F+C (Part 2) Flashcards
Name 5 differentials for a rash in children?
Meningitis (meningococcal septicaemia)
HSP (purpura on buttocks/ extensor limbs)
Measles (starts from head and moves down)
Chicken pox (macule>papule>vesicle>crust)
Herpes simplex (infection around mouth/skin/eyes)
Scarlet fever (preceeding throat infection, sandpaper like rash with strawberry tongue)
Kawasaki disease (conjunctival infection, strawberry tongue, lympadenopathy)
Name 5 symptoms of meningitis in a child?
Fever Prodromal illness (flu like) Irritable and crying Poor feeding Rash Neck stiffness Photophobia
When a baby is premature, how should you correct for this on a growth chart?
Correct for prematurity (before 36+6) up to 2 years
Correct by drawing an arrow backwards to corrected age. E.g. a child with born at 34 weeks who is now 6 months old would have their ‘dot’ on the growth chart at 6 months, but an arrow pointing back 6 weeks to 4.5mnths
What bacterial pathogen causes acute tonsilitis?
Group A strep
Viral is most commonly EBV/ herpes simplex/ cytomegalovirus
Name 5 differentials for a child for fever?
Meningitis Tonsilitis (later scarlet fever) URTI/ bronchiolitis/ pneumonia UTI Otitis Media Leukaemia Chicken pox Kawasaki disease
What organism causes bronchiolitis?
Respiratory synctial virus (RSV)
Gets worse at D5 then starts to improve
What organism most commmonly causes croup?
Parainfluenza virus
How would you distinguish between croup and whooping cough in a history?
Croup = seal like cough, worse on expiration and with agitation
Whooping cough = whoop heard on inspiration, worse at night and expiration
What organism causes whooping cough, what is the management of whooping cough? (4)
Bordella pertussis (normally vaccinated against so now rarer)
Mx: Azithromycin (or other macrolide) if in first 21 days
- Send off nasal swab for proper diagnosis
- Keep off school for 2 days
- Notify public health england
What is the best full general history taking acronym to follow?
I PISS HI
I- Intro and open question
P- PC/ HPC (using SOCRATES)
I- ICE
S- Specific symptoms/ differentials/ red flags
S- Sub-history (PIDS for paeds, WIMPP for obgyn, MOSC for gynae)
H- History completion (PMHx, DHx, FHx, SHx)
I - ICE again and summarise
How should HSP be described to a patient?
Henoch Schonlein Purpura
A type of vasculitis (inflammation of the blood vessels), not normally serious infection, it doesn’t need any treatment, and most of the time doesn’t cause any problems, however we like to monitor you as in very small number of people it can cause some problems with the kidneys - so we keep an eye on things and if this is the case we can do something about it
How does HSP usually present?
Rash (raised red/ purple) - purpuric - doesn’t fade with glass test
On buttocks and extensor limbs
Can also have abdo pain, arthritis and renal failure if more established
How is HSP managed?
Supportive (hydration and paracetamol - no ibuprofen)
Self- resolves in around 3 weeks
Do FBC to rule out leukaemia and ITP
Monitor BP/ kidney function at D7/D14/1/3/6/12 mths
Can give steroids if renal disease develops (1%)
What are your differentials for a suspected HSP? (3)
ITP
Leukaemia
Meningococcal septicaemia
How would you describe testicular torsion to a patient? What age group does it most commonly affect?
Where the testicle twists back on itself and cuts off the blood supply
Young boys are most affected (7-12yrs)
How does testicular torsion usually present? How can it be distinguished from epididymitis?
Sudden onset pain in testicle or abdomen
May have previous transient episodes where testicle has corrected itself. Absent cremasteric reflex (100% sensitive)
When lifted pain is worse (in epididymitis when lifted the pain becomes better).
NB: Improving pain is not always a good sign as pain also decreases as the testis necroses and dies
How is testicular torsion treated? Name some counselling points (3)
Emergency operation (done within 6-8hrs) Small operation (GA, need to go NBM) - Risks of testicle dying and needing removal - This doesn't usually affect fertility - Can insert fake testicle if needed
What general advice around returning to activites following a surgical procedure with a wound is normally given?
No swimming etc until stitches out or 7-10days
Don’t bath/ shower for a few days
Avoid contact sports for 4 weeks
Name 3 risk factors for developing cerebral palsy
Prem birth Congenital infections Injury before birth Hypoxic event during labour Multiple births Congenital malformations Chorioamnionitis
What are your top differentials for a 20 year old female presenting with acute lower abdo pain on the R hand side?
