things i forgot Flashcards
(187 cards)
1
Q
when does cooarctation of aorta present
A
most common at 48 hours when the ductus arteriosus closes
2
Q
secondum ASD pathophysiology
A
patent foramen ovale
3
Q
coaarctation tx
A
PGE1 infusion
surgical repair
4
Q
placenta praevia delivery
A
asx 36-37 weeks
34-36+6 for those with hx of vaginal bleeding and other RF associated with preterm delivery
5
Q
streptococci infective endocarditis
A
benzylpenicillin
6
Q
staph infective endocarditis
A
flucloxacillin
7
Q
PDA increases risk of
A
bacterial endocarditis
8
Q
PDA tx
A
indomethacin
surgical ligation
9
Q
pulmonary stenosis tx
A
transcatheter balloon dilatation
10
Q
differentiating pulmonary stenosis vs aortic stenosis
A
aortic stenosis has carotid thrill
11
Q
which antibiotic for acute epiglottitis
A
cefotaxime
rifampicin for household
12
Q
allergic rhinitis ladder of tx
A
intranasal antihistamines > intranasal corticosteroids > intranasal decongestants e.g. epherdrine >. consider subcut immunotherapy for house dust mite allergen, etc
13
Q
difference in asthma mx between <5 and 5-16yo
A
<5 = if LTRA doesnt work - stop LTRA and refer
5-16 = if LTRA doesnt work - stop LTRA and add LABA
14
Q
moderate asthma severity
A
use metered dose inhaler
15
Q
you admit moderate asthma patients - true or false
A
depends - have a lower threshold if young. also if admitted before
16
Q
bronchiolitis tx
A
if necessary -
humidified oxygen
CPAP
fluids
17
Q
new notifiable disease
A
covid
18
Q
croup admit if
A
stridor at rest
19
Q
cystic fibrosis prophylactic abx
A
flucloxacillin
azithromycin
20
Q
cystic fibrosis mucoactive tx
A
rhdnase
hypertonic sodium chloride +/- rhdnase
mannitol dry powder for inhalation
21
Q
cystic fibrosis causes which GI cx and how to tx
A
distal intestinal obstruction syndrome
tx with gastrografin and laxatives
22
Q
inhaled foreign body tx
A
conscious -
1 encourage cough,
2 5x back blows,
3 5x abdominal thrusts (chest thrusts in under 1)
4 rigid or flexible bronchoscopy
usually rigid
23
Q
lactose intolerance tx
A
refer to dietician
24
Q
ix you can do in lactose intolerance
A
usually clinical
but can do breath hydrogen test
25
hyperemesis ladder of tx
antihistamines > antiemetics > steroid
26
laryngomalacia tx
endoscopic supraglottoplasty
GORD tx
27
otitis externa tx
ciprofloxacin ear drops
oral fucloxacillin if immunocompromised or severe
28
pneumonia in child tx
amox 5 days
29
sinusitis tx
sx<10d nothing
>10d consider high dose nasal corticosteroids
30
sleep disordered breathing
adenotonsillectomy
31
fever pain
need 4-5 for likely GAS
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
32
centor score
3-4 needs abx
33
urticaria
cetirizine
34
viral episodic wheeze
burst therapy
review in 48 hours
35
asthma follow up
if not admitted - review in 48hours
if admitted - review in 2 days
36
admit whooping cough if
under 6m or acutely unwell
significant breathing difficulties
37
whooping cough school exclusion
48 hours post abx or 21d since cough onset
38
anal fissure tx
stool softeners
increase fluid intake
glyceryl trinitrate intra-anally
39
1st line investigations in appendicitis
USS (rare<3yo)
40
clinical shock
weight loss>10%
cold extremities
pale or mottled skin
consciousness altered
hypotension
weak pulses
prolonged cap refill
NOT REDUCED SKIN TURGOR
41
moderate vs mild dehydration tx
ORS 100ml/kg for MODERATE
ORS 50ml/kg for MILD (<5%)
42
alginate therapy trialed for ..
