Child Health 2 Flashcards

1
Q

RF for appendicitis?

A

> Male
10 - 20 yrs old
FHx
White

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of appendicitIs?

A

> fecaliths - most common cause of luminal obstruction
lymphoid hyperplasia
foreign bodies
carcinoid tumours/ neoplastic growths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

most common cause of sepsis in the uk?

A

pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

appendicitis pathophys?

A

> ischemia and inflammation -> tissue necrosis -> appendiceal wall weakening -> perforation > peritonitis -> sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

appendicitis CFs?

A

> pain - starts central and radiates to RIF
vomiting
mild pyrexia
possible diarrhoea
anorexia common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

pain seen in appendicitis?

A

> patients often report the pain being worse on coughing or going over speed bumps. Children typically can’t hop on the right leg due to the pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

examination in appendicitis?

A

> generalised peritonitis if perf
DRE - boggy sensatuon if pelvic abcess present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2 classic signs of appendicitis?

A

Rosvings and Psoas sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Rosvings sign?

A

> palpation in the LIF causes pain in the RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Psoas sign?

A

> pain on extending hip if retrocaecal appendix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ix of appendicitis?

A

> neutrophil dominant leucocytosis common
urine analysis to exclude renal colic and UTI
exclude pregnancy
US if pelvic organ pathology suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ectopic pregnancy?

A

> Can cause RIF pain, N&V and fever like appendicitis
but ectopic pregnancies typically present with a 6-8 week history of amenorrhoea with or without vaginal bleeding and a positive pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ovarian torsion?

A

> both appendicitis and torsion can cause RIF pain and N&V
a palpable adnexal mass is felt in 50-70% of cases of ovarian torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PID?

A

> in pelvic inflammatory disease pain is typically bilateral, there is vaginal/cervical discharge and cervical motion tenderness on examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute mesenteric adenitis?

A

both this and appendicitis can cause lower abd pain with guarding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Differences between acute mesenteric adenitis and appendicitis?

A

mesenteric adenitis typically occurs inchildrenafter aviral upper respiratory tract infectionand it does not cause localised tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Meckles diverticulum?

A

> can cause RIF pain
clinically indistinguishable from acute appendicitis, often identified when normal appendix found during appendicectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Crohns?

A

Crohn’s disease often presents with chronicdiarrhoeaand there may be a positive family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute cholesystits vs appendicitis?

A

> Similarities: both present with right-sided abdominal pain with or without guarding and raised inflammatory markers
Differences: In cholecystitis pain is typically in the right upper quadrant region and there may be a palpable gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ureteric stones?

A

in nephrolithiasis, pain is typically in the flank, colicky in nature and radiates to the groin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

UTI?

A

urinary tract infections typically present with dysuria, urgency and frequency and affect older adults more commonly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mx of appencitis?

A

> laparascopic appendicectomy
prophylactic ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

RF for pyelo?

A

> Female sex
Structural urological abnormalities
Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

most common cause of LUTI?

A

E COLI - rod shaped, gram negative, anaerobic bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Triad of pyelo?

A

> Fever
Loin or back pain (bilateral or unilateral)
Nausea / vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

other CFs of pyelo?

A

> dysuria, suprapubic discomfort and increased frequency
loss of appetite
renal angle tendernes
haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Ix of pyelo?

A

> dipstick - nitrites, leukocytes, blood
MSU - culture and sensitivity testing
BT - raised WCC and CRP
Imaging - US ot CT to exclude other pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Abs used for pyelo?

A

> Cefalexin
If culture results available:
co-amoxi
trimethoprim
ciproflocaxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

chronic pyelo?

A

> recurrent episodes of kidney infection
can lead to CKD and end stage renal failure
DMSA scans used to assess damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

UTI sx?

A

> Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul-smelling urine
Confusion is commonly the only symptom in older and frail patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When should pyelo be suspected over UTI?

A

> Fever
Loin or back pain
Nausea or vomiting
Renal angle tenderness on examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

UTI - dipstick results?

A

> Where only nitrites are present, it is worth treating as a UTI.
Where only leukocytes are present, a sample should be sent to the lab for further testing.
Antibiotics may be considered where there is clinical evidence of a UTI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When is a MSU required?

A

> not all ppts w uncomplicated UTIs require this
pregnancy
atypical sx
no improv w AB
recurrent UTIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Tx of UTI?

A

> Nitro > avoid in GFR < 45
trimethoprim - avoid in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Ab course for Utis?

A

> 3 days for women
5-10 days for IS women, abn anatomy or impaired kidney function
7 days for men, pregnant women or catheter related UTIs
change catheter when diagnosed w catheter related UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Mx of UTI in pregnancy?

A

> 7 days ab, MSU required
cefalexin is typical choice
amoxicillin after sensitivies known
nitro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

use of nitrofurantoin in pregnancy?

A

avoud in T3 - risk of neonatal haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Trimethoprim in pregnancy?

A

avoid in T1 - can cause congenital abn- avoided throughout pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Cysts in pre vs post menopausal women

A

> common in pre-menopausal women
in post-menopausal, concerning for malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

diagnosis of PCOS?

A

> String of pearls appearance of ovaries alone not enough
at least 2 of 3 required:
anovulation
hyperandrogenism
polystic ovaries on US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

ovarian cyst symptoms?

A

> most asymptomatic
pelvic pain
bloating
palpable mass - espec large cysts
fullness in abdomen
Ovarian cysts may present with acute pelvic pain if there is ovarian torsion, haemorrhage or rupture of the cyst.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Follicular cysts?

A

> most common type
cysts persist when the follicle fails to rupture and release the egg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Corpus luteum cysts?

