Y4 zero to finals mix 2 Flashcards
(492 cards)
1
Q
pH bacterial vaginosis and trichomonas
A
pH >4.5
2
Q
pH candidiasis
A
pH <4.5
3
Q
candidiasis diagnosis
A
charcoal swab with microscopy
4
Q
candidiasis mx
A
clotrimazole cream intravaginal (5g 10%)clotrimazole pessary (500mg)3 doses of clotrimazole pessaries 200mg 3 nightsoral antifungal tablets: fluconazole (150mg)
5
Q
sex vs candidiasis medication
A
antifungals can damage latex condoms and impair spermicides: so ALTERNATIVE contraceptive for 5 days after use
6
Q
Chalmydia trichomatis
A
gram -ve bacteriaintracellylar organismMOST COMMON STI IN UK
7
Q
Chlamydia diagnosis
A
NAAT - nucleic acid amplification tests
8
Q
chlamydia tx
A
doxycycline 100mg 2x daily for 7 days-contraindicated in pregnancy/brestfeedingAzithromycin 1g stat then 500mg 1x for 2dErythromycin 500mg 4x day for 7dErythromycin 500mg 2x dayfor 14 daysAmoxicillin 500mg 3x daily for 7 days
9
Q
LGV
A
painless ulcer and painful lymphadenopathy Doxycycline 100mg 2x daily for 21 days
10
Q
Gonnorhoea
A
gram -ve dipoloccus| infects mucous membranes with columnar epithelium (endocervix, urethra, rectum, conjunctiva, pharynx)
11
Q
gonorrhoea symptoms
A
discharge odourlessdysuriapelvic painor epidydimo-orchitis
12
Q
Gonorrhoea diagnossi
A
NAAT
13
Q
gonorrhoea tx
A
A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT knownA single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
14
Q
complication of gonococcal conjunctivitis in neonate
A
Neonatal conjunctivitis is called ophthalmia neonatorum (sepsis, blindness)
15
Q
disseminated gonoccoal infection
A
complication of untreated gonoccoal infection, bacteria spreads to skin and jointsnon-specific skin lesionsjoint aches and painsarthritis that moves between jointsTenosynovitisSystemic symptoms
16
Q
Mycoplasma genitalium and dx
A
non gonococcal urethritisFirst urine sample in the morning for menVaginal swabs (can be self-taken) for women
17
Q
mycoplasma genitalium tx
A
Doxycycline 100mg 2x day for 7dthenAzithromycin 1g stat then 500mg OD for 2 days (unless it is known to be resistant to macrolides)If pregnant/breastfeeding: NO Doycycline
18
Q
PID causes
A
Neisseria gonorrhoeae (severe PID)Chlamydia trachomatisMycoplasma genitalium
19
Q
PID symptoms
A
Pelvic tendernesscervical excitiationcervicitispurulent dischargefeverdysuria, dyspareunia
20
Q
PID tx
A
A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)Doxycycline 100mg 2xday for 14 days (chlamydia and Mycoplasma genitalium)Metronidazole 400mg 2x day for 14 days ( anaerobes such as Gardnerella vaginalis)
21
Q
complications of PID
A
Fitz-Hugh-Curtis syndrome| nflammation and infection of the liver capsule, leading to adhesions between the liver and peritoneum.
22
Q
trichomonas
A
protozoan flagellaswab from posterior fornix of vaginapH >4.5forthy yellow-greenfishy smellstrawberry cervix (colpitis macularis)tx Metronidazole
23
Q
HSV
A
cold sores (hepres labialis) and genital herpesHSV 1 and HSV 2multiple painful ulcersviral PCR
24
Q
HSV tx
A
aciclovir1* genital herpes treat with acyclovir (if contracted before 28weeks gestation) - acyclovir at infection and prophylactic aciclovir from 36w. if asymptomatic -> vaginal delivery1*genital herpes after 28 weeks treat with acyclovir until delivery, C section
25
HIV most common type
HIV -1| virus enters and destroys CD4 T=helper cells
26
AIDS defining ilness
```Kaposi’s sarcomaPneumocystis jirovecii pneumonia (PCP)Cytomegalovirus infectionCandidiasis (oesophageal or bronchial)LymphomasTuberculosis```
27
when to test for HIV
can be negative up to 3 months post exposureAntibody testing for HIVPCR testing for viral load
28
CD4 in HIV
500-1200 cells/mm3 is the normal range| Under 200 cells/mm3 is considered end-stage HIV (AIDS) and puts the patient at high risk of opportunistic infections
29
PCP prophylaxis
co-trimoxazole (septrin)
30
HIV and birth
vaginal delivery if <50 copies/mlC section if >50 copiesIV zidovudine given to mother >10 000Bebo:if mother <50: zidovudine 4wif mother >50: zidovudine, lamivudine, nevirapine for 4w
31
PEP
ART therapy| Truvada (emitricitabine and tenofovir) and raltegravir, for 28d
32
Syphilisi
teponema pallidumspirochetespiral-shaped bacteriaincubation period 21d
33
stages of syphilis
1*: painless ulcer, chancre, local painless lymphadenopathy2* systemic symptoms, condylomata lata resolves after 3-12 weeks3* gummas/gummatous lesions and cardiovascular and neurological complicationsneurosyphilis - in CNS (ocular syphilis, tabes dorsalis)
34
syphilis dx
antibody testing| samples for dark field microscopy or PCR
35
syphilis tx
deep IM benzathine benzylpenicillin alternative: ceftriaxone, amoxicillin, docycyline
36
UKMEC
UKMEC 1: No restriction in use (minimal risk)UKMEC 2: Benefits generally outweigh the risksUKMEC 3: Risks generally outweigh the benefitsUKMEC 4: Unacceptable risk (typically this means the method is contraindicated)
37
What contraception to avoid in breast cacncer?
avoid any hormonal contraception and go for the copper coil or barrier methods
38
What contraception to avoid in cervical/endometrial cancer?
avoid the intrauterine system (i.e. Mirena coil)
39
what contraception to avoid in Wilson's disease?
avoid copper coil
40
RF to avoid COCP
Uncontrolled hypertension (particularly ≥160 / ≥100)Migraine with auraHistory of VTE>35yo smoking >15 cigarettes/dayMajor surgery with prolonged immobilityVascular disease or strokeIschaemic heart disease, cardiomyopathy or atrial fibrillationLiver cirrhosis and liver tumoursSystemic lupus erythematosus and antiphospholipid syndrome
41
when should progestogen injection (Depo provera) be stopped?
before 50yo due to risk of osteoporosis
42
lactational amenorrhoea
effective as contraception for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods)
43
IUS/IUD in breastfeeding?
can be inserted either within 48 hours of birth or more than 4 weeks after birth
44
COCP and rbreastfeeding
should be avoided in breastfeeding and can't be started <6w after childbrith
45
COCP MOA
prevents ovulation progesterone thickens mucusprogesterons recued endometrial proliferation
46
2 types of COCP
monophasic (same amount of hormone in each pill)| multiphasic (varying amounts of hormone to match normal cyclical changes)
47
COCP with lower risk of VTE
progesterone as levonorgester or norethisterone
48
1st line COCP for PMS
Yasmin - the ones with drospirenone (help with water retention, bloating, modd changes)
49
COCP in treatemtn of acne/hirsutism
Dianette - with cuproterone acetate, but high risk of VTE
50
COCP benefits
improves PMS, menorrhagia, dysmenorrhoea, reduced risk of endometrial , ovarian, colon cancer
51
starting COCP
no additional contraception if starting in 1st 5 days of cycleif after 5 days, requres extra contraception for 7 days
52
how to switch COCPs?
