February 2025 Flashcards
What is the most common cause of postpartum haemorrhage?
Uterine Atony
Fibroadenoma management
Depends on patient’s preference
- Can be safely left behind with
reassurance and periodic review.
- Surgery – excision done usually under
GA if patient wants.
Duodenal atresia features
- Neonate w/ vomiting (after first feeds)
- Down syndrome 5%
distal obstruction to the papilla of Vater 80%
-bilious vomiting - M > F
-X-ray: ‘double-bubble’ - drooling
- abdominal distension (very late symptom)
Perthes features
- Normal Caucasian boy
- 4 and 10 years, peak incidence at 5 to 7 years
- 15% bilateral
- widening of joint hip space
Hip pain result of necrosis of the involved bone
-pain may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh. - The quadriceps muscles and adjacent thigh soft tissues may atrophy, and the hip may develop adduction flexion contracture
- antalgic gait with limited hip motion, or a Trendelenburg gate (abductor lurch).
- Pain may be present with passive range of motion and
limited hip movement, especially internal rotation and abduction
Intraductal Papilloma
Clinical Features:
1. Watery/Bloody discharge
2. Just 1 duct compromised
First Investigation:
1. PE.
2. US (<35yo)
Mammography (>35yo)
Best Investigations:
1. FNAC
2. Core Biopsy
3. Breast Ductography (specific)
Management: Surgery
Development of pubic hair
Girls: 8 years
Boys: 9 years
Paget’s disease management
- lumpectomy (breast conserving surgery)
- partial mastectomy or wide local incision
- Total mastectomy only if indication of disease is severe
Management of px with breast cancer spread to several places in bones
- anticancer therapy with hormonal treatment
- chemotherapy
Ventricular septal defect (VSD)
- holosystolic murmur at left sternal border
- acyanotic
septic arthritis management
- Joint drainage & debridement
- IV antibiotics
- orthopaedic surgeon referral
Complications of thyroglossal duct cyst (TDC)
-
Infection
-Malignancy 1% - Overgrowth and pressure of the underlying
structures. - Rupture and fistula formation
Posterior triangle of the neck mass
CCP
- Cystic hygroma
- Cervical rib
- Pancoast tumour
- (Naso/oropharyngeal squamous cell carcinomas)
3-4 years of age + kidney claw sign + abdominal mass does not cross midline
nephroblastoma (Wilm’s tumour)
Rinne test
AC>BC = Normal/SNHL
BC>AC= CHL
Developmental dysplasia (DDH) of the hip features
- neonates from breech delivery
- Female 6xt more likely
- unilateral or bilateral (positive family hx)
- Diminished abduction in flexion of the
affected hip - Apparent inequality of legs: affected
leg being shortened and externally rotated - Asymmetrical skin creases of the groin and
thigh - ‘clicking’ on hip movements
Bacterial conjunctivitis in children school exclusion
- Excluded until discharge has resolved
Weight: 1 standard deviation above/below the 50th percentile
Weight: overweight/underweight
kidney scarring investigation of choice in children
DMSA (gold standard)
- Clinical suspicion of renal injury
- Reduced renal function
- Suspicion of VUR
- Suspicion of obstructive uropathy on ultrasound in older toilet-trained children
Features of Paget’s disease
- eczematous-looking
- dry scabbing nipple rash
- nipple ulceration
- nipple skin thickening
- dilated duct of the breast
Breast cancer screening age group
- 50-74 (mammograms every two years)
- Woman 40 years of age specifically asking due to family history of risk BC
Cervical masses in neonatal period
- thyroglossal duct cyst (TDC)
- teratomas
- sternocleidomastoid tumours of infancy
- vascular or lymphatic malformations.
Hypertrophic Pyloric Stenosis risk factors in children
-Formula feeding
-Male
-Caucasian background
-Firstborn
-Maternal smoking during pregnancy
-Positive family history
-Both erythromycin and azithromycin < 2weeks
slipped capital femoral epiphysis (SCFE) management
- Cease weight-bearing and refer urgently.
