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Last min > Psych, obs and gynae, stats > Flashcards

Psych, obs and gynae, stats Flashcards

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1
Q

Dementia vs depression

A

rapid onset
weight loss/sleep disturbance
global memory loss
Variable MMSE

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2
Q

Thought disorders

A

circumstantiality: excessive detail but eventually answers q
tangentiality: off topic
neologisms: new word formations
clang associations: rhyme
word salad: incoherent speech
knights move thinking: unexpected leaps of ideas (schizophrenia)
flight ideas: links between leaps
echolalia: repetition

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3
Q

Symptoms mania

A

IDIGFASTER
Irritable
Distracted/disinhibited
Insight impaired
Grandiose delusions
Flight ideas
Activity increased
Sleep decreased
Talkative
Elevated mood
Reduced concentration

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3
Q

Mx OCD

A

via YBOCs scale
mild: ERP CBT +/- sertraline 12 weeks and review in 1 week
sev: clomipramine + secondary mental health referral

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4
Q

Mx acute stress disorder

A

CBT
benzos

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5
Q

Symptoms of depression

A

core: low energy, anhedonia, low mood
cognitive: poor conc, suicidal
biological: worse morning, early morning wakening, appetite
psychotic: poverty/guilt/nihilism delusions, hallucinations

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6
Q

PHQ9 + mx

A

<16 = less severe: self help, cbt, ssris
16 or more = severe: cbt + ssri

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7
Q

Mx post mental health admission

A

Referral for CPN (comm psychiatric nurse)
Referral for outpatient psych clinic
Referral to crisis for initial discharge support
CBT
Support groups
Lifestyle advice on sleep, alc, mindfulness etc

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8
Q

Strongest risk factor for schizophrenia

A

fx

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9
Q

First line mx for alc withdrawal

A

chlordiazepoxide
lorazepam if liver cirrhosis

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10
Q

Symptoms of PTSD

A
  1. reliving - flashbacks/hall
  2. avoidance
  3. hyperarousal
  4. emotional numbing
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11
Q

Unexplained symptoms

A

somatisation: multiple physical symptoms
hypochondriasis: belief of serious disease
conversion/functional: motor/sensory loss
dissociative: seperates off certain memories
factitious: intentional
malignering: exaggeration of symptoms for financial gain

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12
Q

Medication to treat tardive dyskinesia

A

tetrabenazine

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13
Q

Mx PTSD

A

If <3 months CBT
If >3 months CBT/ EMDR +/- venafalaxine

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14
Q

Symptoms GAD

A

WATCHERS
worry
autonomic hyperactivity
tension muscles
conc dec
headache
energy loss
restless
sleep disturbance

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15
Q

Organic causes of psychosis

A

drugs
meds: steroids, levodopa
delirium/dementia
b12 deficiency

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16
Q

Schneiders first rank symptoms

A

passivity phenomenon
thought interference
3rd person auditory hallucinations
delusional perception

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17
Q

Definition BPAD

A

1 episode mania/hypomania and another mania/depression

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18
Q

Ix to do before starting methylphenidate

A

hr/bp
height/weight
fbc
lfts
ecg

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19
Q

SSRI for child

A

fluoxetine

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20
Q

Triad for acute dystonia

A

torticolis
trismus
oculogyric crisis

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21
Q

What are principles of MHA

A
  1. existing MH condition
  2. risk to self/others
  3. relapsing/remitting
  4. hospital only option
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22
Q

Sections

A

5(4): detain inpatient 6 hours nurse
5(2): detain inpatient 72 hours consultant
2: 28 days for suspected MH condition via 2 doctors + RMN
3: 6 months if already diagnosed

