2018 Paper Flashcards
Spiral fracture on kid. What do you worry about and next step?
- NAI
- You admit and start safeguarding protocol
Clavicle fracture in newborn management
great prognosis, no specific treatment needed
Femoral fracture management in
- neonates
- <18 months
- 1-6 years
- > 4 years
Femoral shaft fractures:
· Neonates (0-28 days) – padded splints or Pavlik’s harness
· <18 months – Gallows traction
· 1-6 years – straight leg skin traction
· >4 years – intramedullary nail (+ more support if >11y)
Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give?
Repeat steroids
kid that would fall down and scream and stuff but was completely fine afterwards
Temper tantrum
After sudden shock (pain, cold food, fright)
Pale or grey turning
Lose consciousness
Become stiff but has rapid recovery
Diagnosis?
Reflex anoxic seizure
–> reassure but refer to first seizure clinic if 1st seizure
Seen in infants and toddlers
–> Episodes due to cardiac asystole due to vagal inhibition
Cries forcefully then holds breath then turns blue then LOC
Breath holding attack
–> Stop by 4/5 y/o
Behaviour modification
- Sudden, rapid, tonic contraction of trunk and limb muscles with gradual relaxation over 0.5-2 seconds
Diagnosis and management?
Infantile Spasm (West Syndrome)
Peak incidence 3-8 months (90% under 1yo), more common in males
Investigations: EEG (hypsarrhythmia – disordered activity in the brain)
- Management: Vigabatrin or corticosteroids
Kid with yellow and grey stools and was 4 weeks old. What do you test for?
Conjugated bilirubin levels
Kid with bouts of crying and episodes where they flex their knees and hips and red stool.
Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it?
Correct electrolyte imbalance
Voraciously hungry kid, hypotonia and almond eyes what was the diagnosis?
Prader-Willi
7 year old kid has an accident and needs to have his leg amputated below the knee. He says no and wants to wait for his mum to approve first but she’s on a business trip, dad says go for it.
What do you do?
- Apply to Court to get amputation in best interests
- Proceed with the dad’s consent (assuming dad is biological and still with the wife)
- wait for mum to give permission
- kid is gillick competent don’t operate
- Proceed with the dad’s consent (assuming dad is biological and still with the wife)
–> contested answer but I think it is right?
14 year old kid who thieves, got into fights (basically conduct disorder). What is 1st Mx?
If 11-17 is multisystemic family therapy
If 3-11 is parental training
If mild, 2nd line is cognition problem solving in kids 9-14
Recurrent chest infections / wheeze
+
- Ejection-Systolic Murmur at Upper Left Sternal Edge
- Fixed wide splitting of S2
Atrial Septal Defect
Pansystolic murmur at the lower left sternal edge
Ventricular septal defect
Harsh ejection systolic murmur at right upper sternal edge
Slow rising pulse
Narrow pulse pressure
Soft S2
Aortic Stenosis
- Turner and William’s association
- Risk of sudden death and endocarditis
- May present later on in childhood with chest pain or syncope
Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do?
Start anti-TB treatment (the kid has TB with those diameters)
It is considered positive if
-Manteaux >5mm = +ve in immunodeficiency
- Manteaux >10mm = +ve in at-risk groups (child <4yo, healthcare workers, IVDU)
- Manteaux >15mm = +ve in normal population
–> Mx: RIPE
3 year old Kid with hypochromic microcytic anaemia and low ferritin. What could be the cause?
Folate deficiency, Thalassaemia
coeliacs,
fussy eater
fussy eater common in this age, they take less iron and get anaemia, which explained the hypochromic microcytic anaemia blood film
Most common type of Cerebral Palsy?
- Spastic CP (90%)
- Dyskinetic CP (6%)
- Ataxic (hypotonic) CP (4%)
Cerebral Palsy:
hemiplegic weakness with brisk reflexes
‘clasp knife’ rigidity
what area of the brain is affected?
Damage to pyramidal (also known as corticospinal) tracts
Cerebral Palsy:
Involuntary, uncontrolled movements
what area of the brain is affected?
Dyskinetic CP
Caused due to damage to basal ganglia
Cerebral Palsy:
Hypotonia, mal-coordination, delayed motor development ± intention tremor.
What area of the brain is affected?
