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MSRA clinical bits Flashcards

1
Q

Neonatal blood spot screening

A

-congenital hypothyroidism
-cystic fibrosis
-sickle cell disease
-phenylketonuria
-medium chain acyl-CoA dehydrogenase deficiency
-Maple syrup urine disease
-isovaleric acidaemia
-glutair aciduria type 1
-homocystinuria (pyridoxine unresponsive)

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2
Q

4 months immunisations:

A

-‘6-1 vaccine’ (diptheria, tetanus, whooping cough, polio, Hib and hepatitis B)
-PCV
-Men B

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3
Q

Speech and hearing milestones - 3 months

A

-Quietens to parents voice
-Turns toward sound
-Squeals

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4
Q

Speech and hearing milestones - 6 months

A

-Double syllables ‘adah’ ‘eleh’

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5
Q

Speech and hearing milestones - 9 months

A

-Says ‘mama’ and ‘dada’
-Understands ‘no’

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6
Q

Speech and hearing milestones - 12 months

A

-Knows and responds to own name

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7
Q

Speech and hearing milestones - 12-15 months

A

-Knows about 2-6 words (Refer at 18 months)
-Understands simple commands - ‘give it to mummy’

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8
Q

Speech and hearing milestones - 2 years

A

-Combine two words
-Points to parts of the body

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9
Q

Speech and hearing milestones - 2 1/2 years

A

-Vocabulary of 200 words

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10
Q

Speech and hearing milestones - 3 years

A
  • Talks in short sentences
    -Asks what and who questions
    -Identifies colours
    -Counts to 10
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11
Q

Speech and hearing milestones - 4 years

A

-Asks ‘why’, ‘when’ and ‘how’ questions

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12
Q

Gross motor milestones - 3 months

A

-No head lag on pulled to sit
-Good head control on abdomen
-Lumbar curve

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13
Q

Gross motor milestones - 6 months

A

-Arms extended in abdomen
-Grasps feet on back
-Pulls self to sitting
-Back straight sitting
-Rolls front to back

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14
Q

Gross milestones - 7-8 months

A

Sits without support (refer at 12 months)

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15
Q

Gross motor milestones - 9 months

A

-Pulls to standing
-Crawls

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16
Q

Gross motor milestones - 12 months

A

-Cruises
-Walks with one hand held

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17
Q

Gross motor milestones - 13-15 months

A

-Walks unsupported (refer at 18 months)

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18
Q

Gross motor milestones - 18 months

A

-Squats

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19
Q

Gross motor milestones - 2 years

A
  • Runs
    -Up and down stairs with rail
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20
Q

Gross motor milestones - 3 years

A

-Tricycle using pedals
-Stairs without rail

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21
Q

Gross motor milestones - 4 years

A

Hops on one leg

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22
Q

Inheritence - Homocystinuria

A

Autosomal Recessive

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23
Q

Patau syndrome

A

Trisomy 13

-Microcephalic, small eyes
-Cleft lip/palate
-Polydactyly
-Scalp lesions

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24
Q

Edward’s syndrome

A

Trisomy 18

-Micrognathia
-Low-set ears
-Rocker bottom geet
-Overlapping fingers

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25
Q

Fine motor and vision - 3 months

A

-Reaches for object + holds briefly if given

-Sees faces + fixes through 180 degrees

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26
Q

Fine motor and vision - 6 months

A

-Palmar grasp + passes hand to hand

-Looks every direction

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27
Q

Fine motor and vision - 9 months

A

-Points with finger
-Early pincer

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28
Q

Fine motor and vision - 12 months

A

-Good pincer grip
-Bangs toys together

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29
Q

Bricks milestones

A

15 months - Tower of 2

18 months - Tower of 3

2 years - Tower of 6

3 years - Tower of 9

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30
Q

Drawing milestones

A

18 months - Circular scribble

2 years - Copies vertical line

3 years - Copies circle

4 years - Copies cross

5 years - Copies square and triangle

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31
Q

Book milestones

A

15 months - Looks at book, pats page

18 months - Turns pages, several at time

2 years - Turns pages, one at time

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32
Q

Suspected meningococcal septicaemia in community - <1 year old

A

IM benzylpenicillin 300mg

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33
Q

Suspected meningococcal septicaemia in community - 1-10 years old

A

IM benzylpenicillin 600mg

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34
Q

Suspected meningococcal septicaemia in community - >10 year old

A

IM benzylpenicillin 1200mg

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35
Q

Fragile X

A

-Learning difficulties
-Macrocephaly
-Long face
-Large ears
-Macro-orchidism

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36
Q

Noonan syndrome

A

-Webbed neck
-Pectus excavatum
-Short stature
-Pulmonary stenosis

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37
Q

Pierre-Robin Syndrome

A

-Micrognathia
-Posterior displacement of the tongue (may result in upper airway obstruction)
-Cleft palate

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38
Q

Prader-Willi syndrome

A

-Hypotonia
-Hypogonadism
-Obesity

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39
Q

William’s syndrome

A

-Short stature
-Learning difficulties
-Friendly, extrovert personality
-Transient neonatal hypercalcaemia
-Supravalvular aortic stenosis

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40
Q

Cri du chat synrome

A

(chromosome 5p deletion syndrome)

-Characteristic cry
-Feeding difficulty + poor weight gain
-Learning difficulties
-Microcephaly and micrognathism
-Hypertelorism

