F+C (Part 2)

Question 1

Name 5 differentials for a rash in children?

Answer 1

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)

Question 2

Name 5 symptoms of meningitis in a child?

Answer 2

Fever
Prodromal illness (flu like)
Irritable and crying
Poor feeding
Rash 
Neck stiffness
Photophobia

Question 3

When a baby is premature, how should you correct for this on a growth chart?

Answer 3

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

Question 4

What bacterial pathogen causes acute tonsilitis?

Answer 4

Group A strep

Viral is most commonly EBV/ herpes simplex/ cytomegalovirus

Question 5

Name 5 differentials for a child for fever?

Answer 5

Meningitis
Tonsilitis (later scarlet fever)
URTI/ bronchiolitis/ pneumonia 
UTI
Otitis Media 
Leukaemia 
Chicken pox
Kawasaki disease

Question 6

What organism causes bronchiolitis?

Answer 6

Respiratory synctial virus (RSV)

Gets worse at D5 then starts to improve

Question 7

What organism most commmonly causes croup?

Answer 7

Parainfluenza virus

Question 8

How would you distinguish between croup and whooping cough in a history?

Answer 8

Croup = seal like cough, worse on expiration and with agitation
Whooping cough = whoop heard on inspiration, worse at night and expiration

Question 9

What organism causes whooping cough, what is the management of whooping cough? (4)

Answer 9

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

Question 10

What is the best full general history taking acronym to follow?

Answer 10

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

Question 11

How should HSP be described to a patient?

Answer 11

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

Question 12

How does HSP usually present?

Answer 12

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

Question 13

How is HSP managed?

Answer 13

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%)

Question 14

What are your differentials for a suspected HSP? (3)

Answer 14

ITP
Leukaemia
Meningococcal septicaemia

Question 15

How would you describe testicular torsion to a patient? What age group does it most commonly affect?

Answer 15

Where the testicle twists back on itself and cuts off the blood supply
Young boys are most affected (7-12yrs)

Question 16

How does testicular torsion usually present? How can it be distinguished from epididymitis?

Answer 16

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

Question 17

How is testicular torsion treated? Name some counselling points (3)

Answer 17

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

Question 18

What general advice around returning to activites following a surgical procedure with a wound is normally given?

Answer 18

No swimming etc until stitches out or 7-10days
Don’t bath/ shower for a few days
Avoid contact sports for 4 weeks

Question 19

Name 3 risk factors for developing cerebral palsy

Answer 19

Prem birth 
Congenital infections
Injury before birth 
Hypoxic event during labour 
Multiple births
Congenital malformations
Chorioamnionitis

Question 20

What are your top differentials for a 20 year old female presenting with acute lower abdo pain on the R hand side?

Answer 20

Ectopic pregnancy
Ruptured cyst
Appendicitis
Ovarian torsion

PID (less acute)
Endometriosis
IBS/ IBD
Kidney pathology (urinary symptoms)

Question 21

Name some key components of a post-natal depression history?

Answer 21

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

Question 22

A woman presents with vaginal discharge, what investigations do you do?

Answer 22

Cultures- Charcoal high vaginal swab from posterior fornix (Gonorrhoea, TV, BV, candida)

NAAT- Endocervical swab from os - chlamydia and gonorrhoea

Question 23

Name 3 risk factors for developing PID?

Answer 23

New partner
Multiple partners
No condom use
IUD insertion 
Pregnancy termination

Question 24

How is diagnosis of PID made?

Answer 24

Clinically (not from swab)

Lower abdo pain, with deep dysparenunia, vaginal bleed, discharge, fever - may see cervical excitation on examination

Question 25

Name 5 differentials for PID?

Answer 25

``` Endometriosis STI (uncomplicated) Ectopic pregnancy - often more acute Appendicitis - often more acute FIbroids Cervical cancer ```

Question 26

Name 3 investigations for suspected PID?

Answer 26

Pregnancy test - exclude ectopic! Cervical swabs for chlamydia and gonorrhoea (+ve results supports diagnosis but -ve does not exclude)

Question 27

How should PID be treated?

Answer 27

Ceftriazone IM single dose followed by oral doxycycline and metronidazole for 14 days Avoid UPSI Contact all partners in last 6 months

Question 28

What general advice should be given regarding other partners when diagnosed with STI?

Answer 28

All other partners in last 6 months should be contacted and offered screening

Question 29

Name 3 complications of PID?

Answer 29

Infertility (increase with number of episodes and severity) Ectopic pregnancy Chronic pelvic pain Tubo-ovarian abscess

Question 30

How do you distinguish between Crohns and UC?

Answer 30

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

Question 31

Name 5 differentials for a presentation of diarrhoea?

Answer 31

``` Crohns/ UC Gastroenteritis (travel?) IBS Diverticular disease Colorectal cancer ```

Question 32

Name 5 investigations you would do if suspecting IBS?