take one pack after the other with no pill free interval
53
swithing from POP to COCP
switch at any time but 7days extra contracceptionunless switching from desogestrel which inhibits ovulation, then no extras
54
when to stop COCP
4 weeks before major operation
55
the only POP UKMEC 4
active breast cancer
56
POP MOA
Thickening the cervical mucusAltering the endometrium and making it less accepting of implantationReducing ciliary action in the fallopian tubes
57
starting POP
if starting on days 1-5 no extrasif after day 5, additional contraception is required for 48h.if switching from POP - extra contraception for 48h (best to switch during hormone free period)
58
progesterone only injection (DMPA)
IM or SC every 12-13 weeks, medroxyrpogesterone acetatedepo provera: IM sayana press: SC self injectionnoristerat - norethisterone for 8 weeks, altrnative
59
progesterone only injection (DMPA)
IM or SC every 12-13 weeks, medroxyrpogesterone acetatedepo provera: IM sayana press: SC self injectionnoristerat - norethisterone for 8 weeks, altrnative
60
progesterone only injection (DMPA)
IM or SC every 12-13 weeks, medroxyrpogesterone acetatedepo provera: IM sayana press: SC self injectionnoristerat - norethisterone for 8 weeks, altrnative
61
Progesterone injection MOA
inhibits ovulationthickens mucusalters endometrium
62
when to do progesterone injection
day 1-5 of cycle| if after that, 7 days extra contraception
63
SE of progesterone injection
1) weight gain2) osteoporosisalopeciareduced libidodelays return to fertilitymood changesbenefits: recued sickle cell crisis severity, improved endometriosis or dysmenorrhoea
64
progesterogen only implant +MOA
lasts 3 yearsnexplanon (etonogestrel)inhibits ovulationthickens mucusalterns endometrium
65
age of sexual consent
13 yo
66
IUD and smear - organism
actinomyces like organisms
67
UPSI
Levonorgestrel within 72 hours of UPSIUlipristal within 120 hours of UPSICopper coil within 5 days of UPSI, or within 5 days of the estimated date of ovulation
68
levonorgestrel Emergency contraception
COCP or POP can be started immediately additional 7 days condoms COCPadditional 2 days condoms POP
69
Levonorgestrel doses
1.5mg as a single dose| 3mg as a single dose in women above 70kg or BMI above 26
70
Ullipristal (EllaOne) emergency contraception
```single dose (30mg)wait 5 days until starting the combined pill or progestogen-only pill after taking ulipristalcndoms 7days cocp, 2days pop```
71
Ulipristal restriction
Breastfeeding - avoid 7d post ulipristal| Avoid in pts with asthma (Severe)
72
female hormone testing in intertility
serum LH FSH days 2-5 (high LH PCOS, high FSH poor ovarian reserve)serum progesterone on day 21 (or 7 days before period) (rise incidates ovulation)
73
how to stimulate ovulation
```clomifene letrozole (aromatase inhibitor)gonadotropins ovarian drillingmetformin```
74
Azoospermia
absence of sperm in the semen.
75
Cryptozoospermia
very few sperm in the semen sample (less than 1 million / ml).
76
Polyspermia (or polyzoospermia)
high number of sperm in the semen sample (more than 250 million per ml).
77
Normospermia (or normozoospermia)
normal characteristics of the sperm in the semen sample.
78
Oligospermia
```reduced number of sperm in semen sampleMild oligospermia (10 to 15 million / ml)Moderate oligospermia (5 to 10 million / ml)Severe oligospermia (less than 5 million / ml)```
79
IVF steps
```Suppressing the natural menstrual cycleOvarian stimulationOocyte collectionInsemination / intracytoplasmic sperm injection (ICSI)Embryo cultureEmbryo transfer```
80
Ovarian hyperstimulation syndrome
complication of ovarian stimulation during IVF infertility treatment- increase in VEGR increased vascular permeability- oedema, ascites, hypovolaemia- raised renin level- Haematocrist indicates dehydration
81
Prevention of gout
Allopurinol (inhibits xanthine oxidase)| 100mg OD titrated to serum uric acid of 300umol/L
82
Allopurinol interactions
Azathioprine (allopurinol increases azathioprine dose so low dose allopurinol 1/4)Cyclophosphamide (allopurinol reduces renal clearance -> marrow toxicity)Theophylline (allopurinol inhibits it’s breakdown)
83
Alpha blockers use
HTNBPHSE: postural hypotensionDrowsinessConfusion
84
Alpha blockers examples
Postural hypotensionDrowsinessDyspnoea
85
Sildenafil contraindications
Nitrates and nicorandil
86
Oculogyric crisis in overdose. Drug
AntipsychoticsMetoclopramide(Extrapyramidal Side effect)
87
Lithium toxicity precipitants
```ThiazidesBendroflumethazideACE inhibitors and Angiogensin IINSAIDMetronidazole```
88
Digoxin antibody
Digibind
89
Lactic acidosis risk?
Suspend Metformin in illness like diarrhoea and vomiting
90
Serotonin syndrome drugs (causative)
SSRIEcstasyAmphetamineMAO inhibitors
91
Heroin overdose
Respiratory depression| CNS depression
92
Cocaine overdose
Chest painMood changesCardiac symptoms
93
Aminoglycoside antibiotics
Ototoxicity + nephrotoxicity
94
Severe renal impairment VTE prophylaxis
LMWH - allowed in <30 creatinine but high bleeding risk| -> Unfractioned heparin 1st line
95
Anion gap normal and formula
10-18| Na+ + K+) - (Cl- + HCO3-
96
Ethylene glycol toxicity
Metabolic acidosis with high anion gap
97
Cyclosporin se
```Everything highHTNhigh fluidHigh K+Hair, gums, glucose```(It is immunosuppressant)
98
Which diuretics should not be combined?
