2018 remembered Flashcards
A 7-year-old boy whose parents separated 3 months ago was brought in by his mother, who he lives
with. He has been sleeping in his mother’s bed and refusing to go to school. He loses his temper often
and has been verbally aggressive towards his mother’s new partner. He refuses to comply with requests
made by his mother. When he was last at school, he was verbally aggressive and punched a wall
before running home. He is settled in his grandmother’s presence. He spends most of his time playing
video games and does not want to play with his friends, despite having enjoyed this in the past.
What is the most likely diagnosis? A. Attention deficit hyperactivity disorder. B. Conduct disorder. C. Major depressive disorder. D. Oppositional defiant disorder. E. Separation anxiety disorder
D. Oppositional defiant disorder.
DSM V: A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms of the following categories, and exhibited during interaction with at least one individual who is not a sibling: Angry/Irritable Mood 1. Often loses temper
2.
Is often touchy or easily annoyed
3.
Is often angry and resentful
Argumentative/Defiant Behavior
4.
Often argues with authority figures or, for children and adolescents, with adults
5.
Often actively defies or refuses to comply with requests from authority figures or with rules
6.
Often deliberately annoys others
7.
Often blames others for his or her mistakes or misbehavior
Vindictiveness
8.
Has been spiteful or vindictive at least twice within the past 6 months.
Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion AB). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months. Unless otherwise noted (Criterion AB). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture.
B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues) or it impacts negatively on social, educational, occupational, or other important areas of functioning,
C. The behavior does not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also the criteria are not met for disruptive mood dysregulation disorder.
Specify current severity:
Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).
Moderate: Some symptoms are present in at least two settings
Severe: Some symptoms are present in three or more settings.
A baby is delivered urgently because of fetal tachycardia during labour. She is well at birth, but has a
rapid and irregular heart rate. The following ECG is recorded (atrial flutter). The rhythm proves unresponsive to repeated doses of intravenous adenosine.
What treatment is most appropriate to achieve reversion to sinus rhythm? A. Amiodarone infusion. B. Electrical cardioversion. C. Electrophysiologic ablation. D. Oral sotalol. E. Overdrive pacing
B) electrical cardioversion
- paralyse and intubate first - may be able to induce
- adenosine is reasonable first choice
- B-blockers - generally safe and widely used; main SE: hypoglycaemia
A 13-year-old boy diagnosed with ulcerative colitis is admitted with increased bloody diarrhoea and fevers. An abdominal x-ray is performed. What is the most likely explanation for the boy's clinical deterioration? A. Ileus. B. Large bowel ischaemia. C. Spontaneous colonic perforation. D. Toxic megacolon. E. Volvulus
D. Toxic megacolon.
Toxic megacolon is a potentially lethal complication of inflammatory bowel disease (IBD) or infectious colitis that is characterized by total or segmental nonobstructive colonic dilatation plus systemic toxicity.
One possible mechanism is that mucosal inflammation leads sequentially to the release of inflammatory mediators and bacterial products, increased inducible nitric oxide synthase, generation of excessive nitric oxide, and colonic dilatation (diameter >6 cm on XR).
The most widely used criteria for the clinical diagnosis of toxic megacolon are [3]:
●Radiographic evidence of colonic distension
●PLUS at least three of the following:
- Fever >38ºC
- Heart rate >120 beats/min
- Neutrophilic leukocytosis >10,500/microL
- Anemia
●PLUS at least one of the following:
- Dehydration
- Altered sensorium
- Electrolyte disturbances
- Hypotension
A 2-year-old girl presents with a 4-week history of progressively enlarging submandibular
lymphadenopathy as shown below. She is otherwise well. The parents recall that she grazed her chin
prior to the lymphadenopathy developing.
What is the most likely infectious agent to cause this condition?
A. Actinomyces species.
B. Bartonella henselae.
C. Mycobacterium avium intracellulare.
D. Nocardia species.
E. Staphylococcus aureus.
C. Mycobacterium avium intracellulare.
In children, NTM cause four main clinical syndromes:
- lymphadenopathy
- skin and soft tissue infection (SSTI),
- pulmonary disease (predominantly in children with underlying pulmonary conditions)
- disseminated disease (predominantly in immune-compromised children).
- annual incidence of NTM in children range widely: from 0.6 to 1.6 per 100,000 children in Australia, to 3.1 per 100,000. In each of these studies, lymphadenitis was the most common presentation.
NTM are transmitted through environmental sources. M. avium complex (MAC), the most common cause of lymphadenitis, is found in soil and water (from both natural and treated water)
- typically occurs in children between one and five years of age
- cervicofacial nodes, particularly the submandibular nodes, are most frequently involved
- unilateral, nontender node (<4 cm in diameter) that slowly enlarges over several weeks [39]. The overlying skin gradually changes from pink to violaceous and thins to become parchment-like (picture 1) and may eventually suppurate through a sinus tract [1,10,25,39]. Sinus tract formation can occur spontaneously or follow direct trauma to the region. Fever and other systemic findings are variable and are more common if the lymph nodes become secondarily infected by pyogenic bacteria (