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23
Q

Indications for ECT

A

depression
mania
catatonia

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24
Interactions with sertraline
nsaids (give ppi), warfarin/heparin (switch to mirtazapine), aspirin, triptans, maois
25
Neuroleptic malig syndrome vs serotonin syndrome
both n+v, confusion, headaches, autonomic hyperactivity, muscle rigidity neuroleptic: hyporeflexia, aki/rhabdomyolysis serotonin: hyperreflexia, myoclonus, dilated pupils
26
SSRI which causes discontinuation syndrome
paroxetine
27
Features of bulimia
normal weight depression irregular periods dehydrated hypokalaemia Russells sign parotid swelling dental erosion
28
COCP contraindications
UKMEC4: - >35years + >15 cigs day - migraine with aura - vte/stroke/ihd/uncontrolled htn - breast cancer - breast feeding <6 weeks UKMEC3: BMI>35 1st degree fx vte <45
29
Emergency levonorgestrel rules
if >70kg or bmi >26 double dose repeat if vomit within 3 hours
30
COCP missed rules
if missed 1 continue as normal if missed 2: - if within first 7 days emergency contraception + 7 days condoms - if week 3: omit pill free period
31
Risks of COCP
cervical cancer/breast cancer vte cvs
32
Contraception age contrsaindications
>40 cocp >45 injection
33
Contraindication to ulipristal acetate
asthma also wait 5 days before starting normal contraception
34
Time before contraception is effective
(if not first day period): instant: IUD 2 days: POP 7 days: COCP, injection, implant, IUS
35
Mx thrush + preg
pessary clotrimazole
36
Features of non specific urethritis
urethritis without identifiable gonococcal 5+ polymorphonuclear leucocytes only oral doxy
37
Mx mycoplasma genitalium
1 week doxy 2 days azithromycin (or 7 days moxyflucloxacillin if macrolide resistant)
38
Mx genital warts
topical podophyllium/imiquimod if preg then cyrotherapy
39
Symptoms of syphilis
primary: chancre, inguinal lymphadenopathy secondary: systemic lymphadenopathy, fever, maculopapular rash on palms, condylomata late tertiary: gummas, aortitis, neurosyphilis (tabis dorsalis, argyll)
40
Ix and Mx for syphilis
dark ground microscopy = spirochetes im benzathine benzylpenicillin
41
Screening criteria
condition should be high freq + severity test must be simple + safe intervention leads to better outcome screen is ethically acceptable adequate facilities
42
definition of sensitivity vs specificity
sensitivity: proportion of people who have the disease who test + specificity: proportion of people who dont have the disease who test -
43
Incidence vs prevalence
incidence: number new cases of disease arriving in a population in a given time prevalence: all cases of disease existing in a population at a given time
44
likelihood ratio
sensitivity / (1-specificity)
45
number needed to treat
1/ absolute risk reduction
46
Mx hyperemesis g
promethazine nacl + kcl bland food, p6 acupuncture thiamine vte prophylaxis PUQE questionnaire
47
Definitive mx for adenomyosis
hysterectomy
48
Risk factors for endometrial hyperplasia
post menopausal late menopause/ early menarche tamoxifen thyroid pcos diabetes
49
Risks of HRT
vte (not transdermal) breast cancer (cocp) stroke (oest) chd (cocp)
50
Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus
adenomyosis
51
Drug to take whilst waiting for surgery for fibroid
gnrh agonists
52
Complications of ovarian hyper stimulation syndrome
hypovolaemic shock acute renal failure vte
53
1st line for dysmenorrhoea
nsaids - mefenamic acid
54
Infertility + fibroid
myomectomy
55
Where do ovaries drain
paraaortic
56
First line ix vs GS for ovarian ca
1st line: uss abdo GS: laprotomy
57
Types of ovarian cysts
- follicular: commonest, regresses after several cycles - corpus luteum - dermoid: <30yrs - serous cyst adenoma: resembles ovarian cancer - mucinous cyst adenoma: can become very large - fibroma: in meigs syndrome
58
Meigs syndrome
ovarian mass (fibroma) ascites pleural effusion
59
Risk of malig index RMI
uss menopausal status ca125
60
Mx PID
IM ceft 2 weeks doxy + metronidazole
61
1st line ix vs GS ix for ovarian torsion
1st line: pelvic uss + doppler (free fluid + whirlpool) GS: lapro
62
Features anorexia
hypokal enlarged saliv glands arrythmias/ bradycardia peripheral neuropathy osteoporosis hypothermia lugano hair