Ectopic pregnancy
Ruptured cyst
Appendicitis
Ovarian torsion
PID (less acute)
Endometriosis
IBS/ IBD
Kidney pathology (urinary symptoms)
Name some key components of a post-natal depression history?
Intro
Gather information on symptoms (SAG CLASS)
Previous Hx of depression
Ask about bonding with baby, risk assess for any harm to baby
Ask about support at home, other children, partners etc. - do they have help?
Summarise and emphasise support
A woman presents with vaginal discharge, what investigations do you do?
Cultures- Charcoal high vaginal swab from posterior fornix (Gonorrhoea, TV, BV, candida)
NAAT- Endocervical swab from os - chlamydia and gonorrhoea
Name 3 risk factors for developing PID?
New partner Multiple partners No condom use IUD insertion Pregnancy termination
How is diagnosis of PID made?
Clinically (not from swab)
Lower abdo pain, with deep dysparenunia, vaginal bleed, discharge, fever - may see cervical excitation on examination
Name 5 differentials for PID?
Endometriosis STI (uncomplicated) Ectopic pregnancy - often more acute Appendicitis - often more acute FIbroids Cervical cancer
Name 3 investigations for suspected PID?
Pregnancy test - exclude ectopic!
Cervical swabs for chlamydia and gonorrhoea (+ve results supports diagnosis but -ve does not exclude)
How should PID be treated?
Ceftriazone IM single dose followed by oral doxycycline and metronidazole for 14 days
Avoid UPSI
Contact all partners in last 6 months
What general advice should be given regarding other partners when diagnosed with STI?
All other partners in last 6 months should be contacted and offered screening
Name 3 complications of PID?
Infertility (increase with number of episodes and severity)
Ectopic pregnancy
Chronic pelvic pain
Tubo-ovarian abscess
How do you distinguish between Crohns and UC?
UC is starts in rectum and moves up, crohns anywhere
UC more likely to be bloody
UC pain LLQ, Crohns RLQ
Weight loss more likely with Crohns
Name 5 differentials for a presentation of diarrhoea?
Crohns/ UC Gastroenteritis (travel?) IBS Diverticular disease Colorectal cancer
Name 5 investigations you would do if suspecting IBS?
FBC, CRP, U+E, LFT B12/folate/iron Stool culture Faecal calprotectin (between IBS and IBD) Endoscopy and biopsy
What is first line drug tx for both Crohns and UC?
Mesalazine
UC also need to induce remission with steroids
Name 5 key symptoms to ask about with a bowel change history?
Abdominal pain Bloating Altered bowel habit Blood or mucus in stools Straining or pain going Urgency Incomplete evacuation Link to symptoms with eating Nausea and vomiting Fever, weight loss Recent travel
What are the diagnostic criteria for IBS?
6 months hx of abdominal pain with altered bowel habit or relived by defecation
+2 of (Bloating, straining, mucus in stool, aggravation by eating)
What are the three features which make up angina?
Cardiac chest pain
Precipitated by exertion or emotion
Relived by rest/ GTN in 5 mins
Typical angina = all 3
Atypical = 2
Non-anginal = <2
What investigations should you perform in suspected angina?
ECG
Troponins - rule out MI
FBC - exclude anaemia
Fasting glucose/ cholesterol
How do you manage angina (4)?
CVS risk advice + statin
Start aspirin if no CI
1) GTN spray for when symptoms occur
2) Beta blocker or CCB are first line preventives
What are the three most common types of prolapse?
1- Cystourethrocele (prolapse of bladder and urethra)
2- Uterine prolapse (uterus into vagina)
3- Rectocele (rectum into vagina)
Name 5 presenting symptoms of a prolapse?
Sensation of pressure, fullness, heaviness Seeing a bulge Difficulty retaining tampons Spotting Incontinence/ frequency/ urgency Dysparenunia Bowel symptoms
What would you do to examine a vaginal prolapse? (2)
Examine standing and L lateral positions
Use speculate and ask patient to strain
What are your first 3 management steps for treating a prolapse?
1) Conservative (weight loss, pelvic floor exercises, treat constipation)
2) Ring pessary (changed every 6-12 months- can be used if sexually active, effective in 60%)
3) Surgery
Name 3 complications of a prolapse?
Infection or ulceration
Incontinence or retention
Recurrent UTI’s
Bowel dysfunction if rectocele
What can you do to prevent a prolapse? (3)
Pelvic floor exercises (8x TDS for a few months)
Weight loss
Smoking cessation (reduce cough)
Name 3 RF’s for a vaginal prolapse?
Age Vaginal delivery Increasing parity Obesity Previous hysterectomy
Name 5 possible presenting symptoms of HIV?
