Corrections 3 Flashcards
History of stridor + cough should point to a diagnosis of what?
Croup (parainfluenza virus)
At what age is a young person can be treated as an adult and can be presumed to have capacity to decide?
16 y/o
Capacity if <16 y/o?
Children may have capacity to decide, depending on their ability to understand what is involved.
Refusal of treatment in those <16 y/o with capacity?
A person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests.
BUT in Scotland those with parental responsibility cannot authorise procedures a competent child has refused
How long after birth can suboptimal SpO2 readings be expected from a healthy neonate?
First 10 minutes
What is the ideal mx of atypical endometrial hyperplasia?
A total hysterectomy with bilateral salpingo-oophorectomy
What occurs in Richter’s transformation?
Transformation of CLL into a fast-growing diffuse large B cell non-Hodgkin’s lymphoma.
Symptoms of Richter transformation?
- lymph node swelling
- fever without infection
- weight loss
- night sweats
- nausea
- abdominal pain
What are sarcomas?
A diverse group of malignant tumours originating from mesenchymal tissue.
What can sarcomas be classified into?
1) bone sarcomas
2) soft tissue sarcomas
Give 3 types of bone sarcomas
1) osteosarcoma
2) chondrosarcoma
3) ewing’s sarcoma
Give some types of soft tissue sarcomas
1) Liposarcoma
2) Rhabdomyosarcoma (striated muscle origin)
3) Synovial sarcoma
4) Fibrosarcoma
5) Angiosarcoma
6) Leiomyosarcoma (smooth muscle origin)
Features of bone sarcomas?
1) Pain
2) Swelling/palpable mass
3) Impaired function (depending on location)
4) Pathological fractures
5) Systemic symptoms
What is the 1ary treatment for most sarcomas?
Surgery
Mx of children/young people with a suspected bone sarcoma?
Urgert (48h) direct access X-ray
How does ovarian cancer initially spread?
Local spread within pelvic region / peritoneal spread
Mx of sinusitis:
a) acute phase
b) chronic phase
a) analgesia and intranasal decongestants
b) intranasal steroids
According to the Salter-Harris classification, what type of fracture involves the physis, metaphysis and epiphysis?
Salter-Harris IV
At what age should children be able to respond to their own name?
By 12 months
What mechanism of injury typically causes a meniscar tear?
Twisting injuries
What are the menisci?
Two crescent-shaped, fibrocartilaginous structures in the knee that function as shock absorbers, provide joint stability, and distribute load within the joint.
Medial & lateral
Why are the menisci prone to injury?
Due to their avascular zones, they may have a limited ability to heal.
Features of a meniscal injury of the knee?
- pain worse on straightening the knee
- knee may ‘give way’
- displaced meniscal tears may cause knee locking
- tenderness along the joint line
What are 4 clinical tests that can be performed to assess for meniscal pathology?
1) McMurray Test
2) Thessaly Test
3) Apley’s Compression Test
4) Ege’s Test
Describe McMurray’s test
1) The patient is supine with the knee flexed to 90 degrees.
2) The examiner holds the heel with one hand and the knee with the other.
3) For the medial meniscus, the tibia is externally rotated, and the knee is extended and valgus stress applied.
4) For the lateral meniscus, the tibia is internally rotated, and the knee is extended and varus stress applied.
5) A positive test is indicated by pain or a palpable or audible click.
What is the gold standard investigation for diagnosing meniscal tears?
MRI
1st line mx of meniscal tear?
Conservative e.g. rest, ice, compression, elevation (RICE), NSAIDs, and physical therapy to restore range of motion, strength, and proprioception.
Then can consider surgery.
What drugs can cause tinnitus?
1) Aspirin/NSAIDs
2) Aminoglycosides
3) Loop diuretics
4) Quinine
Do multiparous women typically experience fetal movements sooner or later?
Sooner (from 16-18 weeks gestation)
Primiparous: 16-18 weeks
When would you refer for not experiencing foetal movements?
24 weeks
Investigations for reduced foetal movements:
1) <24 weeks gestation (and fetal movements have previously been felt)
2) <24 weeks gestation (and fetal movements have not previously been felt)
3) 24-28 weeks gestation
4) >28 weeks gestation
1) a handheld Doppler (to confirm presence of fetal heartbeat)
2) refer to maternal fetal medicine unit
3) a handheld Doppler
4) handheld Doppler:
- if no fetal heartbeat detectable –> immediate US
- if fetal heartbeat present –> CTG should be used for at least 20 minutes to monitor fetal heart rate (can assist in excluding fetal compromise)
Mx of a missed vs incomplete miscarriage?
Missed:
- oral mifepristone
- misoprostol 48h later
Incomplete:
- single dose of misopostol
Which type of leukaemia may present with massive splenomegaly?
CML –> can cause a sense of fullness
What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?
Aspirin
1st line mx of ITP?