Amiloride + Spironolactone| Both potassium sparing
99
Drugs causing urinary retention
```TCA (Amitryptyline)AntipsychoticsAntihistamineOpioidsNSAID```
100
TCA overdose
Amitryptyline or dothiepin, dusolepin```Dry mouth Dilated pupilsAgitation Sinus tachy Blurred vision QT prolongationComaMetabolic acidosisSeizures Arrhythmias```
101
Tuberculosis drugs SE
Rifampicin (orange secretions, p450 inducer, hepatotoxicity)Isoniazid (hepatitis, agranylocytosis, peripheral neuropathy B6)Pyrazinamide (hyperuricaemia, hepatitis)Ethambutol (optic neuritis, loss of colour vision)
102
P450 inducers
```CRAP GPSSSCarbamazepineRifampicinAlcohol (chronic) Phenytoin ``````GriseofluvinPhenobarbitalSulphonylureaSmokingSt John wort```
103
Inhibitors of p450 (will cause toxicity)
Sick faces . Com (+ grapefruit)```Sodium valproateIsoniazid ChloramphenicolKetoconazoleFluconazoleAlcohol Acute, Amiodarone, Allopurinol CimetidineErythromycinSulfonamides, Sertraline/Fluoxetine .CiprofloxacinOmeprazoleMetronidazole```
104
Heparin mechanism of action
Activates: antithrombin IIIInhibits: thrombin, factors Xa, IXa, XIa, XIIa
105
LMWH mechanism of action
Activates: antithrombin IIIinhibits: factor Xa
106
Salicylate overdose
Respiratory alkalosis followed by metabolic acidosis```TinnitusAnxietySeizuresSweatingLethargyHypervention```
107
Serotonin syndrome
```SSRI/ MAOI/ ecstasyOnset hours Hyperreflexia, Clonus, dilated pupils Tachycardia, HTNpyrexia, rigidityIV fluids, benzodiazepinesMx cyproheptadine, chlorpromazine```
108
Neuroleptic malignant syndrome
```caused by antipsychotics Slow onset hours-daysHyporeflexes, rigidity (lead-pipe) normal pupilsTachycardia, HTNpyrexia, rigidityIV fluids, benzodiazepinesMx: dantrolene```
109
Organophopshate insecticide poisoning
SalivationLacrimationUrinationDiarrhoea+ Small pupilsMx: atropine
110
Galactorrhoea treatment
Dopamine agonist (eg ropinirole)
111
Paracetamol overdose biochemistry
ALP and AST in 10,000
112
Ecstasy/ MDMA overdose
```Agitation, confusion, anxiety, ataxiaTachycardia, HTNfever Hyponatremia Rhabdomyolysis```Mx: dandrolene
113
Aminoglycosides examples
Gentamycin Neomycin Tobramycin
114
ectopic pregnancy location
fallpian tube
115
ectopic pregnancy risk factors
```Previous ectopic pregnancyPrevious pelvic inflammatory diseasePrevious surgery to the fallopian tubesIntrauterine devices (coils)Older ageSmoking```
116
US mass with empty gestational sac
“blob sign”, “bagel sign” or “tubal ring sign''
117
tubal ectopic pregnancy vs corpus luteum
corpus luteum moves WITH the ovary| the tubal ectopic moves SEPARATELY to ovary
118
When should bHCG double?
Every 48h
119
when should pregnancy be visible on US?
hCG >1500 IU/L
120
Ectopic expectant management criteria
```The ectopic needs to be unrupturedAdnexal mass < 35mmNo visible heartbeatNo significant painHCG level < 1500 IU / l```
121
Ectopic medical management criteria
```HCG level must be < 5000 IU / lConfirmed absence of intrauterine pregnancy on ultrasoundThe ectopic needs to be unrupturedAdnexal mass < 35mmNo visible heartbeatNo significant pain```
122
Ectopic surgical management
The ectopic needs to be unrupturedAdnexal mass < 35mmNo visible heartbeatNo significant pain-Laparoscopic salpingectomyLaparoscopic salpingotomy
123
surgical management of ectopic - prophylaxis
Anti D to Rh negative women
124
Miscarriage dates criteria
Early <12 weeks gestation| Late >12 weeks gestation
125
Missed miscarriage
the fetus is no longer alive, but no symptoms have occurred
126
Threatened miscarriage
– vaginal bleeding with a closed cervix and a fetus that is alive
127
Inevitable miscarriage
– vaginal bleeding with an open cervix
128
Incomplete miscarriage
retained products of conception remain in the uterus after the miscarriage
129
Complete miscarriage
– a full miscarriage has occurred, and there are no products of conception left in the uterus
130
Anembryonic pregnancy
– a gestational sac is present but contains no embryo
131
fetal heartbeat
when crown-rump length >7mm
132
<7mm, no heartbeat
repeat US after >7d then if >7mm and no heartbeat: Non-Viable Pregnancy
133
Mean gestational sac diameter >25mm without a fetal pole
Repeat after 1 week and confirm Anembryonic pregnancy
134
Miscarriage medical management
Misoprostol (vaginal suppository or oral dose) - prostaglandin analogue, binds to prostaglandin receptions and softens the cervix, stimulates contractions.
135
Misoprostol side effects
Heavier bleedingPainVomitingDiarrhoea
136
Surgical management of miscarriage
Manual vacuum aspiration under local anaesthetic as an outpatient ORElectric vacuum aspiration under general anaestheticProstaglandins (misoprostol) given before surgical management
137
ERPC - evacuation of retained products of conception
under GAcervix dilated, retained products removed though vaccum aspiration and curettage Key complication: endometritis
138
Recurrent miscarriage definition
3 or more consecutive miscarriagesinvestigations after: 3 1st trimester, 1 2nd trimester miscarriage
139
hereditary thrombophilias (miscarriage)
```Factor V Leiden (most common)Factor II (prothrombin) gene mutationProtein S deficiency```
140
uterine abnormalities (miscarriage)
Uterine septum (a partition through the uterus)Unicornuate uterus (single-horned uterus)Bicornuate uterus (heart-shaped uterus)Didelphic uterus (double uterus)Cervical insufficiencyFibroids
141
Chronic Histiocytic Intervillositis (miscarriage)
2nd trimester miscarriagecauses IUGR and IUD deathinfiltrated of mononuclear cells in intervillous space
142
Ix in recurrent miscarriage
```Antiphospholipid antibodiesTesting for hereditary thrombophiliasPelvic ultrasoundGenetic testing of the products of conception from the third or future miscarriagesGenetic testing on parents```
143
latest legal abortion
24w| 1990 Human Fertilisation and Embryology Act (switched from 28w)
144
Medical abortion
Mifepristone (anti-progestogen) - stops the pregnancy and relaxes cervixMisoprostol (24-48h later) - prostaglandin analogue, softens cervix and stimulates contractions>10w gestation, misoprostol every 3h dose until expulsion
145
Surgical abortion
Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)Cervical priming before the procedure to dilate the cervix with Mife, Miso, Osmotic dilators
146
hyperemesis gravidarum
More than 5 % weight loss compared with before pregnancyDehydrationElectrolyte imbalance
147
PUQE score
Pregnancy-Unique Quantification of Emesis< 7: Mild7 – 12: Moderate> 12: Severe
148
Antiemetics in pregnancy (in order of safety)
Prochlorperazine (stemetil)CyclizineOndansetronMetoclopramide+ginger and acupressure
149
Acid reflux treatment in pregnancy
Ranitidine or Omeprazole
150
When to admit in hyperemesis gravidarum?
