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Flashcards in Pad notes for First Two Rotations Deck (121):
1

How long do you have to wait after C-section before you can get pregnant again and why?

1 year because you have to wait for the womb to heal

2

How to manage a C-section scar

Massage it after shower to avoid fibrosis of the scar and it being pulled inwards - to get a thin and white scar

3

Insertion of IUD after birth

Can't insert IUD before 3 months after birth because womb is not back to its normal size and it will be expulsed

4

Risk factors for late miscarriage x3

Scars on uterus
Previous late miscarriages
Fibroma or mass in uterus

5

Where is affected with hydra-adenitis?

Groin, armpits, between buttocks, labia, below breasts, on buttocks

6

What happens with hydra-adenitis?

Abscesses, swelling, pain and boils

7

Treatment of hydra-adenitis?

Infliximab treatment, 4-weekly infusions

8

What vitamin are all babies given and why?

All babies are given vitamin K because they don't have vitamin K stores
Therefore give any child with prolonged clotting extra vitamin K, check 6 hours later and liver should have had time to synthesise vitamin K

9

What sort of milk do children with chronic liver disease get?

Milk with MCT's (medium chain triglycerides) in it because they are water soluble therefore more easily absorbable

10

What is galactosemia?

Rare genetic disorder that affects an individuals ability to metabolise galactose leading to toxic levels of galactose-1-phosphate

11

Symptoms of galactosemia?

Galactosemia leads to hepatomegaly, cirrhosis, renal failure, cataracts, vomiting, seizure, hypoglycaemia, lethargy, brain damage and ovarian failure

12

Management of galactosemia

Stop breast milk to cure

13

Why is EBV bad in immunosuppressed patients and what happens pathologically?

Because T cells are low when immunosuppressed therefore get EBV B cells and these colonially expand because there are no T cells stopping them - therefore get lymphadenopathy from B cell proliferation

14

What is Sandifer syndrome?

Syndrome of gastro-oesophageal reflux and neurological symptoms

15

Symptoms of Sandifer syndrome?

Spasmodic torticolis and dystonia and gastro symptoms

16

Treatment of Sandifer syndrome

Treatment of associated underlying disease eg. GORD or hiatus hernia

17

What do you worry about with seizures in a child

Neurological problem - eg. neuro migrational disorder etc. always do MRI
Infection - eg.meningitis
Cardiac - look for cardiac SVT - floppy, sweaty and pale
Metabolic - check glucose, lactate, ammonia, amino acids, u&e's, cardinitine

18

What do you query if child is not moving arm in first few months

Surgical trauma eg. clavicle fracture most common
Or NAI

19

When are febrile convulsions seen?

5/6 months to 5/6 years

20

Characteristics for febrile convulsions x5

Temperature just needs to be high
Need to normalise after seizure
Duration 1 then complex febrile seizures)

21

Risk of having a second febrile seizure if you have a first

30% risk of another seizure

22

How do you do neonatal MRI

Feed and wrap or General Anaesthesia

23

What do you give for status epilepticus in children

Diazepam is not given
Lorazepam if access or rectal

24

Another name for metopic synostosis and what is it?

Trigonocephaly - premature fusing of the metopic suture causing a triangular shape to the forehead

25

What does valproate to do lamotrigine?

Valproate increases lamotrigine half-life
All enzyme inducers do this to lamotrigine

26

What effect can topiramate have on kidney

(Treatment for tonic clonic)
It can cause renal stones

27

What type of pain do you get with Gall Stones?

Colicky (coming and going) RUQ pain and jaundice

28

What is Gilberts syndrome

GAL 1 enzyme dysfunction - high bilirubin in blood - can cause jaundice

29

What is given after splenectomy

Lifelong penicillin because risk of being immunocompromised and risk of pneumococcus infection

30

Type of wheeze in foreign body obstruction

Unilateral, sudden onset and also red in the face

31

What would you see in xray of foreign body

Normally in right bronchus and would see hyperinflation distal to obstruction due to air trapping

32

What would you hear on auscultation in bronchiolitis

More creps and crackles than a wheeze

33

What is burst therapy?

Back to back salbutamol nebulisers to open up the airway

34

What treatment differs between asthma-induced and virus-induced wheeze?

Won't give steroids in virus induced wheeze because they are immunosuppressants

35

When do you get productive cough in children?

After age 5/6 - can't really cough up sputum before this
Therefore for sputum sample will need to do gastric washout

36

What is NPA

Nasopharyngeal aspirate - send to lab to see if growing any viruses

37

Maternofetal risk factors for infection in neonate

Vaginal swab +ve for streptococcus
Maternal fever during pregnancy
Rupture of sac >12 hrs
Meconium in amniotic fluid
Neonatal fever
Antibiotics to mum during birth

38

What is Mesenteric Adenitis?

