Pulsenotes finals Flashcards
1
Q
Management of ruptured ectopic
A
Emergency surgery
2
Q
Management of ectopic pregnancy with severe symptoms
A
Surgery
3
Q
Management of ectopic with very high bHCG
A
Surgery
4
Q
Management of ectopic with low hCG
A
Expectant management
5
Q
Management of ectopic with intermediate hCG
A
Medical management
6
Q
Management of ectopic with high hCG (not very high)
A
Medical or surgical
7
Q
Definition of missed miscarriage
A
Non viable pregnancy but no miscarriage symptoms
8
Q
Definition of threatened miscarriage
A
Viable pregnancy with PV bleeding
9
Q
Definition of inevitable miscarriage
A
Non viable pregnancy with PV bleeding and open os
10
Q
Definition of incomplete miscarriage
A
Os is open but foetus not fully expelled
11
Q
Definition of complete misscarriage
A
Os is closed and foetus expelled
12
Q
Follow-up after expectant misscarriage
A
Pregnancy test after 3 weeks
13
Q
Follow-up after medical misscarriage
A
Pregnancy test after 3 weeks
14
Q
Options for surgical miscarriage
A
Local or general anaesthetic
Manual vacuum aspiration or open surgery (general anaesthetic)
15
Q
Risk factors for ovarian torsion
A
Young female
Enlarged ovaries e.g. PCOS or cysts
16
Q
What does a ruptured endometrioma look like?
A
Chocolate coloured fluid seen
17
Q
Complications of endometriosis
A
Adhesions
Endometrioma
Reduced fertility
Cysts
18
Q
Gold standard for endometriosis diagnosis
A
laparoscopy
19
Q
Investigation of endometriosis
A
USS
MRI
Laparotomy
20
Q
Medical management of endometriosis
A
Analgesia
GnRH agonists
21
Q
Indications for surgery in endometriosis
A
Failed medical management
Surgery indicated for fertility
22
Q
High-risk factors for pre-eclampsia
A
Previous pre-eclampsia Current HTN Autoimmune disease Diabetes CKD
23
Q
Medication given for pre-eclampsia prophylaxis
A
Aspirin
24
Q
Signs and symptoms of pre-eclampsia
A
Proteinuria HTN Persistent headache Vision changes Confusion Abdo pain Oedema
25
Management of pre-eclampsia if over 37 weeks
Induction of labour
26
When to admit patients with pre-eclampsia
BP over 160\110
27
First line medication in pre-eclampsia
Labetolol
28
Second line medication in per-eclampsia
Nifedipine or methyl-dopa
29
Investigations in pre-eclampsia
```
BP
Urinalysis
Bloods
Foetal heart beat
USS
CTG monitoring of foetus
```
30
What is vasa praevia?
Vessels cover the cervical os
31
What meds should be given prior to anticipated pre-term labour?
Steroids or magnesium sulfate (helps with foetal lung maturation)
32
Management of minor antepartum haemorrhage
Admit and observe for 24 hours
33
Causes of post-partum haemorrhage
```
Uterine atony (most common cause of bleeding in the 12 hours after birth
Retention of tissue (most common cause of delayed post-partum haemorrhage)
Trauma
```
34
Management of post partum haemorrhage where uterus isn't contracted (feels soft)
Massage
Synthetic oxytocin
If ongoing, balloon / packing
If still ongoing, surgery
35
Causative organism of bacterial vaginosis
Gardnerella vaginalis
36
Diagnosis of bacterial vaginosis
```
3 out of:
Typical discharge (thin grey)
Clue cells
Positive whiff test
Low vaginal pH
```
37
Microscopic finding in bacterial vagonosis
Clue cells
38
Treatment of bacterial vagonosis
Abx (metronidazole)
| Advice on reducing risk
39
Risk factors for bacterial vaginosis
Young females
Change sexual partner
Excessive hygiene
40
Common symptoms in secondary syphylis
General e.g. fever/ headache
Dermatological (dense red-brown rash on trunk, palms and soles)
GI symptoms e.g. hepatitis
Neurological symptoms
41
Most common form of tertiary syphilis
Cardiovascular (often affects aorta e.g. aortitis)
42
Treatment of syphilis
Single dose of IM penicillin
43
What is the Jarisch-Herxheimer reaction?
Acute febrile illness within a day of syphilis treatment. Usually self-resolves within a day
44
Treatment of chlamydia
Single dose azithromycin or seven days doxycycline
45
Who should be followed-up after chlamydia treatment?
Under 25s should have re-testing in 3-6 months due to high rate or reinfection
46
Treatment of gonorrhoea
Single dose of IM ceftriaxone
47
Age affected by bronchiolitis
Under 2 (usually under 1)
48
Symptoms of bronchiolitis
Cough
Cold-like symptoms
Signs of resp distress
Reduced feeding and wet nappies
49
How to differentiate croup and bronchiolitis
Croup tends to have barking cough
50
Symptoms of croup
Barking cough
Cold-like symptoms
Signs of resp distress
Reduced feeding and wet nappies
51
What is biliary atresia?