A

> when corpus lutem fails to break down and instead fills w fluid
can cause discomfort, pain or delayed menstruation
often seen in early pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Serous Cystadenoma

A

These are benign tumours of the epithelial cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Mucinous Cystadenoma

A

These are also benign tumour of the epithelial cells. They can become huge, taking up lots of space in the pelvis and abdomen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

endometrioma?

A

These are lumps of endometrial tissue within the ovary, occurring in patients with endometriosis. They can cause pain and disrupt ovulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Dermoid Cysts / Germ Cell Tumours

A

> benign ovarian cysts
teratomas
associated w ovarian torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

sex cord stromal tumours?

A

> rare, can be benign or malignant
arise from stroma (CT) or sex cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Assessment of ovarian cysts involves?

A

> assessing for features of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

gen malignancy features

A

> Abdominal bloating
Reduce appetite
Early satiety
Weight loss
Urinary symptoms
Pain
Ascites
Lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

ovarian malignancy features?

A

> Age
Postmenopause
Increased number of ovulations
Obesity
Hormone replacement therapy
Smoking
Breastfeeding (protective)
Family history and BRCA1 and BRCA2 genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

link between number of ovulations and ovarian cancer

A

more ovulations -> inc risk of ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

factors reducing number of ovulations and therefore risk of ovarian cancer

A

> late menarche
early menopause
any pregnancy
use of COCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Ix of ovarian cysts?

A

> US
CA125 for ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Women under 40 years with acomplex ovarian massrequire

A

> tumour markers for a possible germ cell tumour
LDH
AFP
HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Risk of malignancy index

A

> estimates the risk of an ovarian mass being malignant, taking account of three things:

Menopausal status
Ultrasound findings
CA125 level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

When do cysts need to be referred?

A

> Complex cysrs or raised CA125 - 2WWW
dermoid cysts - gynae
cysts In postmenopausal women - gynae or 2WW if raised CA125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Simple ovarian cystsinpremenopausal womencan be managed based on their size:

A

> Less than 5cm cysts will almost always resolve within three cycles. They do not require a follow-up scan.
5cm to 7cm: Require routine referral to gynaecology and yearly ultrasound monitoring.
More than 7cm: Consider an MRI scan or surgical evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Meig’s syndrome?

A

> triad of:
ovarian fibroma - overian benign tumour
pleural effusion
ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

pleural effusion + ovarian mass ->

A

Meigs syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

most common benign ovarian tumour in women under age of 30?

A

dermoid cyst. Also torsion is more likely w this than w other ovarian tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Abd pain in kids?

A

> constipation
UTI
coeliac
IBD or IBS
mesenteric adenitis
HSP
pyelo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Abd pain in girls?

A

> Dysmenorrhea (period pain)
Mittelschmerz (ovulation pain)
Ectopic pregnancy
Pelvic inflammatory disease
Ovarian torsion
Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Surgical causes of abd pain - appendicitis

A

central abd pain > RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Surgical causes of abd pain - INTUSSUSCEPTION

A

colicky non-specific abdominal pain withredcurrantjelly stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Surgical causes of abd pain - bowel obst

A

pain, distention, absolute constipation and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

surgical causes of abd pain - torsion

A

sudden onset, unilateral testicular pain, nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

red flags for serious abd pain

A

> Persistent or bilious vomiting
persistent RUQ/ RLQ pain
Severe chronic diarrhoea
Fever
Rectal bleeding
Weight loss or faltering growth
Dysphagia (difficulty swallowing)
Nighttime pain
Abdominal tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

abd migraibe

A

> Abdominal migraine presents with episodes of central abdominal pain lasting more than 1 hour. Examination will be normal.
may be assoc aura, anorexia, N&V, pallor, photophobia, headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

treating acute attacks of abd migraine

A

> Low stimulus environment (quiet, dark room)
Paracetamol
Ibuprofen
Sumatriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Preventative medications for abd migraine:

A

> Pizotifen, a serotonin antagonist
Propranolol, a non-selective beta blocker
Cyproheptadine, an antihistamine
Flunarazine, a calcium channel blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Pizotifen

A

> prev med for abd migraine
needs to be withdrawn slowly - withdrawal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

mesenteric adenitis

A

> inflamed lymph nodes within mesentery
similar symptoms to appendicitis but more coryzal symptoms due to viral infection beforehand
higher fever than appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

mesenteric adenitis vs appendicitis

A

> MA: higher fever
MA: pain STARTS in RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Tx of mesenteric adenitis

A

self limiting, no Tx required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

CD pain

A

> diarrhoea
weight loss
abd mass in RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

uc features

A

> bloody diarrhoea
abd pain in left lower quadrant
tenesmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Red flags in cases of acute abd pain?

A

> billous vomiting
fullness/ masses/ hepatosplenomegaly
perianal/ rectal disease
tenderness over spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

appendicitis under 5

A

> long history
D&V prominent in early stages
may not have pain
can present with abd pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

appendicitis under 2

A

most perforated at presentation, collapse and sepsis syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

management of appenicitis in kids?

A

> fluid resus
surgery
48 hr ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

recurrent abdominal pain?

A

> pain can’t be explained by physical condition
pain at other sites like headache or limb pain common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

RAP - IBS

A

Bloating, loose stools, pain lessens after defecation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

RAP - FAP?

A

Func abd pain - continuous from time to time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

RAP - FAPS

A

Loss of daily activities plus headaches, limb pain, difficulty sleeping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

abd migraine?