Swollen lymph glands in the abdomen - causes abdominal pain similar to appendicitis therefore diagnosis of exclusion when appendicitis can be excluded
Usually clears up without treatment

39

Lung infection in child with CRP 160 will pretty much always be ...

...pneumococcus

40

DDX for difficulty breathing and fever in

Ear infection

41

Green vomit

Obstruction

42

Presentation of volvulus

Acute and grave presentation with vomiting and occlusive signs

43

Choking patient develops unilateral wheeze - what should you do

Not do Haemlick because obstruction has passed into the bronchus and can make it worse

44

What should not be given nutritionally before age 1

Salt

45

What do Barlow and Ortalami look for

Hip dislocation due to developmental dysplasia of the hip

46

What is the significance of PCT

Rises early when bacterial infection - doesn't rise in viral

47

What can be confused with cardiomegaly on infant chest x-ray

Thymus gland

48

What does herpes eye infection give

Keratitis - very sore granuley/gritty infection of cornea
Very painful to move eyelid - infant will keep eye shut to avoid pain

49

What do you suspect if recurrent prolonged fever in infants - at least a week every 1/2 months

Ask if it is an inflammatory syndrome

50

Signs of respiratory distress

Intercostal and subcostal pulling
Balancement thoracoabdominal
presternal pulling
Nostrils

51

How will a child with spondylitis present?

Inflammation of joints of backbone - won't be able to stay sitting up because will be too painful

52

What do you suspect if limping and fever

Joint infection

53

Which way should babies sleep?

Not on their front because they do not have the instinct to turn their head if they can't breathe and this can lead to suffocation

54

What is Marshall syndrome?

Genetic disorder of connective tissue that can cause hearing loss.
Areas commonly affected are eyes (uncommonly large), joints and mouth and facial structures

55

When does neck stiffness become significant? (what age)

Before 18months-2 years - therefore before then not very useful

56

How does neonatal colic present?

Crying, abdominal pain, bloated and gas - not really blood in stoold

57

Normal neonatal stool

Semi-liquid with bits in it (yellow/gold) becomes more consistent as mothers milk changes

58

What is Sanfillipo syndrome?

Inability to break down mucopolysaccardies (type of sugar)
Presents later in life, post-2, may have abnormal facies and then neurological problems and marked behavioural problems
Do not usually live past early 20s

59

What is neonatal mastitis

Inflammation of neonatal breast tissue due to hormones from mothers milk - not a problem but can get infected -

60

What happens to proteins with inflammation

All go up except albumin which goes down and transferrin which doesn't change

61

Presentation of bowel invagination

PR bleed, sudden pain, malaise, can lose consciousness

62

Treatment of bowel invagination

Wash out up anus with sodium solution - should undo vagination. If it doesnt then surgery to undo and check for necrotic bowel

63

Minimum 3 things that need assessing in mobility assessment of elderly

Proprioception
Hip flexion and extension
Gait

64

What sort of fracture are osteoporotic fractures?

Low trauma fractures in bones which are normally strong eg.hip, femur, spine and humerus

65

When do Bisphosphonates need to be taken and how? 2 details

Take first thing in the morning on empty stomach because poor bioavailability and food therefore decreases availability of medication
Also upright with large glass of water to reduce risk of oesophagitis

66

Eg of Bisphosphonate

Alendronic acid

67

What dosage can be used for Bisphosphonates?

Once a week large dose

68

Which medication is relevant in dhx for oestoporosis?

Steroids

69

What 3 conditions are risk factors for osteoporosis?

T1DM
Rheumatoid arthritis
Any malabsorption syndrome

70

Social risk factor for osteoporosis x2

Smoking
Drinking >21 units of alcohol a week in women

71

1st step of Who Pain ladder

1) paracetamol regular
+/- NSAIDs if no contraindication

72

4 red flags for bowel Cancer

Change in bowel habits
Blood in stool
Tenesmus
Palpable mass

73

Who is needed to intervene if patient gets pressure ulcer in hospital

Tissue viability nurse

74

4 ways to prevent pressure ulcer in hospital

Rotation every 2/4 hours
Pressure relieving mattress
Prevlon boots
Check elbows, sacrum and heels at least once a week

75

Blood clot prevention in hospital, and change if poor renal function

Enoxaparin LMWH normal
If eGFR is

76

Two molecular indicators of rheumatoid arthritis

Anti-CCP antibody has highest specificity
Rheumatoid factor has high sensitivity but low specificity

77

What does paracetamol regularly need to be based on

Weight - only 1g QDS if >50kg
Also check LFTs

78

Contraindications for NSAIDs x3

Stomach problems, asthma/COPD, kidney problems

79

What sort of pain are NSAIDs good for?

Good for bone pain
Can be given PR to reduce GIT side effects

80

What is step 2 of WHO pain ladder?