Raised temperature Sore throat Body rash Joint pain Fatigue Muscle pain Swollen LN's
(Short flu like illness for 2-6 weeks post infection then no symptoms for years)
A healthcare worker has recently had a needlestick from a patient with HIV - what treatment should be offered?
Post exposure prophylaxis (PEP) - ideally start within 24 hrs
When should HIV tests be repeated?
If done within 3 months of potential exposure ensure is repeated (negative)
Name 3 things to counsel a patient to prevent HIV?
Use a condom Use PrEP (pre-exposure prophylaxis) Don't share needles, spoons or swabs
Name 7 counselling points for a caesarean section
1 in 5 births in UK
Done under spinal/ epidural anaesthetic so awake
Screen between you and whats going on
Small scar left below bikini line
Normally takes just under an hour
Need 3 days in hospital to recover, avoid driving etc for 6 weeks
Counsel on risks
Can still have vaginal delivery for next child
Name 3 indications for caesarean
Breech position Placenta praevia (low lying placenta) Pre-eclampsia Non-progression labour Concerning CTG
Name 3 risks of a caesarean section
Infection of wound Blood clots Excessive bleeding Damage to nearby areas such as bladder or ureter Breathing difficulties in baby Can give baby small cut
Name 5 counselling points for group
Viral (parainfluenza virus)
Symptoms = barking cough, worse at night, hoarse voice, rasping sound breathing in - preceeded by coryza
Croup normally resolves by itself within 48 hours - sit upright, give fluids etc
DON’T give steam or cough/ cold medicines
Call NHS 111 if worried, child getting worse etc
Call 999 if struggling to breath, they look grey or blue or go quiet and still
Name 5 counselling points for bronchiolitis
Most cases mild and settle without treatment within 2-3 weeks (2% need hospital)
Early symptoms are similar to common cold (runny nose and cough)
Later syx - fever, dry cough, difficulty feeding, wheezing
See GP if - worried, struggling to breath, feeds less than half, dry nappy >12hrs, irritable
Safetynet - dial 999 if (severe difficulty breathing, grey or blue)
1 in 3 children develop bronchiolitis at some point - caused by RSV
Tx: Paracetamol and fluids
What are the 4 components of a developmental exam?
Gross motor - ask to run, balance one leg etc
Fine motor - use pen, make with bricks, swap hands
Language and hearing - Ask to do colours
Social
Height/ weight and head circumference into red book
Name 4 dietary and vitamin points pregnant women should be counselled on?
Folic acid 400mcg from pre-conception > 12 wks
Avoid vitamin A suppliments/ liver (tetratogenic)
Listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
Salmonella: avoid raw or partially cooked eggs and meat, especially poultry
What treatment should be offered to a woman at 20weeks who has previously had group B strep infection before delivery of a previous child?
Intrapartum antibiotics
What are the 4 risk factors for GBS infection?
Prematurity
Prolonged rupture of the membranes
Previous sibling GBS infection
Maternal pyrexia e.g. secondary to chorioamnionitis
Name three indications for intrapartum antibiotics?
GBS infection
Previous baby with GBS infection
Preterm labour
Pyrexia during labour
(Benzylpenicillin)
Name three counselling points for GBS screening?
Not routinely offered, can’t be requested
If swabs done do 3-5 weeks before delivery
Name 5 differentials for bleeding in pregnancy?
Placenta praevia < not normal in early scans
Placental abruption < painful
Vasa previa
Bloody show < mucus in bleed
Non-obstetric (trauma, cervicitis, polyps)
What are your top 5 differentials for diarrhoea?
Cancer < weight loss, age, pr bleed
Gastroenteritis < recent travel, fever, unwell
Lactose intolerance/ coeliac < Diet/ FHx
IBS < 6 months
IBD < Young, blood and mucus, weight loss
Hyperthyroid < Mood, periods, tremor, heat intolerance, sweating, swelling in neck
Name 5 differentials for epigastric pain?
GORD Peptic ulcer Pancreatitis MI Gallstones IBS Hepatitis AAA needs ruling out! (pain in back)
Name 5 general symptoms to ask about with any ?miscarriage?
Blood (amount, spotting/ needing pads, colour, clots) Abdo pain Discharge Bladder/ bowel changes Dysuria How do you feel in yourself!
What are the two types of cows milk protein allergy?
IgE mediated- immediate hypersensitivity (hives etc.)
Non IgE mediated - most common (slower onset, diarrhoea, vomitting etc)
What acronym is used in the management of suspected paeds NAI?
SMACK S- Safety (admit to ward to observe) M - Medical management (analgesia etc.) A- Ask for senior help - To decide on examination, photography - To decide on FBC/ clotting etc C- Contact social service K - Keep proper documents
How do you prescribe oral suspension paracetamol on an FP10 prescription?