- lf acute slip, gentle reduction via traction is
better than manipulation for prevention of
later avascular necrosis. - Once reduced, perform pinning
Idiopathic (immune) thrombocytopenic purpura (ITP) in children management
- If not bleeding: monitoring/observation
- If bleeding: IVIG and corticosteroids (prednisone)
Mammary Duct Ectasia
Clinical Features:
- Unilateral
- Multiple ducts in the SAME breast
- Discharge: Sticky, toothpaste-like green
First Investigation: Mammography
Best Investigations: Ductal lavage (Cytology)
Management: Excisional biopsy
DMSA indications
- Clinical suspicion of renal injury
- Reduced renal function
- Suspicion of VUR
- Suspicion of obstructive uropathy on ultrasound in older toilet-trained children
murmurs that increase in
intensity when the venous return to the heart is
decreased:
- hypertrophic obstructive
cardiomyopathy (HOCM) - mitral valve prolapse
- venous hum (low-pitched continuous
murmurs produced by blood returning from
the great veins to the heart)
Perthes disease management
- refer to surgeon
Surgeon will make call on conservative or surgical
- conservative: brace
- surgical: osteotomy/femoral head fixation, hip replacement worst case
Hypertrophic Pyloric Stenosis features in children
- 2 and 6 weeks of age
- gastric outlet narrowing
- projectile vomiting a few minutes after feeding
- non bloody, non bilious vomiting (may have coffee ground appearance due to repeated vomiting)
- delayed capillary refill > 2 seconds
Renal scarring in children
- Recurrent urinary tract infections (more than
2 times during childhood) - Dimercaptosuccinic acid scintigraphy (DMSA) - Gold Standard
Breast Lumps
Clinical Features: Smooth margins
First Investigation:
1. PE.
2. US (<35yo)
3. Mammography (>35yo)
Best Investigations:
1. FNAC
2. Core Biopsy
Management:
1. Observation.
2. Excision
Paget’s disease differential dx
- Ductal carcinoma in situ
Innocent murmur
7S
-soft
- systolic
- short duration
- sounds (S1 &S2)
- symptomless
- Special tests normal (X-ray, ECG)
- Standing/Sitting changes (not fixed) (increased when supine)
Tanner stages
I:
- 0–15 years
- None
II:
- 8–15 years
- Commencement of puberty
- Breast budding first
- Pubic hair
- Scrotal/Testicular growth, penis growth after a year
III:
- Increase in hair and pigmentation
Anterior triangle of the neck mass
BCC
- Branchial cyst
- Carotid body tumour
- Carotid aneurysm
Down syndrome in children
- short stature
- microcephaly
- centrally placed hair whorl
- small ears
- redundant skin on the nape of the neck
- flat nasal bridge
- Cardiac lesions 30% to 50% (endocardial cushion defect, VSD, tetralogy of Fallot (all 30%)
- Duodenal atresia
kidney scarring features in children
- one kidney smaller than the other
Fibroadenoma features
- Most common benign breast lump
- 20-30 years
- Well defined, round with even surface,
regular margins, rubbery or soft in
consistency, freely mobile, non-tender - Does not increase the risk of cancer
Müllerian agenesis [incomplete]
Check more on clinical features of female agenesis
- Female gonads do not secrete Müllerian-inhibiting factor (MIF)
- Male testes secrete MIF
- empty scrotum
- testes are impalpable in inguinal canal
Pathological murmurs features
Family hx of sudden cardiac death or congenital heart disease
- in utero exposure to certain medications (lithium) or alcohol
- Maternal diabetes mellitus
- History of rheumatic fever
- History of Kawasaki disease
- Grade 3/6 or higher murmurs
- Harsh quality
- Abnormal S2
- The presence of a systolic click
- Increased intensity with decreased venous
return (e.g., when the patient stands) - The patient has any symptoms that could be
related to a cardiac condition (e.g. shortness
of breath, chest pain, poor feeding, etc.)
Atrial Septal Defect (ASD)
- acyanotic
- mid-systolic murmur at the pulmonary area, a split-second heart sound and a loud P2
2 main types:
- Ostium Primum: most dangerous type, can lead to pulmonary hypertension and heart failure, Prophylactic antibiotics recommended
- Ostium Secundum: most common type, e hole is higher in the septum, not serious, symptoms uncommon in infancy
Idiopathic (immune) thrombocytopenic purpura (ITP) in children features
- preceding viral infection
- s frequently < 20,000/μL
- other lab tests normal
septic arthritis in children
- S aureus
- joint aspiration
Hypertrophic Pyloric Stenosis in children management
Initial: Fluid resuscitation
Best: Ramstedts Pyloromyotomy
Developmental dysplasia (DDH) of the hip dx
Barlow test —‘telescoping’ movements in the long axis of the flexed and abducted thighs.