Unable to tolerate antiemetics or keep down fluids>5% weight lossKetones (2+) on urine dipstick
151
complete mole
2 sperms fertilise empty ovum (no genetic material) = no foetal material forms
152
Partial mole
2 sperms fertilise normal ovum = triple chromosome set, haploid cell
153
symptoms of molar pregnancy
```More severe morning sicknessVaginal bleedingIncreased size of uterusabnormally high hCGThyrotoxicosis```
154
Paracetamol overdose mx
activated charcoal if ingested < 1 hour agoN-acetylcysteine (NAC)liver transplantation
155
Salicylate overdose mx
urinary alkalinization with IV bicarbonate| haemodialysis
156
Benzodiazepines overdose mx
Flumazenil (risk of seizures tho)
157
TCA overdose mx
IV bicarbonate - reduced seizure risk and arrhythmia risk| 1st step is correct the acidosis
158
Lithium overdose mx
haemodialysis| sodium bicarbonate
159
Warfarin overdose mx
Vitamin K, prothrombin complex
160
Heparin overdose mx
Protamine sulphate
161
B blockers overdose mx
if bradycardic then atropine| in resistant cases glucagon may be used
162
Etylene glycol
fomepizole - inhibitor of alcohol dehydrogenase| haemodialysis
163
Methanol poisoning mx
fomepizole or ethanol| haemodialysis
164
Organophosphate insecticides overdose/poisoning mx
atropine
165
CO2 poisoning mx
100% oxygen| hyperbaric oxygen
166
Cyanide poisoning mx
Hydroxocobalamin
167
Iron overdose mx
Desferrioxamine, a chelating agent
168
Lithium monitoring
TFT, U&E prior to treatmentLithium levels weekly until stabilised then every 3 monthsTFT, U&E every 6 months
169
Meig’s syndrome
Benign ovarian tumour AscitesPleural effusion
170
Caplan syndrome
Swelling and scarring of lungs in RA (in people who breathed in dust, coal, silica)
171
RA histology
Fibrinoid necrosis surrounded by palisading epithelioid cells
172
Cribriform plate fx
Panda eyes/ periorbital bruisingRhinorrhoea - CSF leakingDo not use nasogastric tube or nasal airway adjunct - can enter the cranium
173
Disulfiram reaction
Reaction to medication (or alcohol cessation medication)| Eg metronidazole, disulfiram
174
Homonymous quadrantopias
Superior - inferior optic radiation temporal lobe lesion (meyers loop)Inferior - superior optic radiation in parietal lobe lesion PITS
175
Bitemporal hemianopia
Upper quadrant defect - inferior chiasm compression, pituitary tumour Lower quadrant - superior chiasm compression, craniopharyngioma
176
Smoking and p450
Induces metabolism
177
Tetralogy of fallot
VSDPulmonary stenosisOverriding aortaRight ventricular hypertrophyEjection systolic murmur left eternal border
178
Vascular dementia
Sudden stepwise deterioration of cognition Risk factors for vascular diseaseGait disturbance and urinary symptoms Change in mood and concentration
179
Lewy body dementia
Parkinsonian symptoms Visual hallucinationsSleep behaviour disorders
180
Frontotemporal dementia
```Personality changesLoss of insight Stereotypes behaviours Slowly progressive, onset <70yoFamily history```
181
Travellers diarrhoea cause
Enterotixigenic escherichia coli
182
POPQ prolapse
Stage 1 cervix prolapses more than 1cm above hymen| Stage 2 - prolapse between 1cm above and 1cm below level of hymen
183
Acute Subdural haematoma
Elderly on warfarin No head trauma Fluctuating confusions and consciousness
184
Yersinia enterocolitica
Invasive gastroenteritisMesenteric lymphadenitisErythrema nodosum
185
Schizoid personality disorder
```AloneLonelinessOdd behaviourNo socialisingFlat affect```
186
Schizotypal personality disorder
Magical and weird thinking
187
Schizophrenia and schizoaffective disorder
Have Psychotic symptoms
188
Ottawa ankle rules
X ray is required if: 1) pain 2) - medial malleolus tenderness- lateral malleolus tenderness- inability to bear weight
189
Absent femoral pulses
Coarctation of the aortaTx balloon angioplastyRe coarctation can occur, plus HTN and CVD
190
Acute PE and shock - thrombolytic choice
Streptokinase
191
Supracondylar humerus fx nerve injury
Anterior interosseous nerve injury| Weakness to 2nd finger
192
Musculocutsneous nerve ix
Atrophy of biceps brachii
193
Ulnar nerve injury
4th and 5th fingers loss of sensation
194
Gonorrhoea symptoms
Thick green-yellow discharge from the vaginaPainful urinationBleeding between periods
195
Chlamydia sx
Pain on urination Vaginal dischargeBleeding between periods
196
Dyskinesia vs akathisia
Tardive dyskinesia - involuntary movement (chorea movement)| Akathisia - restlesness
197
Giant cell arteritis vision loss type
Anterior ischaemic optic neuropathy
198
Cataract surgery complications
Endophthalmitis| Posterior capsule opacification
199
1st line treatment for prolactinoma
Bromocriptine or cabergoline| Dopamine receptor agonist
200
Cat scratch organism and symptoms
Bartonella henselaeBrownish red papulesLymphadenopathy
201
Antistreptolysin O titer
Used to determine recent group A strep infection
202
INR 6-8, no bleeding
Stop warfarin Check INRRecommence warfarin if <5
203
INR >8 minor/no bleeding
Stop warfarin5mg oral vit K, 0.5-1mg IVRecheck INR and can re give vit K in 24hRecommence warfarin if INR <5
204
Raised INR with major bleeding
Stop warfarin| IV phytomenadione and fresh frozen plasma 15mg/kg
205
Shigella treatment
(Severe if bloody diarrhoea - dysentery) Ciprofloxacin 500mg PO BD 1dayOr Azithromycin 500mg PO OD for 3 daysShigella is notifiable disease
206
Pre eclampsia risk factors
```NullparityPrevious pre eclampsiaFamily historyMaternal age >40Pregnancy interval >10Multiple pregnancy HTNBMI >35Pre existing vascular/kidney/diabetes```
207
Hep B serology
HBsAg (positive- currently infected, negative - not currently infected)
208
If HBsAg -ve
Look at a-HBc+ natural infection, naturally immune- no natural infection
209
If HBsAg +
IgM a-HBc + acute infection- chronic infection
210
If HBsAg -| a-HBc -
a-HBs+ immune from Hep B vaccine - never had vaccine or infection
211
SLE ab
Anti-dsDNAanti-HistoneAnti-SmithANA
212
Polymyositis
Anti-Jo1
213
Myasthenia gravis
Anti-acetylcholine receptor
214
Lambert Eaton ab
Anti-VGCC
215
HIV treatment drugs
2 nucleotide reverse transcriptase inhibitors| 1 NNRTI or integrase inhibitor
216
Anatomical landmarks spine
T3 spine of scapulaT7 inferior aspect of scapulaL4 superior aspect of iliac crestS2 PSIS
217
Scabies treatment
Caused by sarcoptes scabiei1) permethrin 5% (whole body and wash after 8-12h, repeat after 1w)2) malathion