Answer 32

``` FBC, CRP, U+E, LFT B12/folate/iron Stool culture Faecal calprotectin (between IBS and IBD) Endoscopy and biopsy ```

Question 33

What is first line drug tx for both Crohns and UC?

Answer 33

Mesalazine | UC also need to induce remission with steroids

Question 34

Name 5 key symptoms to ask about with a bowel change history?

Answer 34

``` 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 ```

Question 35

What are the diagnostic criteria for IBS?

Answer 35

6 months hx of abdominal pain with altered bowel habit or relived by defecation +2 of (Bloating, straining, mucus in stool, aggravation by eating)

Question 36

What are the three features which make up angina?

Answer 36

Cardiac chest pain Precipitated by exertion or emotion Relived by rest/ GTN in 5 mins Typical angina = all 3 Atypical = 2 Non-anginal = <2

Question 37

What investigations should you perform in suspected angina?

Answer 37

ECG Troponins - rule out MI FBC - exclude anaemia Fasting glucose/ cholesterol

Question 38

How do you manage angina (4)?

Answer 38

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

Question 39

What are the three most common types of prolapse?

Answer 39

1- Cystourethrocele (prolapse of bladder and urethra) 2- Uterine prolapse (uterus into vagina) 3- Rectocele (rectum into vagina)

Question 40

Name 5 presenting symptoms of a prolapse?

Answer 40

``` Sensation of pressure, fullness, heaviness Seeing a bulge Difficulty retaining tampons Spotting Incontinence/ frequency/ urgency Dysparenunia Bowel symptoms ```

Question 41

What would you do to examine a vaginal prolapse? (2)

Answer 41

Examine standing and L lateral positions | Use speculate and ask patient to strain

Question 42

What are your first 3 management steps for treating a prolapse?

Answer 42

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

Question 43

Name 3 complications of a prolapse?

Answer 43

Infection or ulceration Incontinence or retention Recurrent UTI's Bowel dysfunction if rectocele

Question 44

What can you do to prevent a prolapse? (3)

Answer 44

Pelvic floor exercises (8x TDS for a few months) Weight loss Smoking cessation (reduce cough)

Question 45

Name 3 RF's for a vaginal prolapse?

Answer 45

``` Age Vaginal delivery Increasing parity Obesity Previous hysterectomy ```

Question 46

Name 5 possible presenting symptoms of HIV?

Answer 46

``` 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)

Question 47

A healthcare worker has recently had a needlestick from a patient with HIV - what treatment should be offered?

Answer 47

Post exposure prophylaxis (PEP) - ideally start within 24 hrs

Question 48

When should HIV tests be repeated?

Answer 48

If done within 3 months of potential exposure ensure is repeated (negative)

Question 49

Name 3 things to counsel a patient to prevent HIV?

Answer 49

``` Use a condom Use PrEP (pre-exposure prophylaxis) Don't share needles, spoons or swabs ```

Question 50

Name 7 counselling points for a caesarean section

Answer 50

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

Question 51

Name 3 indications for caesarean

Answer 51

``` Breech position Placenta praevia (low lying placenta) Pre-eclampsia Non-progression labour Concerning CTG ```

Question 52

Name 3 risks of a caesarean section

Answer 52

``` 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 ```

Question 53

Name 5 counselling points for group

Answer 53

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

Question 54

Name 5 counselling points for bronchiolitis

Answer 54

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

Question 55

What are the 4 components of a developmental exam?

Answer 55

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

Question 56

Name 4 dietary and vitamin points pregnant women should be counselled on?

Answer 56

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

Question 57

What treatment should be offered to a woman at 20weeks who has previously had group B strep infection before delivery of a previous child?

Answer 57

Intrapartum antibiotics

Question 58

What are the 4 risk factors for GBS infection?

Answer 58

Prematurity Prolonged rupture of the membranes Previous sibling GBS infection Maternal pyrexia e.g. secondary to chorioamnionitis

Question 59

Name three indications for intrapartum antibiotics?

Answer 59

GBS infection Previous baby with GBS infection Preterm labour Pyrexia during labour (Benzylpenicillin)

Question 60

Name three counselling points for GBS screening?

Answer 60

Not routinely offered, can't be requested | If swabs done do 3-5 weeks before delivery

Question 61

Name 5 differentials for bleeding in pregnancy?