1-2 weeks
43
more common side of inguinal hernia
right
44
umbilical hernia tx for
small and asx
large and sx
observation until 4-5 years of age
elective repair at 2-3 years of age
45
intussuception abx
clindamycin and gentamicin
46
IBS mx
diarrhoea - loperamide
antispasmodic - pain
47
pyloric stenosis fluids
1.5x fluid maintenance
48
UC induction
topical ASA > oral ASA > steroids
49
meningitis child tx
<3m = cefotaxime + amoxicillin
>3m = ceftriaxone
can give dex if >3m
50
second line kawasaki
steroids and infliximab
51
measles cx
otitis media
pneumonia
encephalitis
subacute sclerosing panencephalitis
keratoconjunctivitis
52
eczema severe itch
non-sedating antihistamine
53
erysipelas tx
penicillin V
54
head lice tx
wet comb and or malathion
55
HSP tx
supportive
joint pain - NSAIDs
scrotal involvement of SEVERE oedema or pain - oral prednisolone
in renal failure - iv corticosteroids
56
paraphimosis - definition and tx
urological emergency - foreskin becomes trapped in the retracted position
tx with analgesia and attempt to reduce gently with warm saline
57
retinoblastoma tx
vitreous seeding present (floaters) - enucleation
minimal or none - systemic chemo
58
Still's dx
NSAIDs
DMARDs
high dose steroids
59
absence seizure tx
ethosuximide + valproate
60
ondansetron problem
increased risk of cleft lip
61
focal seizure tx
carbamazepine
62
which ectopic women cant have IUD
those tx with salpinectomy
63
do not use gestational age from the LMP alone to determine whether a fetal HB should be visible - true of false
true
64
ectopic follow up
if had methotrexate - day 4 and day7 bhcg, then 1 per week
if had surgery - bhcg on day 7 post op and then once a week until negative
65
patch missed change
<48 hours is fine
week1+2 >48 hours
change immediately, barrier for 7 days, emergency contraception if <5d since UPSI
66
"other" ukmec 4
HTN >160 syst or >100 dias
cirrhosis
CURRENT BC
PAST VTE
liver tumour
diabetes w complications
67
vomiting and contraception
< within last 2 hours - COCP and levonorg
within last 3 hours - ellaone
68
cocp and pop confer immediate protection if
started on day1-5 of cycle
69
rotterdam criteria requires anovulation for how long
>2y
70
pcos oligomenorrhoea tx
REFER FOR TVUSS
weight loss
cocp or cyclical progesteron
71
pcos hyperandrogenism tx
co-cyprindiol +- eflornithine cream
metformin
72
pcos fertility tx if medical doesnt wrok
laparoscopic ovarian drilling
73
PCOS ovaries
12+ follicles (measuring 2-9mm in diameter) or volume increase by 10cm^3
74
PCOS long term cx
diabetes
CVD
OSA
endometrial cancer
75
pcos lady becomes pregnant - what do u offer
OGTT at 24-28weeks
76
poi definition
menopause sx PLUS 2x FSH >30 4-6 weeks apart
77
HRT no uterus
oestrogen only
78
menopause in under 50 mx
offer HRT or COCP
79
menopause urogenital sx
vaginal oestrogen
80
HRT and breast cancr
NEVER AFFECTS THE RISK OF DYING FROM BREAST CANCER
O+P INCREASES RISK OF GETTING BREAST CANCER (P COMPONENT)
81
peri-menopause HRT
cyclical - monthly for regular periods, 3monthly for irregular
82
abx prophylaxis for surgical mx of TOP
doxy 7d or stat azithro
83
ultrasound and TOP
required after to confirm evacuation
84
HRT contraindications
breast cancer - past or present
85
alternative to standard PID regimen
ofloxacin + metronidazole for 14d
86
swabs for PID
triple - 2x endo and 1 HVS
87
what to consider adding to prescription for medical mx of urge incontinence
if old - consider topical vaginal oestrogen
88
surgical mx of urge incontinence
botulinum toxin type A
percutaneous sacral nerve stimulation
89
uterine prolapse srugcial tx for women who wants to retain fertility
vaginal sacrospinous hysteropexy
90
pessary types
ring - sex is fine
shelf - cant have sex
gelhorn - cant have sex
cube - advanced prolapse
91
GnRH should not be used for more than 6m due to risk of...