218
Anterior tongue tie vs posterior tongue tie
Anterior: prominent restrictive frelunum seen in front of the tongue Posterior: frelunum back underneath the tongue
219
Allergic rhinitis in pregnancy
Oral loratadine
220
GCS motor
```6 obeys commands5 localises pain4 withdraws from pain3 abnormal flexion 2 abnormal extension1no response```
221
Rubella vaccination antibodies
IgM antibody negative| IgG antibody positive
222
Amiodarone se and tx
se: hypothyroidism, tx with levothyroxine (amiodarone ctd)
223
when to prescribe cyclical combined HRT
LMP <1y ago
224
when to prescribe continyous combined HRT
- taken cyclical combined for 1year- at least 1y since LMP- at least 2y since LMP in premature menopause (<40y)
225
TCA overdose
widened QRS (>160ms)arrhythmia (eg amiodarone and dusoleptin) tx. IV sodium bicarbonate
226
Ethylene glycol overdose tx
Fomepizole
227
opioid detox drug
Methadone
228
lorazepam overdose (benzodiazepine) tx
gaba antagonist| FLUMAZENIL
229
adrenaline doses
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM| cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
230
salicylate poisoning
1) resp alkalosis| 2) metabolic acidosis
231
anaphylactoid reactions to IV acetylcysteine
stop IV acetylcysteinegive nebulised salbutamolrestart IV infusion at a slower rate
232
ciprofloxacin SE
lowers seizure threshold| tendonitis
233
metronidazole se
reaction following alcohol ingestion
234
doxycycline se
photosensitivity
235
trimethoprim side effects
photosensitibtypruritissupression of haematopoiesis
236
LSD intoxication tx
Lorazepam
237
criteria for paracetamol liver transplant
Arterial pH < 7.3, 24 hours after ingestionor all of the following:prothrombin time > 100 secondscreatinine > 300 µmol/lgrade III or IV encephalopathy
238
Alcohol addiction drugs
benzodiazepines for acute withdrawaldisulfram: promotes abstinence (contraindications: ischaemic heart disease, psychosis)acamprosate: reduces craving
239
heparin overdose tx
protamine sulphate
240
ACE inhibitors se
cough| hyperkalaemia
241
bendroflumethiazide se
gouthypokalemiahyponatremiaimpaired glucose tolerance
242
calcium channel blockers se
headacheflushingankle oedema
243
beta blockers se
bronchospasmfatiguecold peripheries
244
doxazosin se
postural hypotension
245
ethylene glycol toxicity
Fomepizole
246
amarurosis fugax tx
Aspirin
247
fever followed by maculopapular rash
(Once fever resolved)| Roseola infantum HHV6
248
Itchy red papillae lesions between toes and fingers
Scabies - sarcoptes scabiei
249
Bilateral malar erythrema
Slapped cheek syndrome / 5th disease| Parvovirus b19
250
Papules and vesicles and pustules
Chicken pox VZV
251
Widespread erythrema and tenderness, desquamation
Scalded skin syndrome| Staphylococcus
252
Painful vesicular lesions on hands, feet, mouth
Hand foot and moths| Coxsackie virus
253
Erythrematous pustules with yellow crust
Impetigo| Staph aureus
254
Erythrematous rash in nappy
```Irritant dermatitis (spares flexures)Candida (involves flexures)Seborrhoeic dermatitis (scalp changes, not itchy)```
255
Vesicles surrounded by maculopapular rash (target like)
Erythrema multiformae
256
Measles
```Spread by dropletsIncubation 7-12dCough, conjunctivitis, fever Koplik spots Rash from behind the ears to face neck and bodySupportive treatment```
257
Mumps
Supportive treatment Complication- orchitis, encephalitisProdromal fever and malaiseDroplet, 12-21 incubation
258
Rubella
Respiratory spread Incubation 15-20Fever and maculopapular rash (from face to body)Concern: congenital infection
259
2 month vaccinations
DTaP/IPV/Hib, MenB, rotavirus
260
3 month vaccinations
DTaP/IPV/Hib, PCV, rotavirus
261
4 months vaccines
DTaP/IPV/Hib, PCV, MenB
262
12 month vaccines
Hib/MenC, PCV, MMR, MenB
263
3 years vaccines
MMR/DTaP/IPV
264
12 years vaccines
HPV
265
14 years vaccines
MenACWY/DTa/IPV
266
Live attenuated vaccines
```TBOPV (polio vaccine)MMRRotavirus Yellow fever```
267
Inactivated vaccines (killed antigen)
Pertrussis| IPV
268
Inactivated toxins
Diptheria| Tetanus
269
Paediatric fluids
0.9 NaCl and 5% dextrose 24h Na 2-4mmol/kg24h K 1-2mmol/kg
270
G4 P3
A pregnant woman with three previous deliveries at term
271
G1 P1
A non-pregnant woman with a previous birth of healthy twins:
272
G1 P0 + 1
A non-pregnant woman with a previous miscarriage
273
G1 P1
A non-pregnant woman with a previous stillbirth (after 24 weeks gestation
274
booking clinics
<10w
275
Dating scan
Between 10 and 13 + 6| An accurate gestational age is calculated from the crown rump length (CRL), and multiple pregnancies are identified
276
Anomaly scan
Between 18 and 20 + 6| An ultrasound to identify any anomalies, such as heart conditions
277
Antenatal appointments
16, 25, 28, 31, 34, 36, 38, 40, 41 and 42 weeks
278
Oral glucose tolerance test in pregnancy
Women at risk of gestational diabetes (between 24 – 28 weeks)
279
Anti-D injections
Anti-D injections in rhesus negative women (at 28 and 34 weeks)
280
placenta praevia on the anomaly scan
Ultrasound scan at 32 weeks
281
vaccines in pregnancy
```Whooping cough (pertussis) from 16 weeks gestationInfluenza (flu) when available in autumn or winter```
282
FAS
```Microcephaly Thin upper lipSmooth flat philtrumShort palpebral fissure Learning disabilityBehavioural difficultiesHearing and vision problemsCerebral palsy```
283
Smoking in pregnancy
```Fetal growth restriction (FGR)MiscarriageStillbirthPreterm labour and deliveryPlacental abruptionPre-eclampsiaCleft lip or palateSudden infant death syndrome (SIDS)```
284
Combined test
between 11 and 14 weeks gestation nuchal translucency >6mmBeta‑human chorionic gonadotrophin (beta-HCG) – a higher result indicates a greater riskPregnancy‑associated plasma protein‑A (PAPPA) – a lower result indicates a greater risk
285
Triple test
between 14 and 20 weeks gestationBeta-HCG – a higher result indicates greater riskAlpha-fetoprotein (AFP) – a lower result indicates a greater riskSerum oestriol (female sex hormone) – a lower result indicates a greater risk
286
quadruple test
between 14 and 20 weeks gestationBeta-HCG – a higher result indicates greater riskAlpha-fetoprotein (AFP) – a lower result indicates a greater riskSerum oestriol (female sex hormone) – a lower result indicates a greater riskInhibin-A - higher inhibin-A indicates a greater risk.
