ILAs/MISC Flashcards
What vaccines are given at 8 weeks old? (9)
Diptheria/Tetanus/Pertussis/Polio/Haemophilus influeunzae type B/Hepatitis B
Pneumococcal (PCV)
Meningococcal group B
Rotavirus gastroenteritis
What vaccines are given at 12 weeks old? (7)
Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B
Rotavirus
What vaccines are given at 16 weeks old? (8)
Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B
Pneumococcal (PCV)
Meningococcal group B
What vaccines are given at 1 year old? (7)
Hib/Meningococcal group C
Pneumococcal (PCV)
Measles, mumps, rubella (MMR)
Meningococcal type B
What vaccines are given at 3 years 4 months? (5)
Diptheria, tetanus, pertussis and polio
MMR
What vaccine is given to girls age 12/13?
Human papillomavirus (HPV)
What is given at 14 years? (7)
Tetanus, diptheria, polio
Meningococcal A C W Y
Other vaccines that may be given? (3)
Paediatric flu vaccine
Tuberculosis if high risk - at birth
Additional pneumococcal/flu/hepatitis vaccines for those with conditions such as diabetes, CKD, haemophilia, immunosuppression, sickle cell
What are developmental milestones? What are the 4 groups?
Acquisition of important developmental skills Gross motor Vision and fine motor Hearing, speech, language Social, emotional, behavioural
What is the moro reflex?
Sudden extension of the head causes symmetrical extension then flexion of the arms
What is the grasp reflex?
Flexion of fingers when object placed in palm
What is the rooting reflex?
Head turns to the stimulus when touched near the mouth
What is the stepping reflex?
Stepping movements when held vertically and dorsum of feet touch a surface
What should a newborn development be?
Limbs flexed, symmetrical posture
Marked head lag on pulling up
Gross motor development? 4 with ages
Head control - 3 months
Sits unsupported - 6-8 months
Stands - 10 months
Walks - 12 months (worrying if not by 18)
Fine motor/vision development? 4 with ages
Fixes and follows - 6 weeks
Reaching - 4 months
Transferring - 7 months
Pincer grip - 10 months
Hearing/speech/language development? 3 with ages
Vocalises alone - 3-4 months
Mama/dada - 6-9 months
3 word sentences - 2 years
Social/behaviour development? 4 with ages
Smiles - 6 weeks
Food in mouth - 6-8 months
Feeds self - 18 months
Interactive play - 3 years
When should a child be able to make a tower of 3-4 bricks?
18 months
When should a child be able to make a tower of 6-8 bricks?
2/2.5 years
When should a child be able to build a brick bridge?
3-3.5 years
When should a child be able to draw a line, circle, square?
Line - 2-2.5
Circle - 3-3.5
Square - 4-5
What 6 things are included in a septic screen?
Bloods (FBC, CRP/ESR, U+E, blood gas) Blood cultures Urine dipstick and MC+S Stool sample Chest X ray Lumbar puncture (protein, glucose, MC+S, gram stain)
What is seen on lumbar puncture in bacterial infection vs viral?
Bacterial - elevated opening pressure, turbid CSF, high WCC, positive gram stain, high protein, low glucose
Viral - normal opening pressure, clear fluid, low WCC, negative gram stain, normal/high protein, normal/low glucose
What does a septic screen screen for?
Severe infection and systemic inflammation
Dose of cefotaxime for meningococcal septicaemia?
2g IV
Diagnosis of Kawasaki disease?
Fever + 4/5 of My HEART Mucosal involvement - lips, mouth Hand/foot redness, swelling, peelin Eye conjunctivitis Adenopathy (lymph) Red rash Temperature >5 days
What is Reye’s syndrome?
Can be caused by aspirin in kids
Brain and liver disease - vomiting, fits, tiredness, confusion
Side effects of IV immunoglobulin?
rare - anaphylaxis
headache, nausea, wheezing/chest tightness
Complications of Kawasaki disease?
CV disease - aneurysm, heart disease, MI
How to work out maintenance fluid dose?
4ml per kilo first 10kg
2ml per kilo second 10kg
1ml per kilo after that
27kg would be 40 + 20 + 7 = 67ml hourly
67 x 24 = 1608ml daily 0.9% sodium chloride
How to correct fluid deficit for dehydration?