osteoporosis
92
endometriosis - does tx have to wait for imaging dx
no medical mx can start with clinical suspision even with normal TVUSS
93
endometriosis surgery in women A who wants baby but not NOW versus B who wants baby ASAP
both laparoscopic excision or ablation of endometriosis
A should receive hormone therapy post op
B should receive adhesiolysis with NO HORMONES POST OP
women with endometriomas should be oiffered excision of the cyst wall
94
benefit of UAE for fibroids
women who dont care about fertility but do not want surgery
95
how do injectsble GnRH work for fibroids pre surgery
induce menopausal state
96
lichen sclerosus tx
betamethasone valerate or mometasone
if doesnt work - tacrolimus
97
dx of PMS
>2 cycle sx diaries
98
CC IA2-IB2
radical hysterectomy and BSO
smaller (<4) can be tx with radical trachelectomy
IB3 = chemoradiation
99
cc stage 2 vs 3
2 = upper 2/3 vag
3 = lower 1/3 vag
100
ovarian cancer tx
midline laparatopy - TAH + BSO
grade 1 low risk do not require chemo
figo stage 1 doesnt require retrograde lymphadenopathy
above this - adjunct chemo - cisplatin
101
vaginal cancer tx
figo 1 - WL excision +- neoadjuvant chemo = radical surgical excision with 10-15mm clear margin
above figo 1 = radical vulvectomy + bilateral inguinal lymphadenectomy
102
vulval cancer sx
vulval swelling
vulval ulcer
pruritus, pain, bleeding, discharge
103
biggest RF for ashermans
d&c after miscarriage
104
asherman ix
saline hysterosalpingogram
105
fluclox for mastitis if
nipple fissure present
sx not improve since 24-48hr of effective breast removal
106
tx for breast abscess
immediate referral to general surgeon for:
1. confirmation by ultrasound
2. incision and drainage
107
duration of LNG-IUS tx for EH w/out atypia
at least 6m
require 6monthly surveillance
108
EH w/out atypia with BMI>35 or taking only oral progesterones require what extra
6monthly biopsies
109
EH w/atypia but declines surgery - what now
LNG-IUS
3monthly surveillance
110
turners associated to which ovarian tumour
dysgerminoma
111
5mg folic acid
diabetic
BMI>30
epileptics
SCA
112
vaccine in preg
flu and covid straight away / anytime
pertussis from 16wk
113
iron <___ at ___week scan - give iron tablets
11
16
114
major RF for IUGR (not inc ones you always remember)
PAPPA<0.4
cocaine use
previous still birth
mum>40yo
chronic HTN
115
Women with a single SFH which plots below the 10th centile or serial measurements which demonstrate
slow or static growth by crossing centiles should be referred for ultrasound measurement of fetal size.
.
116
use of middle cerebral artery doppler
no use in preterm foetus - use Ductus venosus Doppler instead
use in term fetus to estimate acidosis at birth and hence estimate delivery
117
delivery of iUGR
AREDV - csection
otherwise can offer IOL
118
sca mx pregnancy
stop hydroxyurea 3m before pregnancy
low dose aspirin from 12 weeks
delivery is IOL at 38 weeks
119
all women should take
10 micrograms of vitamin D
120
most common cause of PTL
infection
121
how does previous PPROM affect future pregnancies
go straight to obstetrician led care
122
when is magnesium sulphate indicated over 30 weeks
PTL or PTL in next 24 hours - CONSIDER MGSO4 infusion for 30-33+6 weekers (NOT PPROM)
123
other signs of mgs40 toxicity apart from resp depression
oliguria --> renal failure
arrythmias
124
macrosomic babies
cannot have induction
diabetic mums with normal sized fetuses are offered early induction of labour as reduces incidence of IOL
125
bilateral shoulder dystocia
zavanelli method
126
cord prolapse on CTG
variable decelerations is classic sign
127
bishop score <6 but pt has high risk of HS or is attempting VBAC
balloon catheter
128
how does membrane sweep work
releases physiological prostaglandins
129
contraindication to PPROM IOL
<34weeks
130
If a woman has PPROM after 34+0 weeks (but before 37+0 weeks), and has had a positive GBS at any time current pregnancy
offer immediate induction of labour or caesarean birth.