A

> intense pain around umbilicus
reduced appetite, and activities
nausea vomiting, headache, photophobia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Ix for abd pain

A

> IgA
IgE to allergens, total IgE
Fecal calprotectin
and US, endoscopy/ colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

functional dyspepsia Tx

A

rantidine/ omeprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

IBD is most common in

A

12- 16 yrs olds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

IBD - paediatric presentation

A

> fever
anaemia
weight loss
FTT
ammenorrhoea
retarded bone development, mineral deficiencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

necrotising enterocoliotis history

A

abdominal distension, tenderness, abdominal wall erythema, haematochezia, bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

examination in nectrotising enterocolitis

A

> abd distension
bradycardia
haematochezia
tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

investigations for NEC?

A

> Bloods
abd XR
US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

xr findings in NEC?

A

> dilated bowel loops, lack of normal intestinal gas pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

testicular torsion history

A

> acute onset testicular pain
N & V
may be repeated episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

examination in tT

A

> tender, oedema,
affected testicle may appear higher
absent cremasteric reflex
no psin relief w elevation of scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Ix of torsion

A

duplex US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

puberty in girls

A

> breast buds > pubic hair > periods 2 yrs from the start of puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

puberty in boys

A

testicle enlargemeny > penis > scrotum darkening > pubic hair development > deepening of voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

staging for puberty

A

Tanner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Hypogonadotrophic hypogonadism

A

deficiencyof LH and FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

hypergonadotrophic hypogonadism

A

lack ofresponseto LH and FSH by the gonads (the testes and ovaries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Causes of hypogonadotropic hypogonadism

A

> LH/ FSH deficiency > lack of test and oestrgen
result of abn functioning of hypo/ pituitary gland
prev damage e.g, radiotherapy, surgery
hypothyroidism
hyperprolactinaemia
chronic conditions
kallman syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what can delay onset of menstruation in girls?

A

excessive exercise or dieting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what happens in hypergonadotropic hypogonadism

A

> gonds dont respond to stim from LH/ FSH
no negatieve feedback from sex hormones
AP produces more LH and FSH - meaning high gonadotropins and low sex hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Hypergonadotrophic hypogonadismis the result of abnormal functioning of the gonads. This could be due to:

A

> Previous damage to the gonads (e.g. testicular torsion, cancer or infections, such as mumps)
Congenital absence of the testes or ovaries
Kleinfelter’s Syndrome (XXY)
Turner’s Syndrome (XO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

kallman syndrome

A

> genetic condition
causes hypogonadotropic hypogonadism
failure to start puberty
associated w reduced/ absent sense of smell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

when should we investigate for delayed puberty?

A

girl aged 13 or boy aged 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Initial Ix for delayed puberty?

A

> FBC - anaemia
U&Es - CKD
anti TTG or anti EMA - coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

hormonal blood tests for delayed puberty

A

> early morning gonadotropins
TFTs
GH testing
prolactin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

early morning gonadotropin results

A

> low in hypogonadotropic hypogonadism
high in hypergonadotropic hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

genetic testing for delayed puberty

A

> Kleinfelter’s syndrome (XXY)
Turner’s syndrome (XO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

imaging in delayed puberty

A

> X ray of the wrist - const delay
pelvic US in girls
MRI pituitary - Kallman syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Delayed puberty w normal stature

A

> polycystic ovarian syndrome
androgen insensitivity
Kallman’s syndrome
Klinefelter’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

delayed puberty w short stature

A

> Turner’s syndrome
Prader-Willi syndrome
Noonan’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Mx of delayed puberty

A

> replacement sex hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what happens in turners syndrome

A

female has a single X chromosome making them 45XO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Features of turners syndrome

A

> Short stature
Webbed neck
High arching palate
Downward sloping eyes with ptosis
Broad chest with widely spaced nipples
Cubitus valgus
Underdeveloped ovaries with reduced function
Late or incomplete puberty
Most women are infertile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

cubitus valgus

A

When the arm is extended downwards with the palms facing forward,the angle of the forearm at the elbow is exaggerated, angled away from the body (turners syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

3 classical features of turners syndrome

A

> short stature, webbed beck and widely spaced nipples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

conditions associated w turners

A

> recurrent otitis media
recurrent UTIs
hypothyroidism
osteoporosis
diaberes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Tx of turners?

A

> GH replacement - prevents short stature
oestrogen and progesterone replacement - establishment of secondary sex characteristics
fertility TX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

most imp long term health problems for women w Turners

A

> biscuspid aortic valve
coarctation of aorta
inc risk of aortic dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

hormone levels in turners?

A

gonadotropins elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

features of turners in neonates

A

lymphodema - espec feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what is PWS

A

> Loss of genes on the proximal arm of chromosome 15 inherited from the father

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

features of PWS?

A

> Constant insatiable hunger
hypotonia as an infat
hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

PWS facial features

A

> Narrow forehead
Almond shaped eyes
Strabismus
Thin upper lip
Downturned mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Mx of PWS

A

> Controlling access to food
GH to improve muscle development and body composition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Inheritance of noonan syndrome?

A

> autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

features of noonan syndrome?