Dehydrated - 50mls/kg extra
Shocked - 100mls/kg extra
OVER 24 HOURS
Fluids for a 12kg girl 5% dehydrated?
Maintenance 44ml hourly x24 = 1056ml daily
Dehydrated = 50ml/kg extra over 24 hours
50 x 12 = 600
1056 + 600 = 1656ml
Signs of dehydration in children? (6)
Appears unwell Irritable Decreased urine output Sunken eyes Dry mucous membranes Reduced skin turgor Slightly prolonged cap refill time
Signs of shock? (8)
Decreased level of consciousness Pale/mottled skin Cold extremities Prolonged capillary refill time Hypotension Tachycardia Tachypnoea
What is usual fluid bolus given in dehydration? Exceptions?
20mls/kg 0.9% sodium chloride
If trauma or diabetic ketoacidosis give 10mls/kg
What 9 conditions are in the newborn blood spot screening test?
sickle cell disease (SCD) cystic fibrosis (CF) congenital hypothyroidism (CHT) phenylketonuria (PKU) medium-chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria (pyridoxine unresponsive) (HCU)
Dose of thyroxine for congenital hypothyroidism?
10-15mcg a day per kg
Differentials of a sick neonate?
Trauma, tumour, thermal Heart disease, hypovolaemia, hypoxia Endocrine - CAH, DM, thyroid Metabolic disturbance - electrolytes Inborn errors of metabolism Seizures of CNS metabolism Formula dilution or over concentration leading to hypo/hypernatraemia Intestinal catastrophe (NEC, volvulus, intussusception) Toxins Sepsis
Can congenital adrenal hyperplasia be treated antenatally?
Give dexamethasone to reduce virilisation
Biochemical presentation of a salt losing crisis?Management?
LOW SODIUM HIGH POTASSIUM
METABOLIC ACIDOSIS
Saline, dextrose, hydrocortisone IV
Management of CAH?
Hydrocortisone lifelong (glucocorticoid), additional if illness or injury Fludrocortisone (mineralocorticoid) if salt wasting
Characteristics of respiratory acidosis on ABG?
Low pH
High CO2
Causes of respiratory acidosis?
Respiratory depression
Asthma
COPD
Characteristics of respiratory alkalosis ABG?
High pH
Low CO2
Causes of respiratory alkalosis?
Hyperventilation - pain, anxiety, hypoxia
Characteristics of metabolic acidosis on ABG?
Low pH
Low HCO3
Low base excess
Causes of metabolic acidosis?
Increased acid production - diabetic ketoacidosis Decreased acid excretion - addisons disease
Loss of HCO3 - diarrhoea
Characteristics of metabolic alkalosis on ABG?
High pH
High HCO3
High base excess
Causes of metabolic alkalosis?
Vomiting/diarrhoes
Renal loss - diuretics, heart failure
How are respiratory acidosis/alkalosis compensated?
Metabolically - by increasing or decreasing the levels of bicarb to correct pH
How are metabolic acidosis/alkalosis compensated?
Respiratory - retaining or blowing of CO2 to correct pH
What would respiratory acidosis with metabolic compensation look like on ABG?
Low pH
High CO2
High HCO3!
What would respiratory alkalosis with metabolic compensation look like on ABG?
High pH
Low CO2
Low HCO3!
What would metabolic acidosis with respiratory compensation look like on ABG?
Low pH
Low HCO3
Low CO2!
What would metabolic alkalosis with respiratory compensation look like on ABG?
High pH
High HCO3
High CO2!
Murmur in ASD?
EJECTION SYSTOLIC murmur UPPER LEFT sternal edge
Murmur in VSD?
Harsh PANSYSTOLIC murmur LOWER left sternal edge
Murmur in PDA?
CONTINUOUS murmur UPPER left sternal edge
How is RDS managed?
Surfactant through TRACHEAL TUBE
Airway + breathing - clear if needed, high flow humidified oxygen/CPAP/mechanical ventilation
Incubator
Neonatal antibiotics for suspected infection?
Benzylpenicillin and gentamicin
Why do preterm infants get hypoglycaemia and how is it managed?
Poor glycogen stores
Prevention - early frequent milk feeding
Dextrose IV given
NG feeding
Risk of building up fluids too quickly in neonates?
NEC! reflux, aspiration
How is adequacy of nutrition monitored in paeds?
Input/output fluid chart
Weight
Where does IVH originate from in babies?
IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus.