Ortolani test — flexed hips are abducted. thighs are the grasped between the thumbs in front and other fingers behind. The child’s knees are flexed and hip flexed to a right
angle. **positive sign makes audible and palpable ‘jerk’ or ‘clunk’ (not a click). **
- Ortolani and Barlow tests but is usually negative after two months
- Ultrasound is excellent especially up to 3-4 months
Fibroadenoma
Clinical Features: Mobile, non-tender
First Investigation: US
Best Investigations:
1. FNAC.
2. Core Biopsy
Management: Reassure/Review in 3 months
Most appropriate step in management of postpartum haemorrhage after oxytocin and manual stimulation?
Ergometrine (help uterus contract)
slipped capital femoral
epiphysis (SCFE) clinical features
- Overweight adolescent of 10 to15 years
- bilateral in 20%
- Limp and irritability of hip on movement
- Knee pain — referred from the affected hip
- On flexion of the hip, it rotates externally. Hip
is often in external rotation on walking. - Most movements restricted, especially
internal rotation.
anal fissure features [incomplete]
- passage of hard stools
Hepatoblastoma clinical features
-<5 years
- mass in right upper quadrant
- abdominal distension
- right-sided abdominal pain
- familial adenomatous polyposis high risk
- lost appetite and weight
- vomiting and jaundice (very rare)
Midline of the neck mass
TTD
- Thyroid nodule
- Thyroglossal cyst
- Dermoid cyst
infant < 2 years + low-grade fever + abdominal distension + loss of appetite + limb pain + abdominal mass that crosses the midline
Neuroblastoma
- originates from adrenal glands
most common congenital heart disease in infants?
Ventricular Septal Defect (VSD) 1 in 100 Australian infants
Weight: 2 standard deviation above/below the 50th percentile
Weight: obese/severely underweight
Patent ductus arteriosus. (PDA)
-acyanotic
- pansystolic machinery murmur (harsh) at the left sternal border
- wide pulse pressure.
- Definite treatment surgical closure
Weber’s test
Normal = lateralizes equally to both ears
CHL= lateralizes to abnormal ear
SNHL= lateralizes to the normal ear
Bacterial conjunctivitis in children
- gonorrhoea: fast and aggressive (3 and 7 days after birth)
- chlamydia: slow and less aggressive (end of 1st week - 1 month after birth)
Most at risk demographic for developing iron deficiency?
toddlers (weaning off breast milk)
Tetralogy of Fallot (TOF)
4 defects
- blood going from left to right ( acyanotic)
- all have VSD (systolic murmur)
- pulmonary stenosis
- right ventricle hypertrophy
- overriding aorta
anal fissure
- most common cause of painful rectal bleeding in children
- associated with constipation
- bright blood on the
surface of stool, on the nappy or toilet paper
Management of px with breast cancer spread to one area of bone
- Radiotherapy
Colon polyp
- benign hamartomas
- ages 2 and 8 years, peak at 3 to 4 years
- mostly painless
rectal bleeding
palpable polyp
on rectal examination >60%
Transposition of the great arteries (TGA)
- central cyanotic after 10-12 hours
Aorta and pulmonary arteries are reversed - no murmur as there is no hole
- prescribe PG e1
- definite treatment: surgery to correct the transposition
adolescent + fever >38.5C + ↑WBC, ESR, CRP + Acute painful, tender and warm joint + limited movement + refusal to bear weight
Septic arthritis
Upper Limb nerve roots
Brachial Plexus Roots C5-T1:
“Randy Travis Drinks Cold Beer”
* Roots → Trunks → Divisions → Cords → Branches
- C5: Deltoid (shoulder abduction), biceps (flexion).
- C6: Biceps reflex, wrist extension.
- C7: Triceps reflex, wrist flexion, finger extension.
- C8: Finger flexion, grip strength.
- T1: Intrinsic hand muscles (fine motor).
C5 nerve root
Muscle: Biceps
Reflex: Biceps
Motor action: Shoulder abduction, elbow flexion
Sensory region: Lateral upper arm
C5 nerve root lesion
- Weak shoulder abduction
- diminished biceps reflex
- numbness over the lateral upper arm
- Weak shoulder abduction
- Diminished biceps reflex
- Numbness over the lateral upper arm
C5 nerve root lesion
C6 nerve root:
- Motor Functions: Wrist extension, elbow flexion.
- Reflex: Brachioradialis reflex.
- Sensory Area: Lateral forearm, thumb, index finger.
C6 nerve root lesion
- Weakness in wrist extension
- diminished brachioradialis reflex
- numbness over thumb and lateral forearm.