131
PGE2 for induction
dinoprostone is vaginal tablet
or oral misoprostol
132
why is ARM only indicated if bishop>6
baby will likely be high if BS<6
risks cord prolapse
133
epidural effect on 1st and 2nd stage of labour
no change on 1st stage length
linked to increased length of 2nd length - and requirement for assisted delivery
134
chronic htn/gestational htn/pre-eclampsia need what scans
USS and Umbilical artery doppler:
chronic HTN - week 28, 32 and 34
gestational HTN - every 2-4 weeks
pre-eclampsia - every 2 weeks
135
intrapartum BP measuring
hourly
every 15-30 mins if >160/110
136
when to consider mgso4 in pre-ec delivery
previous eclampsic fits OR
any signs of severe pre-eclampsia:
- severe headaches
- scotomata
- N&V
- epigastric pain
137
who gets specialist fetal scan at 20ish weeks
cardiac disease mums
diabetic mums
138
listeria amoxicillin administration
IV
139
hiv and coinfection of hep c
ELCS
140
gestational diabetes postnatal fasting BG interpretation
<6 = moderate chance of T2DM
6.1-6.9 = good chance
>7.0 = near certain
offer insulin if this is over >7
141
2 things elevated in AFLP
ALT
uric acid
142
AFLP mx
DELIVER when stablised pt
143
placenta praevia delivery if stable
34-36 if hx of bleeding
36-37 if has been asx all pregnancy
144
stable abruption >37 weeks
induction of labour
145
stable abruption <37weeks
admit, give steroids - discharge after 48 hours/bleeding stopped if stable
146
DCDA delivery
37wks
147
MCDA delivery
36wks
148
no accelerations
f hypoxia
149
pemphigoid gestationis
DISCRETE LESIONS starts on abdo(50%)
spares face
potent topical steroids or ral pred
150
prurigo of preg
excoriated lesions on extensor limbs, abdo and shoulder
151
pruritis folliculitis tx
topical steroids
152
section 35 vs 37
35 - 28d assessment of accused - no appeal
37 - 6m treatment stint for convicted - appealable
153
section 47
transfer of prisoner to hospital
154
diabetics - best antipsychotic
aripip or 1st gen APs
155
atypical which confers highest risk of hyperprolactinaemia
risperidone
156
HTN associated with which antipsychotics
clozapine MAINLY
aripiprazole
olanzapine
quetiapine
risperidone
157
specific aripiprazole SE
diplopia
158
quetiapine specific SE
sleep anoea
159
things to monitor on antipsychotics
lipids
weight
blood sugar
cardiac risk
blood pressure
FBC
160
RIMA
moclobemide
161
5 signs of BZD withdrawal
anxiety
slurred speech
insomnia
irritbility
tinnitus
162
BZD OD
resp depression
low BP
dilated pupils
163
BSD intoxication
slurred speech
ataxia
stupor
164
tx for the following:
ALCOHOL W/DRAW SEIZURE
DELIRIUM TREMENS
OUTPATIENT W/DRAWAL
INPATIENT W/DRAWL
IV lorazepam
Oral lorazpam AND thiamine IV/IM
oral chlordiazepoxide + thiamine IV/IM
oral chlordiazepoxide + thiamine iV/IM rapid reducing dose
NO SEIZURES OR NOT DELIRIUM THEN CHLOR>LORAZ
165
features of DT
lilliputian hallucinations
anterograde amnesia
fever
CVS collapse
agitation
166
fluox to TCA
Stop fluoxetine over 2 weeks, start TCA at a low dose 4–7 days later and increase dose very slowly
167
non-fluoxetine SSRI to another non-fluoxetine SSRI
direct switch
168
Rapid-cycling bipolar disorder
defined as the experience of at least four depressive, manic, hypomanic, or mixed episodes within a 12-month period.
169
preservation
repitition of words in attempt to change the topic
170
social phobia nice recommendation
education + self help
CBT
SSRI
171
nicher "low" things in anorexia
ESR
platelets, wcc,hb
172
nicher "high" things in anorexia
LFTs
salivary glands
173
anorexia pregnancy
advised to not
also refrain from progesterone injectable - osteoporosis risk
174
If individual CBT-ED, MANTRA, or SSCM is unacceptable,
eating-disorder-focused focal psychodynamic therapy (FPT) may be considered
175
contraindications to anticholinesterases (which can only be prescribed from specialists)
NSAIDs
anticholinergics
beta blockers
176
contraindications to anticholinesterases (which can only be prescribed from specialists)
NSAIDs
anticholinergics
beta blockers
177
VTE prophylaxis post c section
LMWH 10d if emergency
LMWH 10d if elective and mum has RF including smoking, age, mobility, BMII
stockings if multiple RF
178
AD vs VD
VD retains most personality
179
VD sx
stepwise decline
labile
cognitive deficit
focal neurology
180
methadone - check what
ECG for long QTc
181
Foetal Hydantoin Syndrome
associated with phenytoin/carbamazepine use
IUGR
hypoplastic finger nails
microcephaly
cleft lip
distal limb deformities
182
RR in pregnancy
no change
183
what causes decrease in peripheral resistance in pregnancy
progesterone
184
Chloasma gravidarum
hyperpigmentation of face
185
dyskinetic cp
basal ganglia
causes involuntary movements
fanning fingers
twisted appearance
186
ataxic cp
biggest genetic component
hypotonic
balance issues
tremor
delayed motor development
187
TOF feature
clubbing