A

> short stature
broad forehead
downward sloping eyes w ptosis
wide space between eyes
webbed beck
wide spaced nipples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

conditions associoated w noonan syndrome

A

> Congenital HD - pulmonary valve stenosis, cardiomyopathy, ASD
Cryprochidism -> infertility
leukemia
neuroblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Mx of noonan syndrome

A

> supportive
main comp is CHD - often requires corrective heart surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Genetics of klinefelter syndrome

A

> males 47 XXY - additional X chromosome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Features of klinefelter syndrome

A

> usually normal until puberty
wider hips
gynaecomastia
small testicules
reduced libido
infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Tx of klinefelters syndrome

A

> symptom improvement: testosterone injections, breast reduction surgery, IVF

137
Q

klinefelters increases your risk of…

A

> breast cancer comp to men
osteoporosis
diabetes

138
Q

what is kallmans

A

> delayed puberty - hypogonadotropic hypogonadism
X linked recessive inheritance

139
Q

features of kallmans

A

> lack of smell (anosmia)
delayed puberty

140
Q

blood tests in kallmans

A

> sex hormone levels are low
LH, FSH levels are inappropriately low/normal

141
Q

management of kallmans

A

> testosterone supplementation

142
Q

androgen insensitivity syndrome

A

> X linked recessive condition
mutation in androgen receptor gene

143
Q

pathophys of AIS

A

> Extra androgens -> oestrogen
female secondary sexual characteristic
patients are genetically male - XY chromosomes
but have a female phenotype - breast tissue and female genitals

144
Q

Phenotype in AIS

A

> Testes in abdomen or inguinal canal
absence of uterus, upper vagina, ovaries just notmal female external genitalia (AMH produced by testes)

145
Q

what do ppl w AIS lack

A

> pubic hair
male type muscle development
facial hair

146
Q

Presentation of AIS

A

> lack of hair - facial/ pubic
micropenis
clitomegaly
bfid scrotum
dimished male characteristics

147
Q

how does AIS present?

A

> Androgen insensitivity syndrome often presents in infancy with inguinal hernias containing testes.
Alternatively, it presents at puberty with primary amenorrhoea.

148
Q

hormone tests in AIS

A

> Raised LH
normal or raised FSH
normal/raised testosterone for a male
raised oestrogen levels for a male

149
Q

Mx of AIS?

A

> Bilateral orchidectomy (removal of the testes) to avoid testicular tumours
Oestrogen therapy
Vaginal dilators or vaginal surgery can be used to create an adequate vaginal length

150
Q

Generalised tonic clonic seizures

A

> loss of conciousness
tonic (muscle tensing) and clonic (muscle jerking) movements
may be associated tongue biting, incont, groaning, irregular breathing

151
Q

after a tonic clonic seizure there is a ? Period

A

prolonged post ictal period - person feels confused, drowsy and feels irritable/ low

152
Q

Mx of tonic clonic seizures

A

> First line: sodium valproate
Second line: lamotrigine or carbamazepine

153
Q

focal seizures

A

> start In temporal lobes
They affect hearing, speech, memory and emotions.

154
Q

how do focal seizures present

A

> hallucinations
flashbacks and déjà vu
strange beh on autopilot

155
Q

Tx of focal seizures

A

> reverse of that of tonic clonic
First line: carbamazepine or lamotrigine
Second line: sodium valproate or levetiracetam

156
Q

absence seizures

A

> typically happen in children
stare into space
unaware of surroundings
10 - 20s

157
Q

Mx of absence seizures

A

First line:sodium valproateorethosuximide

158
Q

atonic seizures

A

> drop attacks
usually less than 3 minutes
can indicate lennox gastaut syndrome

159
Q

Mx of atonic seizures

A

> First line: sodium valproate
Second line: lamotrigine

160
Q

myoclonic seizures

A

> sudden brief muscle contractions
ppt remains awake during the episode
juvenile myoclonic epilepsy

161
Q

Mx of myoclonic seizures

A

> First line: sodium valproate
Other options: lamotrigine, levetiracetam or topiramate

162
Q

infantile spasms

A

> West syndrome
starts around 6 months
full body spasms occur

163
Q

Tx of infantile spasms

A

> Prednisolone
Vigabatrin

164
Q

febrile convulsions

A

> seizures that occur in children whilst they have a fever
not caused by epilepsy

165
Q

Ix for epilepsy

A

> EEG - after second tonic clonic seizure (children are allowed one simple seizure before investigating for epilepsy)
MRI brain

166
Q

Sodium valproate

A

> first line for most types of epilepsy except focal seizures

167
Q

What are the side effects of sodium vaporate

A

> Teratogenic
Liver damage and hepatitis
Hair loss
Tremor

168
Q

side effects of carbamazepine

A

> Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions

169
Q

carbamazepine

A

1st line for focal seizures

170
Q

phenytoin SE?

A

> Folate and vitamin D deficiency
Megaloblastic anaemia (folate deficiency)
Osteomalacia (vitamin D deficiency)

171
Q

Ethosuximide se

A

> Night terrors
Rashes

172
Q

lamotrigene se

A

> SJS/ Dress syndrime
leukopenia

173
Q

Management of Seizures

A

> Put the patient in a safe position (e.g. on a carpeted floor)
Place in the recovery position if possible
Put something soft under their head to protect against head injury
Remove obstacles that could lead to injury
Make a note of the time at the start and end of the seizure
Call an ambulance if lasting more than 5 minutes or this is their first seizure.

