posterior/ anterior
159
What are the structures behind the medial malleolus?
Tom, Dick and A Very Nervous Harry
```
Tibialis posterior
flexor Digitorum longus
Artery (posterior tibial)
Vein (posterior tibial)
Nerve (posterior tibial)
Flexor hallucis longus
```
160
What systemic diseases should be screened for in MSK history?
RPT - MSK - DHS (repeat MSK dynamic hip screw)
Rheumatic fever (childhood arthritis)
Psoriasis
TB
MSK disorders (SLE, hypermobility, malignancy, OA)
Diabetes
Hypo/ Hyperthyroidism and other metabolic bone Dx)
STI (reactive arthritis -> Reiter's syndrome)
161
What is tarsal coalition?
Coalition—an abnormal connection between the tarsal bones— commonly presents in adolescence as the connection ossifies with growth of the child. Often there is a history of repeated ankle sprains and difficulty walking on uneven ground.
162
After intracapsular hip fracture who qualifies for a total hip replacement?
Patients who were able to walk independently outside with the aid of no more than a stick, who are not cognitively impaired, and who are medically fit for anaesthesia and surgery should be offered a total hip replacement.
163
What is the most commonly damaged nerve in supracondylar fractures? What does this nerve supply?
The AIN supplies the deep muscles of the forearm (flexor pollicis longus, lateral half of the flexor digitorum profundus, pronator quadratus). Damage to the AIN results in loss of pronation of the forearm, weakness in wrist flexion, and inability to flex the thumb.
May also get parasthesia if fracture involves the palmer cutaneous branch
-there is loss of sensation in the lateral palm and the radial three-and-a-half digits.
164
What clinical signs differentiate ectopic and miscarriage?
In a miscarriage, products of conception can build up behind the cervical os and cause pressure. The cervix has many stretch receptors, and when it is trying to dilate, it can stimulate the vagus nerve, causing haemodynamic instability. This causes bradycardia because of the vagal stimulation, rather than the tachycardia that is seen in severe blood loss.
165
What dressing is recommended after debridement?
Non-adherent dressing
166
What are the contraindications to NIV?
Unable to wear mask due to facial trauma or burns
Actively vomiting or have epistaxis
Decreased conscious level
Unable to protect airway
Untreated pneumothorax