63
Features refeeding syndrome
hypokal hypophos hypomag
64
How long after miscarriage do u take pregnancy test
3 weeks
65
Causes of miscarriage
uterine abnormalities - fibroids coagulopathy - antiphospholipid chromosome abnormalities diabetes thyroid pcos
66
Features of antiphospholipid syndrome
venous/arterial thrombosis recurrent miscarriages anticardiolipin ab thrombocytopenia prolonged APTT
67
Mx antiphospholipid syndrome
low dose aspirin if had a thromboembolic event then lifelong warfarin 2-3 INR if pregnant: low dose aspirin and then add on LMWH when fetal heart beat seen on uss
68
Features molar pregnancy
severe n+v thyrotoxicosis (hcg mimics tsh) enlarged uterus pelvic uss snowstorm low tsh, high t4
69
When do to preg test after abortion
2 weeks via multi level test
70
MOA mifepristone + misoprostol
mifepristone: progesterone rec antag - weakens attachment to endometrial wall + cervical softening/dilatation misoprostol: prostaglandin analogue - causes contraction of myometrium to expel
71
Mx uterine hyperstimulation
remove vaginal prostaglandins stop oxytocin infusion consider tocolysis
72
When to give iv benzylpenicillin during labour
+ gbs swab previous preterm labour pyrexia
73
Mx PPROM
admit oral erythromycin 10 days or until in labour if <35 weeks dexamethasone if >34 weeks consider delivery iv mg sulphate if 24-29 weeks
74
When to do external cephalic
36 weeks 1st baby 37 weeks multip
75
Contraindications to external cephalic
ruptured membranes multiple preg major uterine abnormality abnormal ctg <7 days since haemorrhage
76
Risks of twin pregnancies
mum inc risk of htn, anaemia, pph twin-twin transfusion syndrome premature congenital abnormalities
77
Mx cord prolapse
push head back in all 4s minimal handling + keep moist fill bladder
78
Scoring of bishops
if >6 will go into natural Labour so amniotomy + iv oxytocin if <6 unlikely so dinoprostone
79
Prevention of preeclampsia
if 1 high or 2 mod risk factors 150mg aspirin 12 weeks -> delivery
80
When to give 5mg folic acid
bmi >30 fx NTD epilepsy diabetes coeliac
81
Risk factors for VTE in pregnancy
Age > 35 Body mass index > 30 Parity > 3 Smoker Gross varicose veins Current pre-eclampsia Immobility Family history of unprovoked VTE Low risk thrombophilia Multiple pregnancy IVF pregnancy If >3 then LMWH 28 weeks until 6 weeks pp
82
Categories for c section
1. immediate threat to life - within 30 mins 2. compromise - within 75 mins 3. both stable 4. elective
83
SSRIs to give in post partum depression
paroxetine sertraline
84
Risk factors of placenta praevia
previous c section ivf smoking multiparity >40 multiple pregnancy
85
Mx polyhydraminos
indomethacin before 32 weeks amnioreduction
86
Risk factors for placental abruption
>35yrs multiparity pre-ec/htn previous antiphospholipid syndrome smoking
87
Mx obstetric cholestasis
ursodeoxycholic acid emollients chlorphenamine water sol vit k deliver 37 weeks
89
Disseminated gonococcal infection triad
= tenosynovitis, migratory polyarthritis, dermatitis
90
How does each component of virchows triad increase risk of DVT in pregnancy
Venous stasis: uterus compresses on pelvic veins endothelial damage: if obese or multiparous or previous venous damage hypercoagulable: increase in clotting factors in pregnancy
91
Mx DVT in pregnancy
**treatment dose** LMWH - need to monitor factor Xa during bc obesity and pregnancy can affect its bioavailability. Need to check fbc, clotting, u+es before starting.
92
Mx PPH (>500ml)
1. A-E - lie flat, cannulas, g&s 2. rub uterine fundus + catheter 3. iv oxytocin 4. ergometrin (not in htn) 5. carboprost IM (not if asthma) 6. surgical balloon tamponade
93
Manoveures for shoulder dystocia
mcroberts wood screw zavanelli episiotomy
94
Classes perineal tears + mx
1st = minora = no repair 2nd = perineal muscles = ward suture 3rd = anal sphincter = theatre 4th = rectal mucosa
95
PCOS blood results
raised LH:FSH ratio testosterone may be normal or mildly elevated SHBG is normal to low
96
Complications of pcos
infertility endometrial cancer - cocp!! cvs disease gestational diabetes
97
biggest risk factor for ddoh
female

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