174
Q

status epilepticus

A

> med emergency
seizure lasting more than 5 min or 2+ seizures w/o regaining consciousness

175
Q

Mx of status epileptica (ABCDE approach)

A

> Secure the airway
Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood glucose levels
Gain intravenous access (insert a cannula)

176
Q

Meds used for status epileptica

A

> IV lorazapam - repeat after 10 if seizures cont
If the seizures persist the final step is an infusion of IV phenobarbital or phenytoin

177
Q

community meds for status epileptica

A

buccal midazolam and rectal diazepam

178
Q

CF genetics

A

> autosomal recessive
in CTFR gene on chromosome 7
delta F508 mutation

179
Q

pathophys of CF

A

> Thick pancreatic secretions -> blocked duct -> lack of digestive enzymes like lipase
low volume airway clearance -> infections
Congenital bilateral absence of the vas deferens in males -> infertility

180
Q

meconium ileus

A

> first sign of CF
not passing meconium within 24 hrs, abd distentuon and vomiting

181
Q

Sx of CF

A

> Chronic cough, thick sputum
stearrhoea
abd bloating and pain
FTT
recurrent RTI
salty sweat

182
Q

Signs of CF

A

> Nasal polyps
finger clubbing
crackles and wheeze
abd distention

183
Q

diagnosis of CF

A

1) Newborn blood spot testing
2) sweat test - gold standard
3) amniocentesis for genetic testing for CTFR gene

184
Q

why should children w CF avoud other children w CF

A

To prevent pseudomonas transmission

185
Q

CF Mx

A

> Chest physiotherapy
high caloriw diet
CREON tables - panc insufficiency
prophylactic flucoloxacillin
bronchodilation - salbutamil

186
Q

Vaccinations for CF

A

pneumococcal,influenzaandvaricella

187
Q

Monitoring for CF

A

> Spurum for bacteria
hey also need monitoring and screening for diabetes, osteoporosis, vitamin D deficiency and liver failure.

188
Q

salmon pink rash is seen in…

A

Systemic onset JIA (AKA Still’s disease) has a characteristic salmon-pink rash

189
Q

A child with hip pain, limp and recent infective illness →

A

? transient synovitis

190
Q

A young boy is noted to have learning difficulties, macrocephaly, large ears and macro-orchidism ->

A

fragile X

191
Q

Consider referring children with bronchiolitis to hospital if they have any of the following:

A

> a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume, taking account of risk factors
clinical dehydration.

192
Q

Mitochondrial diseases are inherited following 3 principles:

A

> Affected males cannot pass it onto their . children
Affected females will pass it onto all of their children
All individuals who inherit the affected mitochondria, will have the disease

193
Q

Denying Tx as a child

A

In England and Wales a child has the ability to consent to, but not refuse, treatment. Whether a child has demonstrated capacity (as per the Fraser guidelines) is not the relevant issue.

194
Q

features of anorexia

A

> severe weight loss/ low BMI
ammenorrhoea
low BP
lanugo hair growth
tiredness
hair loss
electrolyte abn

195
Q

behaviours in Eds

A

> over exercising
laxative use

196
Q

bulimia nervosa features?

A

> self induced vomiting
binging
enlarged salivary glands
fluctuating weight

197
Q

Avoidant / restrictive food intake disorder
(ARFID)

A

> Can be a mix of signs and symptoms associated with
anorexia and bulimia
Most common type of eating disorder

198
Q

puberty in girls

A

• breast development (Tanner stage 2 )
• menarche follows within 2 y
• early growth spurt

199
Q

puberty in boys

A

• testicular enlargement (Tanner stage 2 ) • later growth spurt

200
Q

CFS/ Myalgic encephalomyelitis symptoms

A

> fatigue - worseened by activity not releived by rest
post exertional malaise
sleep problems - insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep-wake cycle
painful lymph nodes w/o enlargement
sore throat
cognitive dysfunction
general malaise
min of 6 weeks in adults and 4 weeks in children

201
Q

Ix of CFS

A

> FBC, U&Es, LFT, glucose, TFT, ESR, ferritin, coeliac screening, urinanalysis

202
Q

CFS Mx?

A

> refer to CFS service if 3+ months
exercise overseen by ME team
CBT

203
Q

triad of hyperglycaemia (T1D)

A

Polyuria, polydipsia, weight loss

204
Q

Other Sx of T1D

A

> Secondary enuresis (previously dry child)
recurrent infections
recent coxsakie B virus

205
Q

Ix for T1D?

A

> FBC, U&Es, Lab glucose
blood cultures if fever
TPO, anti TTG, ab testing

206
Q

Ab in T1D?

A

Insulin antibodies,anti-GAD antibodiesandislet cell antibodies

207
Q

basal bolus regime

A

> long acting insulin - background
bolus - e.g. actrapid usually 3x a day before meals

208
Q

lipodystrophy

A

> Injecting into the same spot repeatedly can cause a condition called lipodystrophy, where the subcutaneous fat hardens and prevents normal absorption of insulin when further doses are injected into this area. For this reason patients should cycle their injection sites. If a patient is not responding to insulin as expected, ask where they inject and check for lipodystrophy.

209
Q

Insulin pumps

A

> need to be over 12 and have difficulty controlling HBA1C
tethered pumps
patch pumps

210
Q

Ad of insulin pumps

A

better blood sugar control, more flexibility with eating and less injections.

211
Q

Macrovascular comps of diabetes

A

> Coronary artery disease is a major cause of death in diabetics
Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
Stroke
Hypertension

212
Q

microvascular comps of diabetes

A

> Peripheral neuropathy
Retinopathy
Kidney disease, particularly glomerulosclerosis

213
Q

features of hypoglycaemia

A

> sweating
shaking
hunger
nausea
severeL weakness, vision changes, confusion, dizziness

214
Q

Whipples criteria

A

> hypoglycaemia
1) symptoms of hypogly
2) low BG
3) resolution of symptoms with correction of BG

215
Q

insulinoma

A

> serum insulin elevated
low BG
serum C peptide elevated

216
Q

Mx of hypoglycaemia: community

A

1) oral glucose
2) glucogel
3) hypokit - glucagon for IM/ SC injection

217
Q

Mx of hypoglycaemia: hosp

A

> quick acting carb if alert
If the patient is unconscious or unable to swallow, subcutaneous or intramuscular injection glucagon may be given.
Alternatively, intravenous 20% glucose solution may be given through a large vein

218
Q

DKA triad?