287
If risk of Down syndrome 1:150
Chorionic vilious sampling >15weeks| Amniocentesis later in pregnancy
288
Hypothyroid in pregnancy
levothyroxine dose needs to be increased during pregnancy, usually by at least 25 – 50 mcg
289
anti-epileptics safe in pregnancy
Levetiracetam, lamotrigine and carbamazepine
290
anti-epileptics safe in pregnancy
Levetiracetam, lamotrigine and carbamazepine
291
Anti epileptics to avoid in pregnancy
Sodium valproate -neural tube defects and developmental delayPhenytoin is avoided - cleft lip and palate
292
Telogen effluvium
Increased hair shedding, hair shift from anagen/growing phase to telogen/shedding phase. Due to childbirth. trauma, ilness, bereavement
293
Anagen effluvium
Generalised hair loss associated with medications (Chemotherapy, TCA, allopurinol, beta blockers, retinoids)
294
Trichotillomania
people pull their own hair, patchy hair loss in assymetrical distribution
295
Insulinoma
Rise in insulin Rise in C-peptidePresents with hypoglycaemia
296
Factitious hypoglycaemia (eg exogenous insulin injection)
Elevated insulinLow C-peptidePresents with hypoglycaemia
297
5th disease risk
Fetal death if pregnant women infected| - parvovirus b19
298
Measles complications
acute demyelinating encephalitis| hearing loss
299
Rubella complications
congenital deafness (most common cause of congenital deafness)
300
Scarlet fever (group A haemolytic strep) complications
Rheumatic fever
301
Normal CSF results
```WCC (5x 10^6) all lymphocytes, no neutrophilsRBC: 10protein 0.2-0.4 (<1% from serum)glucose: 3.3-4.4 (>60% from serum)pH: 7.31opening pressure: 70-180 mmH2O```
302
Right homonymous hemianopia with macular sparing
left occipital visual cortex
303
Gamophobia
phobia of getting marries
304
Acrophobia
fear of heights
305
Algophobia
fear of pain
306
Kawasaki disease mnemonic and complication
CRASH and burncoronary artery aneurysm
307
DMD treatment
steroids
308
Most common cause of genital ulcerative disease
HSV - 2
309
Tropicamide
mydriatic, pupil dilator
310
Pilocarpine
miotic eye drops
311
cyclopenolate
mydriatric, long acting eye drop
312
HSV microscopy/ also CMV and VZV
multinucleated giant cells
313
Reduced CSF glucose:plasma ratio <60% on LP
bacterial meningitis
314
Erythrema nodosum most common causes
tuberculosis and sarcoidosis
315
cavernous sinus thrombosis
visual disturbanceCNs III, IV, VI ophthalmoplegia and diplopia
316
Aims of antiretroviral therapy
<50 copies of viral loadCD4 >350reduce transmissionincrease quality of life without drug side effects
317
Akathisia vs tardive dyskinesia
tardive dyskinesia - oral-facial movements, excessive blinking, lip smacking, grimacing, tongue movementsakathisia - restlessness, can't sit still
318
Hep C treatment
ledipasvir/sofosbuvir
319
Craniopharyngioma vs Pituitary adenoma
craniopharyngioma in young/adolescent
320
Non communicating hydrocephalus
pinealoma/ pineal gland tumour
321
Lichen sclerosus treatment
topical tacrolimus
322
Staph aureus valve infection findings
gram positive coccuscatalase +vecoagulase -ve
323
Lacrimal gland nerve supply
Intermediate nerve (facial nerve portion)
324
Tx of hypersalivation in clozapine treatment
HyoscinePirenzipineBenzhexol
325
Gastroschisis
no sacc sectionimmediate (<4h) surgery
326
Omphalocele
related to other conditions (trisomy 13, 18, 21, turner syndrome)sacvaginal deliverystaged surgical repair
327
Carbuncle
subcutaneous pus collection discharging via multiple sinuses| Staphylococcal infection
328
Furuncle
Perifollicular (around hair root) abscess caused by Staphylococcus aureus
329
Beta blockers SE in pregnancy
Fetal growth restrictionHypoglycaemia in the neonateBradycardia in the neonate
330
ACE inhibitors and ARBs SEs in pregnancy
Oligohydroamnios| Hypocalvaria
331
Opiates SE in pregnancy
neonatal abstinence syndrome (NAS) 3-72h post birthirritability, tachypnoea, fever, poor feeding
332
Lithium SE in pregnancy
Ebstein's anomaly (tricuspid is set lower in the right side so bigger right atrium and smaller right ventricle)
333
SSRI
paroxetine - strong link with congenital malformation1st trimester - congenital heart defects3rd trimester - PPH
334
Rubella in pregnancy
congenital rubella - infection before <20weeks gestation- Congenital deafness, cataracts- PDA and pulmonary stenosis- Learning disability
335
Chickenpox in pregnancy
mother complication: hepatitis, encephalitis, varicella pneumonitiscongenital varicella syndrome (if <28 weeks gestation): foetal growth restriction, microcephaly, hydrocephalus, scarring, limb hypoplasia, chorioretinitis
336
Listeria in pregnancy
Gram positive bacteria due to unpasteurised dairy products (eg blue cheese) miscarriage, severe neonatal infection
337
CMV in pregnancy
congenital CMV:- growth restriction- vision and hearing loss- microcephaly- learning disability- seizures
338
Congenital toxoplasmosis
intracranial calcificationhydrocephaluschorioretinitis
339
Parvovirus infection in pregnancy complications
5th disease/slapped cheek/ erythrema infectiosum - fetal anaemia - hydrops fetalis (foetal heart failure)- miscarriage or foetal death
340
Zika virus in pregnancy
spread by Aedes mosquitoscongenital zika syndrome: microcephaly, foetal growth restriction, ventriculomegaly and cerebellar atrophytest with PCR and antibodies
341
Anti D injections (when)
28 and 34 (or 28 and birth)| + sensitisation: antepartum haemorrhage, amniocentesis, abdo trauma
342
When is Anti D given in sensitisation event
72h post event| Kleinhauer test determines if further doses are required
343
Small for gestational age
<10th centile assesed via: - estimated foetal weight- foetal abdominal circumeference
344
Severe small for gestational age
<3rd centile for gestational age
345
Low birth weight
<2500g
346
Complications of foetal growth restriction
Fetal deathBirth asphyxianeonatal hypothermia/ hypoglycaemia
347
SGA risk factors
```Old mother <35yoMultiple pregnancylow PAPPAObesitySmokingDiabetesHTNpre-exlampsia```
348
Tx for SGA?
Early delivery +corticosteroids
349
Large for gestational age
=macrosomia>4.5kgestimated fetal weight >90th centile
350
Causes of macrosomia
```Maternal diabetes (Gestational diabetes)maternal obesityoverduemale beboprevious macrosomia```
351
LGA risks
```Shoulder dystocia !!!peineal tearsneonatal hypoglycaemiaclavicular facture/erb palsy/ birth injuryPPH, uterine rupture```
352
PID treatment
1g ceftriaxone IM (single dose), 400mg metronidazole PO BD, doxycycline 100mg PO BD for 14d
353
Dichorionic diamniotic
membrane between the twins, with a lambda sign or twin peak sign
354
Monochorionic diamniotic
membrane between the twins, with a T sign
355
Monochorionic monoamniotic
no membrane separating the twins
356
Lambda sign
- twin peak sign| membrane between twins meets the placents (dichorionic pregnancy)
357
T sign
membrane between twins abruptly meets chorion (monochorionic pregnancy)
358
twin to twin transfusion syndrome
#NAME?