How does IVH present?
Diminished/absent Moro reflex. Poor muscle tone. Sleepiness. Lethargy. Apnoea. Tense/bulging fontanelle Premature babies often show sudden deterioration on day two or three, with periods of apnoea, pallor or cyanosis, failure to suck properly, abnormal eye signs, shrill cry, twitching or convulsions, reduced muscle tone or paralysis
What abnormality seen on ABG in IVH?
Metabolic acidosis
Management of IVH?
Supportive - fluids, blooc, bicarb infusion
Anticonvulsants
Prevention - vitamin K at birth
Prognosis of IVH?
25-50% may die if severe
15% need permanent CSF shunt
Motor and cognitive defects, neurodevelopmental delay
Cause for concern with neonatal jaundice >2 weeks?
dark urine, pale stools
hepatomegaly
poor weight gain
What is the direct coombs test?
The direct Coombs test is used to test for autoimmune hemolytic anemia—that is, a condition where the immune system breaks down red blood cells, leading to anemia
The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells
What is the indirect coombs test?
The indirect Coombs test is used in prenatal testing of pregnant women and in testing prior to a blood transfusion. The test detects antibodies against foreign red blood cells
Pain relief for neonates?
Paracetamol, morphine
What does the NIPE test? When is it done?
Newborn infant physical examination, done within 72hrs and AGAIN at 6-8 weeks
Eyes i.e. congenital cataracts
Heart
Hips i.e. developmental dysplasia of the hip
Testes i.e. undescended
What are Barlows and Ortolanis tests?
Barlows - If the hip is dislocatable — that is, if the hip can be popped out of socket with this maneuver — the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated) by hearing a ‘thunk’ as it goes back in
Vascular causes of unilateral visual loss?
Amaurosis fugax Central retinal artery occlusion/retinal detachment GCA Optic neuritis Vitreous haemorrhag
What is optic neuritis?
Inflammation of optic nerve, may be first manifestation of MS.
Reduced visual acuity over a few days, pain on moving eye
Exacerbated by heat/exercise
Afferent pupillary defect
What is Lhermitte’s phenomenon?
Tingling ‘electrical’ sensation down spine, esp. when bending head forward
Differential diagnosis of blackouts?
Syncope
Epilepsy
Non epileptic attacks
What is syncope?
Syncope is an abrupt and transient loss of consciousness associated with loss of postural tone that follows a sudden fall in cerebral perfusion
Causes of syncope?
Neurogenic - vasovagal, reflex i.e. cough/micturition
Cardiac - arrhythmias, valvular disease
Orthostatic - prolonged standing, heat, dehydration
Why do focal onset seizures need imaging?
More likely to be a structural problem
What are you looking for in JME on interictal EEG?
Normal background
Frequent polyspike and wave discharges
3 vascular territories in stroke
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
4 clinical syndromes in stroke
Total anterior circulation infarct TACI
Partial anterior circulation infarct PACI
Lacunar stroke
Posterior circulation infarct
Benefits of thrombolysis (alteplase) in stroke?
If within 4.5 hours of ISCHAEMIC strokes, improves chance of independence
Risk of death the same
When is risk of stroke after TIA highest?
First 48 hours
Which personality disorders predispose to psychosis?
Paranoid PD Schizotypal PD (social deficit, magical beliefs etc)
What can borderline PDs progress to?
Bipolar
What can obsessive PDs progress to?
OCD
What is attachment theory?
Deep, enduring bond connecting one person to another across time and space
Child seeks attachment figure when upset
Early infant separation/neglect links to later maladjustment i.e. fear of abandonment, disproportionate overreactions to change in routine etc
What is a biopsychosocial formulation?
Predisposing
Precipitating
Prolonging
Protective
factors of biological, psychological and social aspect of the patient to form a diagnosis/management
What is asked about in psych history?
Presenting complaint History of PC Collateral history Past psych history Medical history Drugs and allergies Family history Social history - substance misuse, work, housing Personal history - birth, childhood and school, relationships etc Forensic history Premorbid personality
Mental state exam components?
Appearance and behaviour Mood and affect Speech - tone/rate/volume, circumstantiality/perserveration etc, flight of ideas Thoughts - obsessions, delusions, dissociation Perceptions - hallucinations, illusions Cognition Insight RISK
What gene is mutated in Fragile X ?
