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MRCPCH > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

What is the investigation of choice to confirm a microbiological diagnosis of TB infection?

A

Gastric washings on 3 consecutive mornings for microscopy for acid and alkaline fast bacilli and a culture of mycobacterium tuberculosis

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2
Q

BCG induration of >15mm is considered positive in who?

A

Individuals who have no known risk factors for TB, including those with previous BCG vaccination

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3
Q

BCG induration of >10mm is considered positive in who?

A

Recent migrants from high risk areas
Children <4 years old
IVDU

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4
Q

BCG induration of >5mm is considered positive in who?

A

HIV infected individuals
A recent contact of an individual w/ TB
Individuals w/ fibrotic changes on CXR consistent with previous TB
Patients who have undergone organ transplants
Individuals who are immunosuppressed for other reasons

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5
Q

What is the mainstay of treatment in autoimmune encephalitis?

A

IV Immunglobulins
IV corticosteroids
Plasma Exchange

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6
Q

Which EEG changes are suggestive of Encephalopathy?

A

High voltage rhythmic slow wave activity with prominent spikes in the left parietal region

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7
Q

How long should treatment be continued in the management of iron deficiency anaemia?

A

Until at least 3 months after the Hb level reaches the normal value for that age

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8
Q

How do you calculate PO morphine dosing in palliative patients?

A

Add up the total amount of oramorph used in 24 hours and increase by 25-30%, then divide this into 2 doses

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9
Q

How is breakthrough analgesia dosing calculated?

A

Take the amount of opioid used in the previous 24 hours and then give one sixth of this for breakthrough pain

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10
Q

What is the biggest side effect of methylphenidate?

A

Decreased appetite and weight loss
Reduced height velocity

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11
Q

What is the mechanism of action of Methylphenidate?

A

Acts by increasing dopamine levels in the frontal lobe

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12
Q

How does TCA overdose present?

A

Metabolic acidosis with or without respiratory compensation

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13
Q

How does aspirin overdose present?

A

Mixed metabolic acidosis and respiratory alkalosis

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14
Q

How does opiate overdose present?

A

Respiratory depression causing a respiratory acidosis

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15
Q

Scurvy is a deficiency of what?

A

Ascorbic Acid

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16
Q

What are the symptoms of scurvy?

A

Deficiency of ascorbic acid results in a fragility of the capillary walls resulting in petechiae in the skin, mucosa and subperiosteal haemorrhages in bones

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17
Q

What is a possible cause of worsening respiratory symptoms in patients with CF?

A

Aspergillosis

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18
Q

What is the treatment of choice for IIH?

A

Acetazolamide

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19
Q

What are the CXR findings in Pneumocystis Jerovecii?

A

Classically bilateral interstitial andWh alveolar shadowing (may also be normal)

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20
Q

What are the investigations of choice in Hirschsprungs Disease?

A

Bariam Enema
Rectal suction biopsy

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21
Q

Which condition presents with a history of painless blistering on hands and feet which starts when crawling?

A

Epidermolysis Bullosa Simplex

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22
Q

Which layer of the skin does Epidermolysis Bullosa affect?

A

Intraepidermal

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23
Q

Which layer of the skin is affected in Dystrophic Epidermolysis Bullosa?

A

Uppermost dermis - babies are described as butterfly babies because their skin in so fragile

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24
Q

What are the side effects of Amphotericin B?

A

Hypomagnesaemia
Hypokalaemia

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25
Q

Describe the formal visual assessments in children of different ages?

A

4 weeks - visual evoked potentials
6 weeks - optokinetic nystagmus
3 months - fixes and follows
10 months - identifies and picks up small objects
2-3 years - identification of miniature toys at 3m
3-4 years - optotype matching
5 years - snellen chart

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26
Q

What is the investigation of choice for brainstem death testing?

A

Clinical diagnosis

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27
Q

What is the investigation of choice for Chlamydia in boys?

A

First-catch urine sampling for NAAT testing

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28
Q

Delayed cord separation and multiple skin abscesses?