359
Prengnacy checks for anaemia
FBC atBooking clinic20 weeks gestation28 weeks gestation
360
Additional US in multiple pregnancy
2 weekly scans from 16 weeks for monochorionic twins| 4 weekly scans from 20 weeks for dichorionic twins
361
Monoamniotic twins birth
elective caesarean section at between 32 and 33 + 6 weeks
362
Diamniotic twins birth
37 and 37 + 6 weeksVaginal delivery if 1st bebo is cephalicC sectionElective c section when 1st bebo not cephalic
363
urine dipstick nitrites and leukocytes
gram -ve bacteria E.Coli break down nitrates into nitritesleukocytes - test for leukocyte esteraseNitrites are a MORE ACUTE sign of infection than leukocytes
364
UTI causing organisms
E Coli (gram-ve, anaerobic, rod-shaped), found in faecesKlebsiella pneumoniae (gram-ve anaerobic rod)Candida albicansStaph saprophyticusPseudomonas auerginosaEnterococcus
365
Physiological changes in pregnancy
Plasma volume increases (reduced Hb concentration)
366
Low MCV
iron deficiency
367
Raised MCV
B12, Folate deficiency
368
HB screening in pregnancy
Thalassaemia - all women tested| Sickle cell disease - women at high risk
369
Tx options for B12
Intramuscular hydroxocobalamin injections| Oral cyanocobalamin tablets
370
VTE risk factors in pregnancy
```SmokingParity ≥ 3Age > 35 yearsBMI > 30Reduced mobilityMultiple pregnancyPre-eclampsiaGross varicose veinsImmobilityFamily history of VTEThrombophiliaIVF pregnancy```
371
VTE prophylaxis in pregnancy
28 weeks if there are three risk factors| First trimester if there are four or more of these risk factors
372
LMWH examples
enoxaparindalteparintinzaparin
373
PE ix
chest X rayECGCTPA in abnormal xray or VQCTPA-breast cancer risk, VQ childhood cancer
374
DVT ix
doppler ultrasound
375
Massive PE treatment
UnfrActioned heparin| surgical embolectomy
376
Pre-eclampsiatriad
HypertensionProteinuriaOedema
377
RF for preeclampsia and tx
Tx, aspirin from 12 weeks until birth```Pre-existing hypertensionPrevious hypertension in pregnancyDiabetesChronic kidney diseaseOlder than 40BMI > 35More than 10 years since previous pregnancyMultiple pregnancyFirst pregnancyFamily history of pre-eclampsia```
378
pre eclampsia diagnosis
SBP above 140 mmHgDBP above 90 mmHgPLUS any of:ProteinuriaOrgan dysfunctionPlacental dysfunction
379
proteinuria quantification
Urine protein:creatinine ratio (above 30mg/mmol is significant)Urine albumin:creatinine ratio (above 8mg/mmol is significant)
380
HELLP
HeamolysisEleveated Liver enzymesLow Platelets
381
Pre eclampsia tx
LabetololNifedipineMethyldopa (3rd line, must be stopped within 48h from birth)IV hydralazine (antihypertensive in severe preeclampsia)IV magnesium sulphate
382
Gestational diabetes treatment
Fasting glucose <7 mmol/l: diet and exercise for 1-2w, then metformin, then insulinFasting glucose >7 mmol/l: start insulin ± metforminFasting glucose >6 mmol/l plus macrosomia (or other complications): start insulin ± metformin
383
Alternative for metformin in pregnancy
Glibenclamide (sylfonylurea)
384
target sugar levels in pregnancy
Fasting: 5.3 mmol/l1 hour post-meal: 7.8 mmol/l2 hours post-meal: 6.4 mmol/l
385
Sliding scale insulin
dextrose and insulin infusion is titrated to blood surgar levels during labour in T1D
386
Pre existing diabetes delivery
Planned beterrn 37 and 38+6
387
Babies of mothers with diabetes rf
```Neonatal hypoglycaemiaPolycythaemia (raised haemoglobin)Jaundice (raised bilirubin)Congenital heart diseaseCardiomyopathy```
388
Neonatal hypoglycaemia
aim for sugar >2mmol/L,| if below: IV dextrose or nasogastric feeding
389
Obstetric cholestasis
```Itching (palms and soles)FatigueDark urinePale, greasy stoolsJaundice```
390
Rashes in pregnancy
Pemphigoid getationis - includes bellybutton| Polymorphic erupion - tam gdzie majtki / stretch marks
391
Obstetric cholestasis bloods
Abnormal liver function tests (LFTs), mainly ALT, AST and GGTRaised bile acids
392
Tx for obstetric cholestasis
Ursodeoxycholic acid, Emollients/calamine lotion Antihistamine (chlorphenamine)
393
Acute fatty liver of pregnancy symptoms
```General malaise and fatigueNausea and vomitingJaundiceAbdominal pain(lack of appetite)Ascites !!!```
394
Acute fatty liver of pregnancy bloods and tx
Raised bilirubinRaised WBC countDeranged clotting (raised prothrombin time and INR)Low plateletstx delivery of bebo
395
Polymorphic eruoption of pregnancy
Also / pruritic and utricarial papules and plaques of pregnancy tx emollients, steroids, antihistamines
396
Placenta praevia
placenta over the internal cervical os| - risk of antepartum haemorrhage
397
Low lying placenta
20mm from internal cervical os
398
foetal vessels
umbilical arteries x2| umbilical vein x1
399
placenta praevia vs vasa praevia risk
Placenta previa: corticosteroids from 34-36w, C section 36-37Vasa praevia: cotricosteroids 32w, C section 34-36
400
vasa previa
Foetal vessels exposed outside the umbilical cord or placenta
401
Superficial placenta accreta
Placenta implants in surface of myometrium
402
Placenta increta
Placenta attaches deeply into myometrium
403
Placenta percreta
Placenta invades past myometrium and perimetrium and reaches other organs (eg bladder)
404
How to assess depth/width of placental invasion?
MRI scans
405
Delivery in placenta accreta
Delivery 35-36+6Hysterectomy Uterus preserving surgery
406
ECV
50% successfulnulliparous: ECV if breech >36wmultiparous: ECV if breech >37wTocolysis with SC terbutaline (beta agonist) + anti D
407
Major causes of cardiac arrest in pregnancy
Obstetric haemorrhagePESepsis (metabolic acidosis and septic shock)
408
signs of labour
Show (mucus plug from the cervix)Rupture of membranesRegular, painful contractionsDilating cervix on examination
409
phases of birth
latent: 0-3cm, 0.5cm/hactive: 3-7cm, 1cm/htransition: 7-10cm 1cm/h
410
Preterm prelabour rupture of membranes (P‑PROM)
amniotic sac has ruptured before the onset of labour and before 37 weeks gestation
411
Prolonged rupture of membranes (also PROM)
amniotic sac ruptures more than 18 hours before delivery
412
Prematurity and classes
Birth before 37w Under 28 weeks: extreme preterm28 – 32 weeks: very preterm32 – 37 weeks: moderate to late preterm
413
Diagnosis of PPROM
ILGFBP-1: high concentrations in amniotic fluid| PAMG-1: alternative
414
Mx of PPROM
Prophylactic Abx (erythromycin 250mg 4x/10d or until labour ir earlier)
415
Preterm labour with intact membranes
Foetal fibronectin:if <50ng/ml, negative and preterm labour unlikely
416
Antenatal steroids regime
2 doses of IM bethametasone 24h apart
417
Main complication of induction of labour
due to vaginal prostaglanding - -> uterine hyperstimulation - Individual uterine contractions lasting more than 2 minutes in duration- More than five uterine contractions every 10 minutesIt leads to: foetal hypoxia, uterine rupture, emergency C section
418
Mx of uterine hyperstimulation
Stopping oxytocinvaginal prostaglandinsTocolysis with terbutaline
419
IOL options
Membrane sweep (from 40w)Vag Prostaglanding E2 (Dinoprostone)Cervical ripening baloonArtifical rupture of membranes with oxytocin infusion
420
Baseline rate of CTG
110-160 normal abnormal <100, >180
421
Variability in CTG
5-25 Normal| <5 for 50 min or >25 for 25min
422
Prolonged decelerations
2-10 mindrop of >15bpm from baselinemeans: foetal hypoxia
423
Oxytocin in labour
syntocinon - oxytocin| atosiban - oxytocin receptor antagonist (- used for tocolysis
424
Ergometrine
stimulates smooth muscle contraction in uterus and blood vessels - SE: hypertension, diarrhoea, vomiting, angina
425
Pain relief in labour
```Paracetamol and codeineGas and air (entonox)IM pethidine/Diamorphine Pt controlled analgesia: RemifentanilEpidural (levobupivacaine or bupivacaine mixed with fentanyl)```
426
Maternal infection in instrumental delivery mx
Single dose of co-amoxiclav
427
Instrumental delivery risks for baby
Cephalohematoma (ventouse)| facial nerve palsy (forceps)
428
Instrumental delivery risks for mother
```femoral nerve (anterior thigh weakness, knee extension weakness, patella reflex loss)obturator nerve (hip adduction and rotation loss, numbness of medial thigh)```
429
Lateral cutenous nerve injury
numbness of anterolateral thigh
430
lumbosacral plexus injury
foot drop and numbness of anterolateral thigh, lower leg, foot
431
common peroneal nerve injury
foot drop
432
Classification of perineal tears
1st – injury limited to the frenulum of the labia minora2nd – perineal muscles, but not the anal sphincter3rd – the anal sphincter, but not the rectal mucosa4th– the rectal mucosa
433
3rd degree tear subcategories
3A - <50% external anal sphincter3B - >50% external anal spincter3C - external and internal anal sphincters affected
434
Antibiotics in sepsis 6
piperacillin and tazobactam (tazocin), gentamicin,amoxicillin, clindamycin and gentamicin.