Oral prednisolone
What is the most common cause of early-onset severe infection in the neonatal period?
GBS
What are some risk factors for GBS infection?
1) prematurity
2) prolonged rupture of membranes
3) previous sibling GBS infection
4) maternal pyrexia e.g. 2ary to chorioamnionitis
Should universal screening for GBS be offered to all women?
No
N.B. a maternal request is NOT an indication for screening
What is the risk of materal GBS carriage in women who’ve had GBS detected in a previous pregnancy?
50%
Who is offered intrapartum antibiotic prophylaxis (IAP) against GBS?
1) Women who have had GBS detected in a previous pregnancy (they should be offered IAP OR testing in late pregnancy and then antibiotics if still positive)
2) women with a previous baby with early- or late-onset GBS disease
3) women in preterm labour regardless of their GBS status
4) women with a pyrexia during labour (>38ºC)
What is the abx of choice for GBS prophylaxis?
Benzylpenicillin
If women are to have swabs for GBS, when should this be offered?
35-37 weeks or 3-5 weeks prior to the anticipated delivery date
What is vestibular neuronitis characterised by?
isolated, spontaneous vertigo
can present on waking
Describe nystagmus in vestibular neuronitis?
unidirectional horizontal nystagmus
What is vertigo worsened by in vestibular neuronitis?
the vertigo is worsened by changes in head position, although is usually constant even when the head is still
What can CXR in transient tachypnoea of the newborn show?
Hyperinflation and fluid in the horizontal fissure.
3 key types of cerebral palsy? Location of damage?
1) spastic –> damage to UMNs
2) dyskinetic –> damage to the basal ganglia and the substantia nigra
3) ataxic –> damage to cerebellum
2 key features of dyskinetic cerebral palsy?
1) athetoid movements
2) oromotor problems
If low-lying placenta is found at the 20-week scan, what is next step?
Rescan at 32 weeks
Does vestibular neuronitis affect hearing?
No –> does NOT cause hearing loss
What should be monitored when administering mag sulphate?
1) RR –> can caus respiratory depression
2) reflexes –> can cause hyporeflexia
What is 1st line mx of magnesium sulphate induced respiratory depression?
Calcium gluconate
Mx of an undisplaced intracapsular NOF fracture?
Internal fixation
Mx of a displaced intracapsular NOF fracture?
Hemiarthroplasty or total hip replacement
what are clang assocations?
ideas related only by rhyme or being similar sounding
What RR in paeds is a red flag?
> 60 per minute –> refer to hospital
When is the NICE fever traffic light system used?
Children <5 y/o
Give some ‘red flag’ aka ‘high risk’ features in the NICE traffic light system
- Grunting
- Tachypnoea
- RR >60
- Moderate or severe chest indrawing
- Reduced skin turgor
- Age <3m & temp >38
- No response to social cues
What is ‘power’?
The probability of (correctly) rejecting the null hypothesis when it is false
What is the likelihood ratio for a positive test result?
How much the odds of the disease increase when a test is positive
Formula for the likelihood ratio for a positive test result?
sensitivity / (1 - specificity)
What is the likelihood ratio for a negative test result?
How much the odds of the disease decrease when a test is negative
Formula for the likelihood ratio for a negative test result?
(1 - sensitivity) / specificity
What is the most appropriate study design to investigate an infectious outbreak?
case-control study
Role of CK in assessing reinfarction in MI?
Creatine kinase (CK-MB) remains elevated for 3 to 4 days following infarction.
Troponin remains elevated for 10 days.
This makes CK-MB useful for detecting re-infarction in the window of 4 to 10 days after the initial insult
How long after an MI does troponin stay raised for?
10 days
Mx of AF if there is coexistent heart failure, first onset AF or an obvious reversible cause?
Rhythm control e.g. amiodarone
What type of diabetes insipidus does CKD cause?
Nephrogenic
What is a Galeazzi fracture?
a dislocation of the distal radioulnar joint with an associated fracture of the radius
You are performing a newborn examination.
What best describes the clinical findings of a clubfoot?
Inverted + plantar flexed foot which is not passively correctable
Presentation of a posterior hip dislocation?
shortened and internally rotated leg
What imaging is used to identify bowel obstruction?
Erect CXR
Maintenance mx of a patient with UC if they have had a severe relapse or ≥2 exacerbations in the past year?
Oral azathioprine or oral mercaptopurine to maintain remission
Is acute infective hepatitis a notifiable disease?
Yes
Is there a need to check for H.pylori eradication if symptoms have resolved after treatment?
No
What is timeframe after H. pylori treatment in patients require re-testing?
Urea breath test at 4 weeks
Formula for relative risk reduction?
(EER - CER) / CER
Where should IM adrenaline be injected into?
Anterolateral aspect of middle third of thigh (vastus lateralis)
What is point prevalence?
The number of cases in a defined population or number of people in a defined population at the same time.