FMR1 on X chromosome
How to work out alcohol units?
Units = vol in litres x ABV%
What is the main inhibitory and excitatory neurotransmitter?
Inhibitory - GABA
Excitatory - glutamate
How does alcohol affect GABA/glutamate?
Enhances GABA which is inhibitory
Inhibits glutamate which is excitatory - that’s why withdrawal is agitated
benzodiazepines have same effect so give in withdrawal
3 medications to help alcohol abstinence?
Disulfiram
Acamprosate
Naltrexone
MASER features for bipolar?
Mood Attention Self esteem Energy Risk
Causes of hyponatraemia?
Renal failure Diuretics Water loss Heart failure Nephrotic syndrome
Symptoms of hyponatraemia?
Confusion Seizures Cardiac failure Oedema Nausea D+V
Causes of hypernatraemia?
Not enough water
Diuretics
Diabetes insipidus
Symptoms of hypernatraemia?
Thirst Confusion Seizures Coma Signs of dehydration
Causes of hypokalaemia?
Thiazide/loop diuretics
Cushings
D+V
Poor intake
Symptoms of hypokalaemia?
Muscle weakness - rhabdomyolysis
Arrhythmias
Constipation
Paralysis, paraesthesia late
Causes of hyperkalaemia?
Decreased renal excretion
Potassium sparing diuretics
Symptoms of hyperkalaemia?
First nothing Weakness Paralysis Heart arrhythmias SoB, death
Causes of hypocalcaemia?
Para/thyroid surgery Chronic renal failure Pancreatitis Respiratory alkalosis Osteomalacia
Symptoms of hypocalcaemia?
Tetany
Depression
Neuromuscular excitability - - muscle twitching
Causes of hypercalcaemia?
Hyperparathyroidism
Cancer
Lithium use
Symptoms of hypercalcaemia?
Bones - pain, fractures Stones - renal stones Groans - confused Thrones - constipation Psychic moans - depression
How often is breast screening done?
Mammograms every 3 years from age 50 to 70 (trial of 47-73)
What is cervical screening?
Checks for cervical intraepithelial neoplasia (CIN) - precancerous dysplasia using a brush to collect cells
How often is cervical screening done?
aged 25 to 49 – every 3 years
aged 50 to 64 – every 5 years
over 65 – only women who have recently had abnormal tests
What does the infectious diseases programme in pregnancy screen for?
HIV
Syphilis
Hepatitis B
What is the combined test for Downs/Edwards/Patau? When is it done?
Nuchal translucency at dating scan
Serum b-HCG
Pregnancy associated plasma protein A (PAPP-A)
Between 11-13+6 weeks
What is quadruple maternal serum screening for Downs? When is it done?
hCG
alpha fetoprotein
uE3
inhibin A
14-20 weeks
How is screening for Edwards/Patau done if over 14 weeks?
Mid pregnancy anomaly scan 18-20+6 weeks
What condition does the mid pregnancy scan look for? (11)
anencephaly open spina bifida cleft lip diaphragmatic hernia gastrochisis exomphalos serious cardiac abnormalities bilateral renal agenesis lethal skeletal dysplasia Edwards' syndrome, or T18 Patau's syndrome, or T13
How gets tested for gestational diabetes?
Any woman with 1 or more risk factors - BMI above 30, previous baby over 4.5kg, prev gestational diabetes, parent/sibling with diabetes, south asian
When is OGTT done?
women who’ve previously had gestational diabetes: oral glucose tolerance test (OGTT) should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.
women with any of the other risk factors should be offered an OGTT at 24-28 weeks
When is booking visit? What is done?
8-12 weeks
General info about lifestyle, BMI
Bloods - HIV, syphilis, hep B, haemoglobinopathies, rhesus status, anaemia, red cell antibodies
urine dipstick
When is first dating scan?
10-13+6
When is anti-D given for rhesus negative women?
First - 28 weeks
Second - 34 weeks
Whenever sensitisation i.e. bleeding, amniocentesis
Describe the HPG axis
Hypothalamus produces gonadotrophin releasing hormone
Anterior pituitary releases follicle stimulating and luteinising hormones
Ovary releases oestrogen
What part of the embryo is the urogenital system from?
Intermediate mesoderm
Genital system develops from gonadal ridges from primordial germ cells
What is the SRY gene?
SRY gene induces testes development, lack of results in ovaries
What is the Mullerian duct?