435
Mastitis treatment
flucloxacillin| infection with staph aureus
436
Candida of the nipple
```topical miconazole (2% after breastfeed)Treatment for the babcy (miconazole gel or nystatin)```
437
Sheehan's syndrome
avascular necrosis of pituitary gland ischaemia due to reduced perfusion.Only affects Anterior pituitary.
438
posterior pituitary hormones
ADH| oxytocin
439
Sheehan's syndrome presentation
reduced lactation (lack of prolactin)amenorrhoea (lack of LH FSH)adrenal infufficiency (low cortisol, lack of ACTH)hypothyroidism (low TSH)
440
Tx of Sheehan's syndrome
Oestrogen and progesteroneHydrocortisone for adrenal insufficiencyLevothyroxineGrowth hormone
441
GBS prophylaxis
Intrapartum haemorrhage: previous GBS, pyrexia in labour, Swabs at 35-37w or 3-5w before delivery Benzylpenicillin
442
Serum progesterone in infertility
Check 7 days before period<16 repeat, treat16-30 repeat>30 ovulation
443
EllaOne
Ullipristal acetate
444
Urge incontinence
Bladder retrainingAntimuscarinixs (oxybutynin, tolteridone, darifenacin) Mirabegron: for old frail
445
Stress incontinence
Pelvic floor trainingTape procedureDuloxetine (Contraction of urethral sphincter)
446
Ullipristal acetate (EllaOne)
120h Do not give to asthmaticsNo breastfeeding for 7daysReturn to hormonal contraception after 5d
447
COCP postpartum
Contraindicated in <6 weeks post Partum
448
HRT SEs
NauseaBreast tendernessFluid retentionWeight gain
449
HRT complications
Risk of VTE, stroke, IHDRisk of endometrial cancer Increased risk of Breast cancer (due to addition of oestrogen)
450
Diagnostic tests for Downs
<13w chorionic villous sampling| >15w amniocentesis
451
Endometriosis tx
NSAIDsCOCPOr GnRH
452
1* PPH
IV syntocinon 10u OR IV ergometrine 500mcgIM carboprost Intrauterine balloon tamponade (ligation of uterine arterie or internal iliac artery)
453
Pregnancy and VTE
Do not give DOAC and warfarin >4 rf: LMWH until 6 weeks post partum>3 rf: 28w-6w pp LMWHDVT before delivery: until 3 mth pp LMWH
454
Epilepsy in pregnancy drug
Lamotrigine
455
Mucinous cystadenoma
If ruptured, causes pseudomyoxoma peritonei
456
Meig’s syndrome
Benign ovarian tumourAscitesPlural effusionCauses FIBROMA
457
Dermoid cyst
Most Common benigh ovarian tumour <25
458
Follicular cyst
Most Common cause of ovarian enlargment
459
Ovarian cancer RF
```Many ovulationsEarly menarcheLate menopauseNullparityIncreased risk with all HRT```
460
Drugs causing folate deficiency
Pnenytoin| Methrotrexate
461
Misoprostol mode of action
Strong myometrial contractions causing tissue expulsion
462
Mifepristone mode of action
Thins uterine lining
463
Endometrial cancer rf
```(Frail elderly - progesterone therapy) Risk factors: periods increase risk of ovulations- nullparity- early menarche- late menopause- unopposed oestrogen- obesity```
464
Magnesium sulphate and eclampsia tx
IV bolus 4g 5-10mIV infusion 1g/h Calcium gluconate for resp depression
465
Injectable (progesterone only) contraception
Do not give >50 as reduces bone density
466
Congenital rubella syndrome
```<16w infection Sensorineural deafnessCongenital cataractsCongenital Heart disease Salt and pepper chorioretinitis```
467
Semen analysis
Min 3 days and Max 5 days abstinenceSample delivered within 1hVolume >1,5mlpH >7.215mln/ml concentration
468
Hep B in mother, bebo management:
Hep B vaxx <12h, 1mth, 6mthHep B IG 0.5ml <12hNo transmission via breastfeeding
469
Breast cancer
Increased risk when progesterone added| Also pregnancy increased risk
470
COCP rf
Increased: Breast and cervical cancer Decreased: ovarian and endometrial
471
Implantable contraceptive
Nexplanon or implanon| 3y
472
Cervical excitation conditions
PID| Ectopic pregnancy
473
Unopposed oestrogen risk
Endometrial cancer
474
N&V medication in pregnancy
Metoclopramide| Do not use >5d
475
Desogestrel
POP| 12h Window for taking
476
Hyperechogenic bowel
CFDown’s syndrome CMV
477
HRT adding progesterone
Increased Breast cancer risk
478
Increased nuchal translucency
Down’s syndrome Congenital Heart defectAbdominal wall defect
479
Hyperemesis gravidarum
5% weight lossDehydration Electrolyte imbalabce
480
Progesterone rf
Increased risk of Breast cancer and VTE
481
Varicella zoster monitoring
IgM - chickenpox now| IgG - chickenpox in the past
482
Drugs to avoid in breastfeeding
```Abx (ciprofloxacin, tetracycline, chloramphenicol, sulphonamides)LithiumBenzodiazepinesAspirinCarbimazoleMETHOTREXATESulfonylureasCytotoxic drugsAmiodarone```
483
BV diagnostic criteria
Thin white discharge Clue cells pH <4.5Whiff test +veFishy greyOral metronidazole
484
Trichomonas vaginalis
```Yellow greenOffensive Strawberry cervixVulvovaginitisFrothy discharge ```Oral metronidazole
485
Gonorehoea
IM ceftriaxone
486
Felty’s syndrome generic
HLA DR4
487
Apgar score
1,5,10 min| Pulse, resp effort, colour, tone, reflex
488
CF diet
High calorie, High fat diet| To reduce streathorrhoea
489
Meckels diverticulum Scan
Techtenium scan
490
<1 BLS
15:2| Two thumbs
491
>1 BLS
Lower sternum, 1 hand, 15:2
492
Thelarche
1st stage of breast development
