Random Flashcards
In a lady of high BMI and taking carbamazepine what is the most appropriate contraception? Why?
All woman who are taking an enzyme-inducing drug (EID) (carbamazepine is an example of an EID) should be advised to use a reliable contraceptive that is unaffected by EIDs.
Copper intrauterine device Progesterone injection (Depo-provera) Mirena intrauterine system
contraceptive injection (Depo-Provera) would not be the most suitable option. This is because it is associated with weight gain (2-3kg over 1 year).
rifampicin and rifabutin also EIDs
When under which percentile would a child need to be referred to a specialist paediatrics unit? What investigations should be carried out in the mean time?
0.4th
TFTs and Insuline like growth factor
What is GMC guidance on FGM?
The GMC guidance about Female genital mutilation (FGM) and child protection states; ‘The mandatory duty (to tell an appropriate agency) will not apply in relation to at risk or suspected cases or over 18s, although doctors must follow our guidance on child protection if they think that a child is at risk. It also will not apply if a professional can identify that another individual working in the same profession has already made a report to the police in connection with the same act of FGM.’
Informing the daughter, police or child protection at this stage would be unnecessary, the daughter is over 18 and this would be a breach of confidentiality. However, equally not doing anything and just flagging this up in the daughters notes would not be appropriate as you dont know when her next visit to the GP will be. Discussing this at the partners meeting is the best option, as this allows discussion with others who may know the laws better or may have been in this situation before.
Syndromes that cause obesity in children?
growth hormone deficiency hypothyroidism Down's syndrome Cushing's syndrome Prader-Willi syndrome
Drugs to be avoided during breastfeeding?
antibiotics: ciprofloxacin, tetracycline, , sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulphonylureas cytotoxic drugs amiodarone
What is the management of pregnant women who have been exposed to chicken pox?
f there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies
if the pregnant women is not immune to varicella she should be given varicella zoster immunoglobulin (VZIG) as soon as possible. RCOG and Greenbook guidelines suggest VZIG is effective up to 10 days post exposure
consensus guidelines suggest oral aciclovir should be given if pregnant women with chickenpox present within 24 hours of onset of the rash
What is management for incontinence?
Depends on if it is Urge or Stress
If urge : bladder retraining, bladder stabilising drugs: antimuscarinic oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation). Immediate release oxybutynin should, however, be avoided in ‘frail older women’
If stress incontinence is predominant:Pelvic floor muscle training: 8 contractions performed 3 times per day for a minimum of 3 months
•surgical procedures
What are your actions if patient who is under-18 attends practice asking for contraception?
- children under the age of 13 years are considered unable to consent for sexual intercourse and hence consultations regarding this age group should automatically trigger child protection measures
- the age of consent for sexual activity in the UK is 16 years. Practitioners may however provide advice and contraception if they feel that the young person is ‘competent’
What are the Fraser guidelines?
- the young person understands the professional’s advice
- the young person cannot be persuaded to inform their parents
- the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
- unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
- the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
Causes of delayed puberty and short stature?
- Turner’s syndrome
- Prader-Willi syndrome
- Noonan’s syndrome
Causes of delayed puberty and normal stature?
- polycystic ovarian syndrome
- androgen insensitivity
- Kallman’s syndrome
- Klinefelter’s syndrome
Examples of tumour suppressor genes which are associated with increased risk of cancer?
WT1 for Wilm’s tumour
Rb for retinoblastoma
c-Myc for Burkitt lymphoma
p53 for multiple cancers (including Li-Fraumeni syndrome)
BRCA1 for breast and ovarian cancer
What are Anorexia investigational features?
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
What are some causes of microcephaly?
normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis
After a seizure, what was a patient do with regards to driving?
Following a first seizure = seizure free for 6 months before license to be reissued.
If formal diagnosis of epilepsy = seizure-free for at least 12 months before license to be reissued.
informing the DVLA is the patient’s responsibility and .
doesn’t apply to heavy goods vehicles