A

Leucocyte Adhesion Deficiency (Established by testing flow cytometry for CD11b)

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29
Q

What are the ECG findings in WPW syndrome?

A

Short PR interval
Delta Waves (specifically in lead II)
Broad QRS complex

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30
Q

What are the symptoms of Phenytoin Toxicity>

A

CNS dysfunction - nystagmus, diplopia, ataxia, slurred speech

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31
Q

When assessing limb BP, what difference in mmHg is significant?

A

20mmHg

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32
Q

How long should be left before giving a live vaccination to immunosuppressed patients?

A

3 months following stopping oral steroids
6 months following chemotherapy or radiotherapy

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33
Q

Which organism causes a rapid deterioration in respiratory symptoms in patients with CF?

A

Burkholderia Cepacia

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34
Q

What is the treatment for B. Cepacia in patients with CF?

A

Ceftazidime and Aminoglycoside

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35
Q

What is the classical presentation of Wilson’s disease?

A

Pyschiatric (depression/ neurotic behaviour)
Neurological (extrapyramidal symptoms)
Hepatic (elevated transaminases/ asymptomatic hepatomegaly)

36
Q

Saddle shaped nose =

A

Fetal alcohol syndrome

37
Q

What are the features of Smith-Lemli-Opitz syndrome?

A

Microcephaly
Low set ears
Ptosis
Micrognathia
Synodactyli
Hypospadias

38
Q

What is the recommended investigation for SMA type 1?

A

Molecular genetic testing with targeted mutation analysis for SMN1 gene

39
Q

Which condition is characterised by a herald patch (oval, pink rash with collarette of scales)?

A

Pityriasis Rosea

40
Q

What are the exclusion criteria for slapped cheek disease (Parvovirus B19)?

A

Avoid pregnant women
Exclusion is ineffective because patients are infectious during the prodrome
Notification is not necessary

41
Q

What is the investigation of choice for Pertussis?

A

Pernasal swab

42
Q

What criteria would suggest a diagnosis of Diabetes Insipidus?

A

Urine osmolality < 300
Serum osmolality > 300

43
Q

What are the possible complications of Neurofibromatosis Type 1?

A

Eyes: Glaucoma, Hamartomas
Neurological: Learning difficulties, spinal compression
Predisposition to tumours: Astrocytomas, phaeochromacytoma, Wilm’s tumours
Renal artery stenosis leading to hypertension

44
Q

Diarrhoea with high temperatures, relative bradycardia and rose spots on chest and abdomen?

A

Salmonella

45
Q

What is renal genesis?

A

A condition in which one or both of the kidneys fail to develop

46
Q

Which medications can cause drug induced aplastic anaemia?

A

Phenytoin
Chloramphemicol
Gold
Phenylbutazone

47
Q

What is the treatment for listeria (gram positive bacillus)?

A

Ampicillin - should be suspected in a neonate with meconium stained liquor

48
Q

What are second line antibiotics in neonates?

A

Vancomycin and Gentamicin

49
Q

William’s,syndrome is associated with which cardiac conditions?

A

Supravalvular Aortic Stenosis
Peripheral pulmonary stenosis

50
Q

Melanosis Coli is seen in which type of laxative abuse?

A

Senna abuse

51
Q

What blood levels should be checked in patients on IVIG replacement?

A

Liver function
Trough Immunoglobulin levels
Hepatitis C status

52
Q

What are the diagnostic criteria for cystic fibrosis?

A

Sweat test result with chloride levels >60
Neonatal serum IRT >900 (Guthrie test)
Stool elastase levels (normal is >200)

53
Q

IgA nephropathy presents how many days following viral URTI?

A

2-3 days

54
Q

How many days post URTI does Post-streptococcal GN present?

A

1-2 weeks

55
Q

What is the treatment for Neiserria Meningitidis?

A

Ceftriaxone
Cefotaxime (if patient is on TPN/ calcium infusions)

56
Q

Presents with acute encephalopathy with hepatic involvement?

A

Reye’s Syndrome

57
Q

What are the main side effects of methotrexate?

A

Mucositis
Hepatotoxicity
Myelosuppression
Pulmonary Fibrosis

58
Q

Pyridoxine deficiency features?

