1. Medical History Flashcards
On a growth chart, how many ‘centile’ lines crossed would make you concerned about a child failing to thrive/grow? a. 3 b. 1 c. 5 d. 2 e. 4
2
See https://goo.gl/images/giSH8P for an example of a growth chart that shows failure to thrive. In this case the underlying diagnosis is coeliac disease (malabsoprtion disease triggered by gluten intake). In the first few months of life a baby is breastfed and/or given formula milk. Around 4-6 months is when children start having enough head control to safely eat solids. So this child was not exposed gluten until they started solids and that’s when their disease manifested. After the diagnosis was made and the child was put on a gluten free diet, they were able to catch up to their previous potential growth.
What should be at the top of your differential diagnosis list when considering a 2 y.o. presenting with post-tussive (post cough) vomitting of 2 weeks duration?
a. gastroenteritis
b. pertussis (whooping cough)
c. inhaled foreign body
d. brain tumour
e. pneumonia (lung infection)
pertussis (whooping cough)
In pneumonia, if there is any vomitting it would be vomitting without being post-tussive (after coughing), the child would be systemically unwell, and there would be persistent fevers .
With an inhaled foreign body there may be a wet cough (foreign body blocking normal movement of secretions), and the presence of a FB does not usually cause bouts of coughing leading to vomitting.
Intracranial tumour would cause early morning vomitting, not post-tussive. But it is important to think about the brain as a differential site for disease when thinking about vomitting.
No diarrhoea so less likely to be infectious gastroenteritis.
What is the most appropriate INITIAL treatment for acute congestive cardiac failure in a stable patient (conscious, can talk at least in phrases, able to carry out activities of daily living)?
a. diuresis (increase production of urine)
b. minimum 2L fluid intake
c. urgent cardiologist (heart doctor) review
d. sleep propped up on several pillows e. hospitalisation
-a. diuresis (increase production of urine)
Patient stable so does not require hospitalisation at this stage.
Cardiologist review may be useful but not an important immediate first step – diuresis is effective treatment, semi-urgent GP review is an appropriate first step
Sleep propped up on several pillows – provides symptom relief but doesn’t treat underlying cause of fluid overload
Minimum 2 L fluid intake – CCF patients should be on a fluid restriction usually 1.2L
Which of the following is the most imminent sign of impending airway obstruction?
a. unresponsiveness
b. talking in words only
c. wheezing
d. swollen lips
e. drooling
-
drooling
Drooling means patient is not swallowing, which is a mechanism to protect the airway. We temporarily obstruct our airway when we swallow. This sign was seen in epiglottitis, which is extremely rare now due to childhood immunisation against haemophilus influenza B.
Wheezing – is a sound from narrowed bronchioles, heard on auscultation with stethoscope. It is a not related to the condition of major airways.
Talking in words only – considerable respiratory distress but not impending obstruction of an airway.
Swollen lips – although concerning for anaphylaxis, if an isolated finding, may just be a localised allergic reaction
Unresponsive – may not necessarily have an obstructed airway
Which one of the following is a shockable rhythm in cardiac arrest?
a. pulseless electrical activity
b. asystole (flat line)
c. ventricular fibrillation
d. supraventricular tachycardia
e. atrial fibrillation
-ventricular fibrillation
Which of the following is a cardiovascular risk factor?
a. BMI = 25
b. polycystic ovarian syndrome
c. age >45y.o.
d. mediterranean diet
e. hypothyroidism (low thyroid hormone)
age >60y.o.