Develops into uterus, fallopian tubes and upper vagina
Wolffian duct regresses
Investigations of amenorrhoea?
Hormone tests - bhcG, FSH, LH, prolactin, thyroid, testosterone
Chomosome analysis
US pelvis
CT/MRI head
Treatment of amenorrhoea?
Surgery if treatable congenital anomaly
Weight loss/stop exercising as much/less stress
Gonadal dysgenesis/pof - HRT
PCOS - treat i.e. with the pill
High prolactin - dopamine agonists
Cervical stenosis/Ashermans - surgery to remove adhesions
Causes of acute pelvic pain?
Menstruation/ovulation Sex PID UTI Miscarriage/ectopic Torsion/cyst rupture Premature labour/placental abruption/uterine rupture Fibroids, pelvic tumour Appendicitis, IBS
Assessment of pelvic pain?
Acute - urinalysis, MSU, high vaginal and endocervical swabs, pregnancy test, USS if suspected ectopic
Chronic - STI screen, Ca125, urinalysis, transvaginal USS, laparoscopy
Management of pelvic pain? (3)
Pain relief
COCP/GnRH agonist if cyclical
Diagnostic laparoscopy
Favourable position for normal vaginal delivery?
Occipito-anterior
Normal head position at engagement?
Occipito-transverse
Lie with increased risk of cord prolapse?
Footling breech
Symptoms of primary and secondary post partum haemorrhage?
Primary - blood loss, collapse, enlarged uterus, trauma
Secondary - blood loss, enlarged uterus, tender, open internal os
What are the 4 T’s of post partum haemorrhage?
Tone
Trauma
Tissue
Thrombus
Definition of low birth weight?
2.499kg or less
Less than 10th centile
Define IUGR
Fetuses failing to reach their OWN growth potential (not just constitutionally small as in sfd, may not even be small)
May be related to placental dysfunction
What is fetal macrosomia? Causes?
Baby over 4kg at birth
Caused by maternal diabetes, prolonged pregnancy, excessive weight gain
Risks of macrosomic babies?
Shoulder dystocia Obstructed labour Instrumental/c section PPH Hypoglycaemia - RDS (breastfeed)
Risks of IUGR babies?
Stillbirth Cerebral palsy Preterm delivery Convulsions Meconium aspiration
Why should you not give ACEi with NSAIDs?
High risk of renal failure
community support for heart failure?
GP and specialist centres community nurses, home visits Social care palliative care rehabilitation patient groups pharmacy deliveries
What is Qrisk score?
Score for predicting cardiovascular risk - risk of a person developing CVD over next 10 years for people between 35 and 74
At risk groups to miss vaccinations?
Looked after children Children with physical/learning difficulties Children of single or teenage parents Not registered with GP In hospital Travellers, asylum seekers
Signs of respiratory distress in children?
Nasal flaring Accessory muscles use Stridor, wheeze Tracheal tug Chest recession
Red light NICE indicators for a sick child?
Pale/mottled/blue No response, appears ill High pitched cry Grunting Tachypnoea >60 Chest recession Reduced skin turgor Bulging fontanelle Non blanching rash Stiff neck Seizures AGE 3 MONTHS TEMP >39 FEVER >5 days
What 3 things are needed for consent?
Voluntarily
By an individual with capacity
Fully informed
When can confidentiality be breached?
With consent
If clinically relevant/needed
Risk to patient or someone else
Health risk to others - DVLA
What are the Fraser guidelines regarding contraception under 16? UPSSI
Understanding of advice
Parents will not be informed despite asking
Sex will continue either way
Suffering mentally/physically if no treatment given
In her best interest
Tools for dementia screening in primary care?
Mini mental state examination
GP-COG
6-CIT
Depression screening tool?
PHQ-9
Risk factors for TB?
HIV/immunosuppression Diabetes Malnutrition Smoking Alcohol Overcrowding Low socioeconomic status
Prevention of TB?
BCH vaccine for high risk newborns Symptom education Medication education Contact tracing Limit overcrowding
Symptoms of TB?
Weight loss Fever Night sweats Fatigue Cough - phlegm/blood Breathlessness If disseminated - abdo pain, bone pain, headache
Causative agent in TB?
Mycobacterium tuberculosis
Treatment of TB?
Isioniazid
Rifampicin
Pyrazinamide
Ethambutol