A

> hyperglycaemia
Met acidosis
ketosis

219
Q

Features of DKA?

A

> V high BG - blurred vision, headache, lethargy
Kussmal breathing
acetone breath
abd pain, nausea and vomiting (ketosis)
often precipitated by infections, poor compliance with insulin therapy, or newly diagnosed diabetes mellitus.

220
Q

diagnosis of DKA?

A

> bg > 11
pH under 7.3
ketones > 3 or urine ketones ++ on dipstick

221
Q

management of DKA?

A

1) fluid replacement - isotonic saline
2) IV insulin infusion (dextrose added when BG is under 14)
3) monitor potassium (falls w insulin use)
4) long-acting insulin should be continued, short-acting insulin should be stopped

222
Q

DKA - endocrinologist review

A

> both the ketonaemia and acidosis should have been resolved within 24 hours. If this hasn’t happened the patient requires senior review from an endocrinologist
the patient should be reviewed by the diabetes specialist nurse prior to discharge

223
Q

DKA - cerebral oedema

A

> espec in kids
headache, altered mental status, seizures, and focal neurological deficits
especially with fluid replacement

224
Q

Patau syndrome (trisomy 13) symptoms

A

> Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

225
Q

Edward’s syndrome (trisomy 18) Sx

A

> Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

226
Q

Fragile X Sx

A

> Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism

227
Q

Noonan syndrome Sx

A

> Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

228
Q

Pierre Robin syndrome

A

> Micrognathia
Posterior displacement of the tongue
Cleft palate

229
Q

Prader-Willi syndrome

A

> Hypotonia
Hypogonadism
Obesity

230
Q

Williams syndrome

A

> Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

231
Q

Cri du chat syndrome (chromosome 5p deletion syndrome)

A

> characteristic cry
feeding problems, poor weight gain
LDs
Microcephaly and micrognathism
Hypertelorism

232
Q

genetics of downs

A

> 3x chromosome 21 - trisomy 21

233
Q

Features of downs

A

> hypotonia
brachycephaly (small head w flat back)
short
prominent folds on eyes
single palmar crease

234
Q

complications of downs

A

> LDs
recurrent otitis media
deafness - eustachian tube abn
hypothyroidism

235
Q

what is more common in childrens w downs

A

leukemia and dementia

236
Q

antenatal screening for downs

A

> combined test: first line
triple test
quaruple test

237
Q

Downs: combined test

A

> 11-14 weeks gestation
US: measures nuchal transluency (increased)
Beta HCG (higher risk when greater value)
PAPPA - lower result -> greater risk

238
Q

triple test for downs

A

> 14 - 20 weeks gestation
beta HCG - higher value = more risk
AFP and serum oestriol = lower value -> greater risk

239
Q

quadruple test for downs?

A

> beta HCG, AFP, serum oestriol
plus inhibin A - higher value -> greater risk

240
Q

Antenatal Testing for Downs Syndrome

A

> when risk score is greater than 1 in 150
amniocentesis offered later in pregnancy
chronic villus sampling earlier
non invasive prenatal testing

241
Q

monitoring for downs

A

> Regular thyroid checks (2 yearly)
Echocardiogram to diagnose cardiac defects
Regular audiometry for hearing impairment
Regular eye checks

242
Q

Genetics of fragile X

A

> mutation in FMR1 gene
X lined - males always affected but females vary in how much they’re affected

243
Q

Mx of fragile X

A

> supportive
manage ADHD, autism or seizures if they occur

244
Q

What is haemachromatosis

A

> autosomal recessive
iron overload (iron stiorage disorder)

245
Q

genetics of haemachromatosis

A

> C282Y mutation in HEF gene on chromosome 6

246
Q

Presentation of haemachromatosis?

A

> usually after 40 when iron overload becomes symptomatic
later in females due to menstruation
bronze skin
testicular atrophy
amenorrhoea
hepatomegaly
ED

247
Q

diagnosis of haemachromatosis

A

> serum ferritin - first Ix
transferrin saturation
genetic testing
liver biopsy w Perls stain

248
Q

Mx of haemachromatosis

A

> venesection
monitoring serum ferritin

249
Q

sickle cell genetics

A

> autosomal recessive affecting gene for beta globin on chromosome 11
one copy of the mutation: sickle cell trait

250
Q

screening for sickle cell

A

newborn blood spot

251
Q

complications of sickle cell

A

> anaemia
acute chest
avascular necrosis
crises

252
Q

Sickle cell crisis

A

> They can occur spontaneously or triggered by dehydration, infection, stress or cold weather.
hydrate
analgesia (avoid NSAIDs when renal impairment)
keep warm

253
Q

vaso-occlusive crisis?

A

> painful crisis
distal ischemia
t typically presents with pain and swelling in the hands or feet but can affect the chest
It can cause priapism in men by trapping blood in the penis, causing a painful and persistent erection.
Priapism is a urological emergency, treated by aspirating blood from the penis.

254
Q

splenic sequestration crisis

A

> RBCs block blood flow in spleen
enlarged and painful spleen
Blood pooling in the spleen can lead to severe anaemia and hypovolaemic shock.

255
Q

Mx of splenic sequestration crisis

A

> emergency
Management is supportive, with blood transfusions and fluid resuscitation to treat anaemia and shock.

256
Q

comps of splenoc sequestration

A

> Splenic sequestration crisis can lead to splenic infarction, leading to hyposplenism and
susceptibility to infections, particularly by encapsulated bacteria (e.g., Streptococcus pneumoniae and Haemophilus influenzae).
Splenectomy in recurrent cases

257
Q

Aplastic crisis?