BMI = 25 – normal
hypothyroidism – not a risk factor
mediterranean diet – cardioprotective
polycystic ovarian syndrome – imbalance of reproductive hormones leads to insulin resistance and increases risk of diabetes
In an acute asthma attack, what is the maximum amount of ventolin puffs you can give to a child <5 y.o. at one time?
a. 4
b. 2
c. 1
d. 6
e. 12
6
- 2 – during milder attacks, e.g. every four hours
- 4 puffs every 4 minutes 4 times is an alternate strategy for treating acute attack – no response warrants ambulance transfer to hospital
- 12 – for children > 5 and adults
What medication is contained within an epipen?
a. paracetamol
b. adrenaline
c. ventolin
d. antihistamine
e. no medication, placebo effect
-adrenaline
- Ventolin is used in asthma puffers for acute relief. It dilates airways by causing muscle relaxation and decreases mucus secretion.
- Antihistamines are medications like Claratyne, Telfast etc. which are used in allergies.
- Paracetamol is panadol, commonly available painkiller.
Which one of the following indicates possible underlying epilepsy instead of simple febrile convulsion?
a. family history of febrile convulsions
b. seizure recurs within 24 hours period
c. seizure affects both sides of the body
d. age 6 months to 6 years
e. age 6 months to 6 years
-seizure recurs within 24 hours period
- Family history of epilepsy however would increase risk of a patient having epilepsy but does not necessarily point to an underlying diagnosis if other features of simple febrile convulsion are present
- Age 6 months to 6 years – normal age group for febrile convulsions
What question below is the most useful to assess problematic alcohol intake? a. have you felt guilty about your alcohol intake? b. do you smoke when you drink? c. do you drink spirits? d. do you drink alone? e. at what age did you start drinking?
- Do you drink alone? – not necessarily an issue!
- Do you drink spirits? – if sticking to recommendatiosn of 2 standard drinks, not problematic
- Do you smoke when you drink? – often come hand in hand but doesn’t assess alcohol intake
- At what age did you start drinking? – recommendations are not until older teenage years, the later the better, however this question doesn’t reflect current level of drinking.
Which one of the following is a red flag symptom for menstruation?
a. passing clots
b. post menopausal bleeding
c. menarche age 8
d. heavy bleeding for first 2 days
e. dysmenorrhoea (painful periods)c
-
post menopausal bleeding
Which of the following correctly matches ethnicity/country of origin to increased disease risk?
a. middle east, thalassaemia
b. japanese, bowel cancer
c. african, cystic fibrosis
d. chinese, cystic fibrosis e. caucasian, bronchiectasis (dilated small airways)
middle east, thalassaemia
Middle east, thalassaemia – ANSWER. Important in preconception counselling (will be covered in haematology week)
Caucasian, bronchiectasis – no, cystic fibrosis
Japanese, bowel cancer – no, actually gastric cancer
List 5 questions in a systems review of the cardiovascular system
- Have you had any pain/ pressure in chest/neck/arms?
- Are you short of breath on exertion? How much exertion is needed?
- Have you ever woken up at night short of breath?
- Can you lie flat without feeling breathless?
- Have you had swelling of your ankles?
- Pain in the chest, neck or arm;
- Shortness of breath on exertion;
- Waking up at night from shortness of breath;
- Ankle swelling;
- Awareness of your heartbeat;
- Pain in calves on exercising;
- Have you had any heart problems or high blood pressure?
List 7 questions in a social history
- Are you a smoker?- If yes how long have you smoked, how many cigarettes do you take a day? Have you made any attempts to quit?
- How often do you drink alcohol?
- Who do you live with?
- What is your occupation?
- Have you recently travelled anywhere?
- Does your child go to daycare?
- (If male patient): Have you had sexual relations with the same sex?
- SNAP - smoking, nutrition, alcohol, physical exercise;
- Recreational drugs;
- Last overseas travel;
- Living arrangement;
- Level of independence in activities of daily living;
- Occupation;
- Family and social support;
- Stressors;
- Level of education;
- Trouble with the law
What does SOCRATES stand for?
Site of symptom
Onset – when and how (sudden severe pain/ gradual onset)
Character
Radiation– does symptom travel anywhere else
Associated symptom
Timing: duration/ time of day
Exacerbating/relieving factors
Severity: scale