A

Often caused by B6 deficiency
Typically causes seizures which are unresponsive to anti-epileptic medications

59
Q

What is beri-beri syndrome a deficiency of?

A

Thiamine

60
Q

What are the symptoms of Beri-Beri disease?

A

Irritability
Vomiting
Seizures
Endemic in Indonesian

61
Q

Lyme disease can present as ??

A

Meningitis

62
Q

What is the investigation of choice for patients with hereditary angioedema?

A

C1 Inhibitor levels
C4 complement levels

63
Q

Which age group is Pneumococcal Conjugate vaccine given in?

A

Under 2 years

64
Q

Which age group is Pneumococcal polysaccharide vaccination given in?

A

Over 2 years

65
Q

What are the features of Still’s disease aka systemic juvenile idiopathic arthritis?

A

Arthralgia/ Arthritis
High fever that often occurs in the evening
Serositis
Fleeting salmon coloured, macular rash
Anaemia
Elevated acute phase reactants

66
Q

Which conditions can cause renal complications despite renal transplantation?

A

Alport’s syndrome
HUS
HSP
Cystinosis
Nephrotic syndrome
IgA Nephropathy

67
Q

Which rash typically consists of multiple target lesions?

A

Erythema Multiforme

68
Q

Which condition is erythema multiform associated with?

A

Mycoplasma

69
Q

What are the possible causes of mixed upper and lower motor neurone signs?

A

Fredreich’s Ataxia
MND
Vitamin B12 deficiency

70
Q

What is the first line anti-convulsant choice in neonates?

A

Phenobarbital

71
Q

Prolonged QTc and associated sensorineural deafness?

A

Jervell-Lange-Neilson

72
Q

What is Haptoglobin?

A

Haptoglobin is a protein present in the bloodstream which binds to free Hb and removes it from the bloodstream

73
Q

What are the haematological findings during the acute phase of haemolysis in G6PD?

A

Decreased haptoglobin
Increased plasma methaeme albumin
Haemoglobinuria
Heinz bodies present (denatured haemoglobin and are seen in acute haemolysis)

74
Q

What are the criteria for diagnosis of NF1?

A

Six or more cafe-au-lait spots (>5mm pre-pubertal, >15mm post-pubertal)
Two or more neurofibromas
Axillary or inguinal freckling
Optic pathway glioma
Two or more lisch nodules
Osseous lesions (thinning of the cortex of long bones, sphenoid dysplasia)
1st degree relative with NF1

75
Q

What are the features of Galactoassaemia?

A

Oil drop cataracts
Neonatal conjugated jaundice
Proximal renal tubular acidosis
Hepatomegaly
Hypoglycaemia

76
Q

What do oil drop cataracts signify?

A

Galactoassaemia

77
Q

What is the diagnostic investigation of choice for galactosaemia?

A

Red cell enzyme levels

78
Q

What is posterior fossa syndrome?

A

Dysarthria + Emotional Lability + Ataxia + Mutism

79
Q

What is the treatment of choice for Pertussis?

A

Azithromycin

80
Q

What are the features of Cystinosis?

A

Deposition of cysteine in the eyes, kidneys and thyroid gland - causing retinitis pigmentosa, hypothyroidism and renal tubular acidosis (hyperchloraemic metabolic acidosis) + polyuria and polydipsia

81
Q

What is the treatment of choice for Hypoplastic left heart syndrome?

A

Norwood Procedure

82
Q

What are the investigations of choice for post-varicella cerebellitis?

A

MRI head
LP

83
Q

What is Reye syndrome?

A

Triad of encephalopathy, fatty liver degeneration and elevated transaminases in the post-infectious period, often associated with aspirin ingestion

84
Q

What are the classical findings on blood gas of pyloric stenosis?

A

Hypochloraemic hypokalaemia metabolic alkalosis

85
Q

Which conditions are coloboma seen in?

A

CHARGE syndrome
Rubenstein-Taybi Syndrome
Trisomy 13
Goldenhar Syndrome

MRCPCH (14 decks)

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