A

> temp absence of creation of new RBC
usually triggered by parovirus B19
Leads to aplastic anaemia

258
Q

Acute chest syndrome presents w

A

Acute chest syndrome presents with fever, shortness of breath, chest pain, cough and hypoxia. Achest x-raywill showpulmonaryinfiltrates.

259
Q

ACS Mx

A

> Analgesia
Good hydration (IV fluids may be required)
Antibiotics or antivirals for infection
Blood transfusions for anaemia
Incentive spirometry using a machine that encourages effective and deep breathing
Respiratory support with oxygen, non-invasive ventilation or mechanical ventilation

260
Q

Hydroxycarbamide

A

works by stimulating the production of fetal haemoglobin (HbF) -> reduced freq of vaso-occlusive crises

261
Q

Crizanlizumab

A

Mab against P selectin -> reduced freq of vaso-occlusive crises

262
Q

Pathophys of epistaxis

A

> originate from Kiesselbach’s plexus, which is also known as Little’s area
when mucosa is disrupted in this area such as a child picking their nose -> bleeding

263
Q

Presentation of epistaxis

A

> can be triggered by nose picking, colds, vigorous nose blowing, trauma and changes in the weather.
if they swallow during the bleed, can present witj vomiting blood
bilateral bleeding can indicate a bleed from posterior nose

264
Q

You may have to advise patients and parents on how to manage a nosebleed:

A

> Sit up and tilt the head forwards. Tilting the head backwards is not advised as blood will flow towards the airway.
Squeeze the soft part of the nostrils together for 10 – 15 minutes
Spit any blood in the mouth out rather than swallowing

265
Q

Nosebleeds: hospital admission

A

> When bleeding does not stop after 10 – 15 minutes, the nosebleed is severe, from both nostrils or they are unstable, patients may require admission to hospital. Treatment options are:

> Nasal packing using nasal tampons or inflatable packs
Nasal cautery using a silver nitrate stick

266
Q

Naseptin

A

> can be prescribed for 10 days after a nosebleed to reduce crusting, inflammation, infection
CI in peanut or soya allergy

267
Q

final common pathway for mucous drainage

A

middle turbinate

268
Q

which sinuses drain to the middle meatus

A

> frontal
maxillary
anterior ethmoidal

269
Q

which sinuses drain to superior meatues

A

> sphenoid
posterior ethmoidal

270
Q

choanal atresia

A
271
Q

causes of nosebleeds

A

> Trauma
Insertion of foreign bodies
Bleeding disorders such as ITP
cocaine use

272
Q

features of sinusitis

A

> facial pain- typically frontal pressure pain which is worse on bending forward
nasal discharge: usually thick and purulent
nasal obstruction

273
Q

Mx of sinusitis

A

> analgesia
nasal decongestants
intranasal steroids if symptoms for 10+ days
oral ab if severe - phenoxymethylpenicillin first-line

274
Q

chronic rhinosinusitis?

A

> inflammation of nasal sinuses for 12+ weeks

275
Q

predisposing factors for chronic sinusitis?

A

> atopy
nasal obstruction e.g. septal deviation or nasal polyps
recent infection
swimming
smoking

276
Q

features of chronic sinusitis?

A

> facial pain: typically frontal pressure pain which is worse on bending forward
nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection
nasal obstruction: e.g. ‘mouth breathing’
post-nasal drip: may produce chronic cough

277
Q

Management of recurrent or chronic sinusitis

A

> avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

278
Q

Red flags symptoms for sinusitis

A

> unilateral symptoms (such as obst, discharge, crusting, facial swelling)
persistent symptoms despite compliance with 3 months of treatment
epistaxis
cancer referral pathway

279
Q

who are nasal polyps more common in?

A

> men
not commonly seem in children/ elderly

280
Q

Associations w nasal polyps

A

> CF
asthma - paticularly late onset
aspirin sensitivity
Kartagener’s syndrome

281
Q

samters triad

A

asthma, aspirin sensitivity and nasal polyposis is known as Samter’s triad.

282
Q

features of nasal polyps

A

> nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell

283
Q

Mx of polyps

A

> Unusual features which always require further investigation include unilateral symptoms or bleeding.
all patients with suspected nasal polyps should be referred to ENT
topical corticosteroids shrink polyp size in around 80% of patients

284
Q

nasopharyngeal carcinomas

A

> sq cell carcinoma of the nasopharynx
common in southern china
associated w EBV infection

285
Q

Features of nasopharyngeal carcinomas

A

> cervical lymphadenopathy
unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI

286
Q

Tx of nasopharyngeal carcinomas

A

radiotherapy

287
Q

Imaging in nasophyrangeal carcinomas

A

combined CT and MRI

288
Q

intramural gas on AXR ->

A

NEC

289
Q

DDH in an older child

A

An older child with missed DDH may present with a Trendlenberg gait and leg length discrepancy

290
Q

There is often the loss of internal rotation of the leg in flexion in

A

slipped capital femoral epiphysis

291
Q

gold standard for diagnosis of hirschsprungs disease

A

Rectal biopsy is the gold standard for diagnosis of Hirschsprung’s disease

292
Q

Grips

A

Palmer, Point, Pincer - 6, 9, 12

293
Q

duodenal atresia

A

duodenal atresia is commoner in Down’s patients, it is also the most common cause of bilious vomiting in the first few days of life.