Biliary tree not fully formed leads to obstructive jaundice in a newborn
52
Imaging in suspected ovarian cancer (no mass)
Urgent abdo and pelvic USS
53
Sites of dissemination of gonorrhoea
Joints
Skin
Brain
Heart
54
Management of pyloric stenosis
NG tube
IV access, bloods, fluids
Surgery
55
Acute management manic episode
Antipsychotic
| Consider a benzodiazepine
56
Section 2
Patient detained for assessment and treatment for 28 days
57
Platelet count in Henloch-Schonlein purpura
Normal
58
Section 5(2)
Doctor detained person for 72 hours for assessment
59
Management of neuroleptic malignant syndrome
Stop precipitating drug
Cooling and fever control
Symptom relief e.g. manage agitation
60
Symptom of conjunctivitis
Red eye
Discharge
Vision intact
61
What suggests viral conjunctivitis?
Bilateral
62
What symptom suggests allergic conjunctivitis?
Itchy
63
What symptoms suggest anterior uveitis?
```
Pain
Red eye
Gradual loss of vision
Irregular pupil
Association with inflammatory diseases
```
64
Symptoms of angle closure glaucoma
```
Acute painful red eye
unilateral Headache
Nausea and vomiting
Visual loss
Halo around lights
```
65
Symptoms of open angle glaucoma
Often asymptomatic and picked up routinely
| May have gradual vision loss
66
Signs in angle closure glaucoma
Fixed mid dilated pupil that isn’t reactive
Hazy pupil
Red eye
67
What is idiopathic cholestasis of pregnancy?
Liver disease of pregnancy (typically 2nd and 3rd trimester) causing pruritis and bile accumulation
68
Good standard for diagnosis of angle closure glaucoma
Gonioscopy (looks disentangle closure)
69
Medication to reduce intraocular pressure
IV acetazolamide
70
Treatment to cure closed angle glaucoma
Laser iridotomy (creates hole in iris for fluid to drain)
71
Surgical options in glaucoma
Cataract surgery
| Iridectomy
72
What does a cherry red spot indicate?
Retinal artery occlusion
73
Symptoms of retinal artery occlusion
Vision loss
Cherry red spot on retina
Pale retina
74
Retinal vein occlusion on ophthalmoscopy
Retinal haemorrhage and exudate
75
Retinal vein occlusion symptoms
Acute painless vision loss
76
Ophthalmoscopy in GCA
Pale and oedematous optic disc
77
Treatment of GCA with vision loss
IV steroids for 3 days
| Then oral steroids as normal in GCA
78
Management of bronchiolitis
Mostly supportive
| If severe, feeding / hydration support or respiratory support
79
Imaging in suspected ovarian cancer (no mass)
Urgent abdo and pelvic USS
80
Sites of dissemination of gonorrhoea
Joints
Skin
Brain
Heart
81
How to differentiate reactive and septic arthritis
Reactive will have sterile joint aspiration
82
What is Henloch-Schonelein purpura?
Vasculitic rash following viral illness
83
Main differentials in new onset petichial or purpuric rash in children
Immune thrombocytopenic purpura
Henloch-Schonlein purpura
Infection
Cancer
84
Platelet count in Henloch-Schonlein purpura
Normal
85
Symptoms of neuroleptic malignant syndrome
```
On anti-psychotic
Altered mental status and agitation
Rigidity
Fevers
Autonomic dysfunction
AKI
```
86
Management of neuroleptic malignant syndrome
Stop precipitating drug
Cooling and fever control
Symptom relief e.g. manage agitation
87
When does neuroleptic malignant syndrome occur?
Any time but usually first 2 weeks of taking drug
88
Key investigation in neuroleptic malignant syndrome
Raised CK
89
What is retinitis pigmentosa?
Inherited vision disorders due to loss of photoreceptor function
90
Symptoms of retinitis pigmentosa
Progressive night vision loss and progressive peripheral vision loss
91
Ophthalmoscopy in retinitis pigmentosa
Pigmented around edge of retina
92
Treatment of proliferative diabetic retinopathy
Panretinal photocoagulation
93
Investigation in patient with thickened endothelium and suspected endometrial cnacer
Papelle biopsy
94
What is idiopathic cholestasis of pregnancy?
Liver disease of pregnancy (typically 2nd and 3rd trimester) causing pruritis and bile accumulation
95
What organism causes lymphogranuloma venereum
Chlamydia trachomatis
96
Symptoms of lymphogranuloma venereum
Painless ulcers
Lymphadenopathy
Proctitis if rectal
97
Symptoms of antidepressant withdrawal syndrome
Nausea, headache, dizziness, fatigue within a week of stopping SSRI
98
Prognosis of antidepressant withdrawal syndrome
Typically mild and resolves within 1-2 weeks