- Weakness in wrist extension
- diminished brachioradialis reflex
- numbness over thumb and lateral forearm.
C6 nerve root lesion
C7 Nerve Root
- Motor Functions: Elbow extension, wrist flexion, finger extension.
- Reflex: Triceps reflex.
- Sensory Area: Middle finger.
C7 nerve root lesion
- Weakness in elbow extension
- diminished triceps reflex
- numbness over the middle finger.
- Weakness in elbow extension
- diminished triceps reflex
- numbness over the middle finger.
C7 nerve root lesion
C8 Nerve Root
- Motor Functions: Finger flexion (grip strength).
- Reflex: None.
- Sensory Area: Medial forearm, ring and little fingers.
C8 nerve root lesion
- Weakness in finger flexion and grip
- numbness over medial forearm and little finger.
- Weakness in finger flexion and grip
- numbness over medial forearm and little finger.
C8 nerve root lesion
T1 Nerve Root
- Motor Functions: Finger abduction/adduction (intrinsic hand muscles).
- Reflex: None.
- Sensory Area: Medial upper arm.
T1 nerve root lesion
- Weakness in finger flexion and grip
- numbness over medial forearm and little finger.
- Weakness in finger flexion and grip
- numbness over medial forearm and little finger.
T1 nerve root lesion
Median Nerve
- Motor Functions: Wrist flexion, forearm pronation, flexion of thumb, index, and middle fingers; thumb opposition.
- Sensory Area: Palmar surface of the thumb, index and middle fingers, and half of the ring finger.
Median nerve lesion
- Proximal lesion: “Ape hand” deformity, weak forearm pronation, wrist flexion.
- Distal lesion: “Hand of benediction” (can’t flex index and middle fingers when making a fist).
- Sensory: loss of sensation over the thumb, index and middle fingers, and half of the ring finger
- Proximal lesion: “Ape hand” deformity, weak forearm pronation, wrist flexion.
- Distal lesion: “Hand of benediction” (can’t flex index and middle fingers when making a fist).
- Sensory: loss of sensation over the thumb, index and middle fingers, and half of the ring finger
Median nerve lesion
Ulnar Nerve
- Motor Functions: Finger abduction/adduction (interossei), flexion of medial fingers, wrist flexion (ulnar deviation).
- Sensory Area: Medial 1½ fingers (palmar and dorsal).
Ulnar nerve lesion
- Proximal lesion: “Claw hand” (incomplete flexion of medial fingers), weak grip.
- Distal lesion: Complete claw hand.
- Sensory loss over medial 1½ fingers.
- Proximal lesion: Incomplete flexion of medial fingers, weak grip.
- Distal lesion: Complete flexion of medial fingers, weak grip.
- Sensory loss over medial 1½ fingers.
Ulnar nerve lesion
Axillary Nerve
- Motor Functions: Shoulder abduction (deltoid).
- Sensory Area: Lateral shoulder.
Axillary nerve lesion
- Weakness in shoulder abduction (15°–90°)
- numbness over lateral shoulder.
- Weakness in shoulder abduction (15°–90°)
- numbness over lateral shoulder.
Axillary nerve lesion
Musculocutaneous Nerve
- Motor Functions: Shoulder abduction (deltoid).
- Sensory Area: Lateral shoulder.
Musculocutaneous Nerve lesion
- Weakness in elbow flexion and forearm supination
- sensory loss over lateral forearm.
- Weakness in elbow flexion and forearm supination
- sensory loss over lateral forearm.
Musculocutaneous Nerve lesion
Anterior Interosseous Nerve
- Motor Functions: Flexion of distal thumb and index finger.
- Sensory Area: None.
Anterior Interosseous Nerve lesion
Weak pinch sign (inability to form “OK” sign).
Weak pinch sign
Anterior Interosseous Nerve lesion
Anterior interosseous nerve is a branch of which nerve?
Median nerve
Posterior Interosseous Nerve
- Extends the wrist and fingers (except for the brachioradialis and extensor carpi radialis longus).
- Key muscles: Extensor digitorum, extensor indicis, extensor digiti minimi, extensor carpi ulnaris, extensor pollicis longus/brevis, abductor pollicis longus.
- Sensory Area: None (purely motor nerve).
Clavicle Fracture
- Fall onto affected shoulder
- Pat is supporting arm which is in full adduction
Clavicle Fracture - Classification
- middle third
- lateral third
- medial third