294
Q

murmur seen in turner’s

A

Turner’s syndrome is associated with an ejection systolic murmur due to bicuspid aortic valve

295
Q

meconium ileus ->

A

Muconeum ileus -> Hirschsprung or CF

296
Q

blood in stool in pre-mie

A

Blood in stool in pre-term baby -> NEC

297
Q

SCFE presentation

A

Obese boy with groin/thigh/knee pain → ?slipped capital femoral epiphysis

298
Q

child w limp/ pain and a fever

A

If a child with a limp/hip pain has a fever they should be referred for same-day assessment, even if a diagnosis of transient synovitis is suspected

299
Q

what is associated w malrotation?

A

Exomphalos and diaphragmatic herniae are commonly associated with malrotation.

300
Q

what is not seen in downs syndrome

A

rocker bottom feet - seen in trisomy 18 or Edwards

301
Q

loss of internal rotation of the leg

A

There is often the loss of internal rotation of the leg in flexion in slipped capital femoral epiphysis

302
Q

billous vomitig on first day ->

A

Bilious vomiting on the first day is likely due to intestinal atresia

303
Q

limp pathways

A
  1. Fever and limping - bloods to r/o septic arthritis
  2. Trauma and limping - XR to r/o #
  3. No fever, not unwell, no trauma and limping - reassure, analgesia advise and GP follow-up if not improving with good safetynet
304
Q

mneumonic for kawasakis

A

> C: conjunctivitis (bilateral).
R: rash (non-vesicular).
A: adenopathy (cervical).
S: swollen, strawberry tongue.
H: hand swelling (or feet).
Burn: fever lasts >5 days and is very high.

305
Q

eczema herpeticum

A

> rapidly progressing painful rash
caused by herpes simplex 1 or 2
seen in kids w atopic eczema

306
Q

Mx of eczema herpetcium

A

> IV aciclovir - life threatening

307
Q

lesions in eczema herpeticum

A

monomorphic punched out

308
Q

how is acute epiglottitis diagnosed

A

direct visualisation from senior anaesthatist

309
Q

BLS algorithm for kids - order of intitial steps

A

1) 5 rescue breaths
2) check pulses

310
Q

what is the koebner phenomenon

A

> The Koebner phenomenon describes skin lesions that appear at the site of injury. It is seen in:
psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum

311
Q

what feature of bronchiolotis would necessitate immediate ref to hosp

A

grunting

312
Q

when can steroids not be used for kids with meningitis

A

under 3 months - DO NOT give steroids

313
Q

massive rectal bleeding in a 1/2 yr old

A

Meckels diverticulum is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.

314
Q

Features of atypical UTI:

A

> Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms.

315
Q

Barlows vs ortlanis

A

> Barlow (B is before in the alphabet) Ortali (O is after).
You dislocate FIRST (Barlows)

316
Q

most common fractures seen in NAI

A

Humeral, radial, femoral

317
Q

Double bubble sign ->

A

DUOdeal atresia

318
Q

leg appearance in a hip fracture

A

Leg is shortened and EXTERNALLY ROTATED with hip fracture

319
Q

how does ITP present

A

ITP is often preceded by a viral illness and the presence of an isolated thrombocytopaenia is typical of ITP. In TTP, schistocytes are often seen on blood smears.

320
Q

pathogen causing NF in Chickenpox ppts

A

Invasive group A Streptococcus, a β-haemolytic Streptococcus,

321
Q

causes of snoring in kids

A

> obesity
nasal problems
recurrent tonsillitis
downs syndrome
hypothyroidism

322
Q

which heart lesion is associated w DMD

A

dilated cardiomyopathy

323
Q

cardiac problem associated w downs

A

AVSD

324
Q

FIRST LINE IN WHOOPING COUGH

A

azithromycin or clarithromycin if the onset of cough is within the previous 21 days

325
Q

IVDU w IE can present w

A

discitis

326
Q

summary of school exclusion req

A

> CP - all lesions crusted over
impetigo - 48hrs after ab
Scarlet fever - 24 hrs after ab
MMR - mumps - 5 letters, M&R - 4 days after rash onset
Whooping cough - 2 whoops - 2 whoops so can return to school 2 days after antibiotics (48hrs) or 21 days from onset of illness if no antibiotics.
HFM - no exclusion required

327
Q

what does downs inc risk of

A

Alzheimers disease

328
Q

what can cause diabetes in kids

A

CF

329
Q

What is used to promote patent ductus arteriosus

A

Indomethacin or ibuprofen is used in patent ductus arteriosus to promote duct closure

330
Q

inheritance seen in PWS

A

IMPRINTING

331
Q

for a man with his mitochondrial disease how many of his children will inherit the condition

A

0% - Mitochondrial diseases are inherited from mother to child only

332
Q

pattern seen in roseola infantum

A

fever when rash Improves

333
Q

mneumonic for paeds red flags

A

> Really Sick Babies Get Antibiotics
1. Recessions (moderate or severe chest wall recessions)
2. Skin turgor reduced
3. Blue or mottled appearance
4. Grunting
5. Asleep (does not wake if aroused)

334
Q

mesenteric adenitis

A

> sim pres to appendicitis but preceding history of viral infection
does not need Tx

335
Q

acute vs chronic subdural haemtoma on CT

A

> Chronic: old blood which appears black
Fresh blood is white

336
Q

intercranial bleed in an alcoholic ->

A

chronic subdural haem

337
Q

initial Mx of hirschprungs Dx

A

rectal washouts, bowel irrigation

338
Q

children under 3 months w a UTI ->

A

Children under 3 months with a suspected UTI should be referred to specialist paediatrics services

339
Q

PS leads to…

A

elevated bicarb, hypocholaramic hypokalaemic alk