Ataxic (hypotonic) CP
Damage to cerebellum
–> most genetically determined
Kid having 1st set of primary vaccinations, what would stop you giving it?
Previous true anaphylaxis reaction
or
Current fever of >38.5
A 3 year old girl has 5 days of fever and a left sided neck lump.
Her temperature is 38.5°C, pulse
140bpm, respiratory rate 25 breaths per minute, oxygen saturation 98% breathing air.
Toxic left shift and reactive neutrophils
Most likely diagnosis?
Lymphadenitis
Kid needs fluids, but you can’t get standard IV access. Where do you go?
Intraosseous access
HIV with undetectable viral load. what is contraindicated in labour?
foetal blood sampling
Woman had an implant inserted but she’s getting it removed. What is the most likely reason why?
irregular bleeding
–> never understood this question but apparently this is the answer
What cancer are you at increased risk at with HRT?
Breast
Mother had rupture of membranes at like 32 weeks. What do you give her?
Oral erythromycin
Post partum haemorrhage with high BP. What do you give
Oxytocin is to be preferred initially, especially in women with hypertension or pre-eclampsia
Foreign woman has come in and is pregnant. What vaccine should she be offered?
dumb question- all women should be recommended whooping cough, but she was foreign so they probably wanted Hep B I think
Woman 38/40 has come in for her elective c/s, ECV failed, what do you do now?
just carry on with the C/S as planned
Woman previously had a abortion cos of severe spina bifida. No other clinical information given. What do you advice her on folic acid doses for her next pregnancy?
5mg from before conception to at least 12W
Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong?
brachial plexus injury
secondary to probably shoulder dystocia coz of diabetes
A 26 year old woman at 9 weeks gestation attends midwife antenatal clinic for her booking
bloods.
Which is the routine screening blood test for Hepatitis B infection?
Hepatitis B surface antigen
A couple in their mid-twenties have been trying to conceive for 2 years. The male partner
has been diagnosed with azoospermia.
Which is the most likely cause of azoospermia?
Mumps Orchitis
-> this has come up in so many exams
Woman who is exclusively breastfeeding and wants contraception
Reassure and give nothing
–> not to sure but seems to be hinting at lactational amenorrhea
–> you need to check she does not have periods and that she is exclusively breatfeeding
Alcoholic has cellulitis, given chlordiazepoxide and Abx, what else do you give?
thiamine/Pabrinex
Girl with anorexia was admitted and she started eating. Then she gets muscle spasms, and abdominal pain. What would be deranged/ what’s the most important thing to check for???
Phosphate
Drug to give for depression in a guy who had an MI
Sertraline
A 46 year old male inpatient has recently been initiated on clozapine following relapse of
paranoid schizophrenia. He reports chest pain and tachycardia. ECG demonstrates ST
elevation. Which is the most likely diagnosis?
Myocarditis
Woman experienced trauma 6 months ago/has PTSD best management?
- trauma focused CBT wasn’t option
Eye Movement Desensitisation and Reprocessing
–> could also be cognitive analytical therapy?
Woman blushes in public. Diagnosis?
social phobia
Alcoholic wants to quit and wants something for reducing cravings
Acamprosate
dilated pupils, urinary retention, obs normal-ish - cause of overdose?
TCA
Husband brings in wife who has bipolar, who’s taken 20 “white” tablets - has a tremor and other sx. What tablet has she overdosed on?
lithium overdose
Newborn with portwine stain in trigeminal distribution. What do you need to do?
Arrange MRI because of high risk of Sturge-Weber syndrome.
Radiologic imaging (MRI or CT scan) are needed to look for vascular malformations in the eyes and brain. Patients with port wine stains involving the upper face (and particularly the forehead) should be referred to an ophthalmologist to determine if glaucoma or other characteristic eye findings are present.
What signifies onset of active labour?
dilated >4cm
A newborn appears to be in severe respiratory distress and appears blue. Despite being given high flow O2, his saturations remain at 65%.
What is the next best step to take with regards to his management?
Infusion of Prostaglandin
What is the most important thing to look at in follow up of HSP?
Urine Protein
15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis?
Chronic renal failure
Child with episodes of smelling strange things, hard to communicate with during these episodes, falls asleep for an hour after and doesn’t remember anything
Focal seizure