Weak opiates (codeine, tramadol, dihydrocodeine)
+ PRN laxatives and antiemetics
Keep baseline paracetamol

81

Step 3 of WHO pain ladder

Strong opioids (morphine sulphate, buprophine, oxycodone, fentanyl, alfentinil, diamorphine)

82

Which is first choice in WHO Step 3 and when is this changed?

Morphine is first choice but if liver/kidney function goes then fentanyl or alfentinil

83

What do you do with step 2 medication when escalating to step 3 of WHO pain ladder?

If just need a bit more pain relief to top up when moving - the keep step 1 and 2 and use anticipatory PRN oromorph
If pain all the time with step 2, then get rid of weak opiate and use strong opiate

84

How do you decide dose for strong opiate in WHO step 3?

Do PRN oromorph, see how much they need. Then add it up and the next day give half in the am and half in the pm and PRN if they need extra

85

What can be added to who pain ladder if neuropathic pain

All away along can give neuropathic pain adjuvants - gabapentin, pregabalin, amitriptyline, carbamazepine

86

Non-pharmacological management of pain x4

TENS machine, hot water bottle, hydrotherapy, CBT

87

Non pharmacological management of nausea and vomiting x2

Ginger
Peppermint water

88

Non pharmacological management of breathlessness x5

Chest physio, handheld fan, relaxation, singing, CBT

89

Pharmacological management of breathlessness

Weak opiates

90

Which is the best laxative for Opiate constipation?

Senna

91

Which antiemetic is not good to give with bowel obstruction?

Domperidone because it is a prokinetic

92

Most common cause of fine crackles on auscultation

Pulmonary fibrosis (IPF, drugs, rheumatoid, chemo)
Sarcoid

93

Which drugs can cause pulmonary fibrosis? X4

Methotrexate, amiodarone, chemotherapy, nitrofurantoin

94

What is nitrofurantoin

Antibiotic used for urinary tract infections

95

Cause of coarse crackles

Chest infection

96

What is indapamide?

Thiazide diuretic (causes k+ loss)

97

What is ondansetron?

Antiemetic used to treat nausea caused by chemotherapy and surgery

98

What is DOLS?

Deprivation of liberty safeguard - keeping against wishes but in best interest
Should be used for basically any patient with dementia who can't leave a hospital

99

What is HNA?

Health needs assessment

100

How can fluids be given in palliative care and what sort?

Can be given SC rather than IV but only saline (not dextrose or Hartmann) and very slowly - 10-12hr bag

101

What do you hear on cardiac auscultation with pulmonary hypertension?

Loud p2 over pulmonary valve area

102

How are left sided murmurs best heard?

In expiration

103

What can occur after the release of renal obstruction?

Post obstruction diuresis - get large electrolyte imbalance

104

Indications for using NG tube x4

Unsafe swallow (smaller feeding tube)
Neuromuscular
Aspiration for obstruction and vomiting (Rialls tube - larger)
Giving medications which can't be given IV eg.betablockers

105

Investigations of causes of a fall x2

Sitting and standing BP
infection screen

106

Investigations of consequences of a fall x2

Ct scan
X-ray for fractures

107

What is needed for capacity according to the mental capacity act x4 stages

Need to understand a clear question
Need to understand risk and benefits
Need to be able to remember long enough to make an informed decision
They need to be able to communicate this decision to you

108

What should be starting point for assessing capacity

Assume they have capacity unless proven otherwise

109

What act comes into play if they lack capacity

Best interest act

110

What is an Advanced Care Plan?

Supposed to influence best interest decisions - not legally binding and can't get sued if you don't use it but you should try to

111

What is an advanced directive which is legally binding?

Advanced decision to refuse treatment - unlike the advanced care plan is is legally binding

112

Sections for discharging patient as part of continuing healthcare checklist

Section 2 needs to be done minimum of 48hours before discharge to prepare package of care
Section 5 done minimum 24hours after section 2 and 24hrs before discharge - means patient is now fit for discharge

113

Effects of long term steroids x5

Bone problems - osteoporosis
Gastritis therefore give PPI
Can cause and derange diabetes
Weight gain
Immunosuppression

114

Side effects of quetiapine

Drowsiness

115

Effect of dementia treatment on MMSE scores

Study showed that MMSE score increased when dementia patients are treated with paracetamol instead of anticholinesterase inhibitors - implying pain may have a role in dementia

116

What is risk associated with c.diff infection

Can cause toxic mega colon which is very dangerous - therefore monitor inflammatory markets and check for bloated abdomen

117

What can occur post prostate treatment

Stress incontinence

118

What is functional incontinence

Because unable to reach the toilet eg. Due to immobility

119

Lifestyle risk factor for gynaecomastia

Increased alcohol intake

120

Causes of mastalgia

Usually no pathological cause - breast cancer is typically painless

121

Scale for risk of breast cancer from examination/investigation

B1 - normal
B2 - something but benign
B3 - something probably benign
B4 - something probably malignant
B5 - something and malignant