Answer 61

Placenta praevia < not normal in early scans Placental abruption < painful Vasa previa Bloody show < mucus in bleed Non-obstetric (trauma, cervicitis, polyps)

Question 62

What are your top 5 differentials for diarrhoea?

Answer 62

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

Question 63

Name 5 differentials for epigastric pain?

Answer 63

``` GORD Peptic ulcer Pancreatitis MI Gallstones IBS Hepatitis AAA needs ruling out! (pain in back) ```

Question 64

Name 5 general symptoms to ask about with any ?miscarriage?

Answer 64

``` Blood (amount, spotting/ needing pads, colour, clots) Abdo pain Discharge Bladder/ bowel changes Dysuria How do you feel in yourself! ```

Question 65

What are the two types of cows milk protein allergy?

Answer 65

IgE mediated- immediate hypersensitivity (hives etc.) Non IgE mediated - most common (slower onset, diarrhoea, vomitting etc)

Question 66

What acronym is used in the management of suspected paeds NAI?

Answer 66

``` 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 ```

Question 67

How do you prescribe oral suspension paracetamol on an FP10 prescription?

Answer 67

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

Question 68

How do you prescribe amoxicillin oral suspension on an FP10 prescription?

Answer 68

``` 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

Question 69

When taking a miscarriage history name 5 things you ask about?

Answer 69

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

Question 70

What requirements must be met do to medical management of miscarriage?

Answer 70

Need to be able to return for follow up No abdominal pain HcG < 1500 and mass <35mm No intrauterine pregnancy

Question 71

Name the SOCRATES and other questions done in an antepartum haemorrhage history?

Answer 71

``` 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 ```

Question 72

What acronym should be used for travel histories?

Answer 72

``` 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 ```

Question 73

What maintenance fluid is given in paeds? How do you calculate the volume

Answer 73

Maintain: Bag: 0.9% saline, 5% dextrose and 10mmol potassium in 500ml bag First 10kg: 100ml/kg Second 10kg: 50ml/kg After: 20ml/kg

Question 74

How do you replace fluids in a dehydrated child?

Answer 74

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

Question 75

How do you prescribe morphine in palliative care?

Answer 75

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

Question 76

Do all children with meningitis get an LP?

Answer 76

Ideally yes - but don't let it delay antibiotics! Give ab's and steroids, then do LP

Question 77

When is a heel prick test performed and what does it test for?

Answer 77

5 days Sickle cell, congenital thyroid, CF + lots of metabolic disease

Question 78

How should women with T1 or T2DM be counselled regarding birth timing?

Answer 78

``` Deliver all (vag or c-section) a little bit early - Make sure seen by diabetic specialist consultant ```

Question 79

Name 5 differentials of abdominal pain in later pregnancy?

Answer 79

``` Pre-term labour Placental abruption Uterine rupture Chorioaminionitis (fever, discharge) Pre-eclampsia or HELLP syndrome ``` (Non-obstetric)

Question 80

Name 3 RF's for placenta praevia

Answer 80

``` Previous PP Previous caesrean Increasing age Multiparity Smoking or drug use IVF ```

Question 81

How do you manage placenta praevia?

Answer 81

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

Question 82

Name 3 RF's for placenta abruption

Answer 82

``` Previous abruption Multiple pregnancy Pre-eclampsia Multiparity Previous caesarean Smoking Thrombophillia ```

Question 83

How do you manage a placental abruption?

Answer 83

ABCDE (mothers life takes priority) Put in L lateral position Give 2L fluids then blood Cesarean once mum is stable

Question 84

At what age should a child be able to scrible with a pen?

Answer 84

18mths

Question 85

At what age should a child be able to say a single word?

Answer 85

9mths

Question 86

At what age should a child be able to obey instructions?

Answer 86

2yrs

Question 87

At what age should a child (a) drink using a cup and (b) use a fork and spoon?

Answer 87

a) 1 yr | b) 2yrs

Question 88

At what age should a child a) stand and b) walk and c) run/ do stairs

Answer 88

a) 9mths b) 15 months (refer at 18) c) 2yrs

Question 89

Name 5 differentials for a breast lump?

Answer 89

``` Fibroadenoma Breast cyst Cancer Papilloma Fat necrosis Phyllodes tumour ``` Paget's (eczema on nipple) Inflammatory breast cancer (mammogram may be normal)

Question 90

How does fibroadenosis present?

Answer 90

Young woman complaining of lumpy breasts, worse during her period

Question 91

How do you treat cyclical breast pain?

Answer 91

Trial topical NSAIDS - Swap if on COCP Get well fitting bra, diet and lifestyle