Paracetamol 120mg/5ml oral suspension
Take 240mg (10ml) every 4-6 hours as required
Maximum 4 doses in 24 hours
Provide 200ml
The above is for a 7 year old - see BNF
How do you prescribe amoxicillin oral suspension on an FP10 prescription?
Amoxicillin 250mg/5ml oral suspension Take 500mg (10ml) three times per day Supply 210ml (7 days)
The above is for a 7 year old - see BNF
When taking a miscarriage history name 5 things you ask about?
Weeks, complications so far?
Blood (amount/ clots)
Pain
Rule out STI and UTI
Bladder or bowel symptoms
MOSC (minus M)
- Focus on previous pregnancies or miscarriages
PMHx
- Bleeding disorders
What requirements must be met do to medical management of miscarriage?
Need to be able to return for follow up
No abdominal pain
HcG < 1500 and mass <35mm
No intrauterine pregnancy
Name the SOCRATES and other questions done in an antepartum haemorrhage history?
S- Sure its from vagina? O - Onset, duration, number of episodes, still bleeding? C- Character (red/ brown, clots, mucus) R - A - N+V, fevers, well in self T- Ever happened before? ES WIMPP PMHx - Bleeding disorders
What acronym should be used for travel histories?
WAFAPP W- Where (city/ country) A- Accommodation F- Food and drink A- Activities (fresh swim, injuries, animals, sex) P- Purpose of trip P- Prophylaxis and vaccinations
What maintenance fluid is given in paeds? How do you calculate the volume
Maintain:
Bag: 0.9% saline, 5% dextrose and 10mmol potassium in 500ml bag
First 10kg: 100ml/kg
Second 10kg: 50ml/kg
After: 20ml/kg
How do you replace fluids in a dehydrated child?
Assess how dehydrated they are (clinically) and decide how much they’ve lost:
Mild: Replace orally
Moderate (dry mucus membranes, low skin turgor) or severe:
- Fluid bolus IV stat (20ml/kg) - give one if moderate, if severe may need several
How do you prescribe morphine in palliative care?
Calculate what amount of morphine they were on previously (table in BNF)
- Calculate amount morphine in 24hrs
Convert that into modified release morphine tablets (BD) and then add oromorph PRN at 1/6 of total daily dose every 2-4 hours as required
Add metoclopramide for sickness and lactulose for constipation
Do all children with meningitis get an LP?
Ideally yes - but don’t let it delay antibiotics!
Give ab’s and steroids, then do LP
When is a heel prick test performed and what does it test for?
5 days
Sickle cell, congenital thyroid, CF
+ lots of metabolic disease
How should women with T1 or T2DM be counselled regarding birth timing?
Deliver all (vag or c-section) a little bit early - Make sure seen by diabetic specialist consultant
Name 5 differentials of abdominal pain in later pregnancy?
Pre-term labour Placental abruption Uterine rupture Chorioaminionitis (fever, discharge) Pre-eclampsia or HELLP syndrome
(Non-obstetric)
Name 3 RF’s for placenta praevia
Previous PP Previous caesrean Increasing age Multiparity Smoking or drug use IVF
How do you manage placenta praevia?
Don’t do vag exam - TVUS only
Follow up scans (@20wks there is 90% chance resolve, @32weeks on 10% chance)
Minor (>2cm from os) can still do vag
Major - need c-section, don’t have intercourse, aim to deliver at 38 weeis
Name 3 RF’s for placenta abruption
Previous abruption Multiple pregnancy Pre-eclampsia Multiparity Previous caesarean Smoking Thrombophillia
How do you manage a placental abruption?
ABCDE (mothers life takes priority)
Put in L lateral position
Give 2L fluids then blood
Cesarean once mum is stable
At what age should a child be able to scrible with a pen?
18mths
At what age should a child be able to say a single word?
9mths
At what age should a child be able to obey instructions?
2yrs
At what age should a child (a) drink using a cup and (b) use a fork and spoon?
a) 1 yr
b) 2yrs
At what age should a child a) stand and b) walk and c) run/ do stairs
a) 9mths
b) 15 months (refer at 18)
c) 2yrs
Name 5 differentials for a breast lump?
Fibroadenoma Breast cyst Cancer Papilloma Fat necrosis Phyllodes tumour
Paget’s (eczema on nipple)
Inflammatory breast cancer (mammogram may be normal)
How does fibroadenosis present?
Young woman complaining of lumpy breasts, worse during her period
How do you treat cyclical breast pain?
Trial topical NSAIDS
- Swap if on COCP
Get well fitting bra, diet and lifestyle