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41
Q

Paediatric normal heart rate

A

< 1 110 - 160
1-2 100 - 150
2-5 90 - 140
5-12 80 - 120
>12 60 - 100

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42
Q

Paediatric normal respiratory rate

A

<1 30 - 40
1-2 25 - 35
2-5 25 - 30
5-12 20 - 25
>12 15 - 20

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43
Q

Down’s syndrome risk - maternal rage 20

A

1 in 1,500

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44
Q

Down’s syndrome risk - maternal rage 30

A

1 in 800

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45
Q

Down’s syndrome risk - maternal rage 35

A

1 in 270

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46
Q

Down’s syndrome risk - maternal rage 40

A

1 in 100

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47
Q

Down’s syndrome risk - maternal rage 45

A

1 in 50 or greater

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48
Q

Hearing testing: newborn/infant

A

Otoacoustic emission test for all newborns (Newborn Hearing Screening Programme)

Auditory Brainstem Response test - if otoacoustic emission test abnormal

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49
Q

Hearing testing 6-9 months

A

Distraction test

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50
Q

Hearing testing 18m - 2.5y

A

Recognition of familiar objects

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51
Q

Hearing testing >2.5 years

A

Performance testing

Speech discrimination tests (similar sounding words)

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52
Q

Hearing testing >3 years

A

Pure tone audiometry - at school entry

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53
Q

Trinucleotide repeat disorders

A

-Fragile X
-Huntington’s
-myotonic dystrophy
-Friedreich’s ataxia
-spinocerebellar ataxia
-spinobulbar muscular atrophy
-dentatorubral pallidoluysian atrophy

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54
Q

Opthalmia neonatorum: typical organisms

A

Chlamydia trachomatis - days 1-5

Neisseria gonorrhoea - day 3-2 weeks

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55
Q

Measles

A

-Prodrome: irritable, conjunctivitis, fever

-Koplik spots

-Rash behind ears > whole body.
-Discrete maculopapular > confluent blotchy

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56
Q

Mumps

A

-Fever, malaise, myalgia

-Parotitis: unilateral to bilateral

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57
Q

Rubella

A

-Maculopapular rash starts on face > whole body > fades day 3-5
-Suboccipital and postauricular lymphadenopathy

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58
Q

Erythema infectiosum

A

“Fifth Disease/Slapped-Cheel”

Parvovirus B19

Lethargy, fever, headache

Slapped-cheek rash, spread to proximal arms and extensors

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59
Q

Scarlet fever

A

Toxins from Group A haemolytic strep

Fever, malaise, tonsillitis, strawberry tongue

Fine punctate rash with circumoral pallor

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60
Q

Hand, foot and mouth

A

Coxsackie A16

Sore throat, fever, vesicles in mouth/palms/soles

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61
Q

Chickenpox

A

Fever initially

Itchy rash: head/trunk and spreads.

Macular > papular > vesicular.

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62
Q

Colour - Green

A

Normal colour

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63
Q

Colour - Amber

A

Pallor reported by parent/carer

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64
Q

Colour - Red

A

Pale/mottled/ashen/blue

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65
Q

Activity - Green

A

-Responds normally to social cues

-Conent/smiles

-Stays awake/awakens quickly

-Stron normal cry/not crying

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66
Q

Albinism

A

Autosomal Recessive

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67
Q

Ataxic telangiectasia

A

Autosomal Recessive

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68
Q

Congenital adrenal hyperplasia

A

Autosomal Recessive

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69
Q

Cystic fibrosis

A

Autosomal Recessive

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70
Q

Cytsinuria

A

Autosomal Recessive

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71
Q

Familial Mediterranean Fever

A

Autosomal Recessive

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72
Q

Fanconi anaemia

A

Autosomal Recessive

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73
Q

Friedreich’s ataxia

A

Autosomal Recessive

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74
Q

Glycogen storage disease

A

Autosomal Recessive

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75
Q

Haemochromatosis

A

Autosomal Recessive

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76
Q

Homocystinuria

A

Autosomal Recessive

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77
Q

Lipid storage disease: Tay’Sach’s, Gaucher, Niemann-Pick

A

Autosomal Recessive

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78
Q

Mucopolysaccharidoses: Hurler’s

A

Autosomal Recessive

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79
Q

PKU

A

Autosomal Recessive

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80
Q

Sickle cell anaemia

A

Autosomal Recessive

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81
Q

Thalassaemias

A

Autosomal Recessive

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82
Q

Wilson’s disease

A

Autosomal Recessive

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83
Q

Achondroplasia

A

Autosomal Dominant

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84
Q

Acute intermittent porphyria

A

Autosomal Dominant

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85
Q

Adult polycystic disease

A

Autosomal Dominant

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86
Q

Antithrombin III deficiency

A

Autosomal Dominant

87
Q

Ehlers-Danlos syndrome

A

Autosomal Dominant

88
Q

Familial adenomatous polyposis

A

Autosomal Dominant

89
Q

Hereditary haemorrhagic telangiectasia

A

Autosomal Dominant

90
Q

Hereditary spherocytosis

A

Autosomal Dominant

91
Q

Hereditary non-polyposis colorectal carcinoma

A

Autosomal Dominant

92
Q

Huntington’s

A

Autosomal Dominant

93
Q

Hyperlipidaemia type II

A

Autosomal Dominant

94
Q

Hypokalaemic periodic paralysis

A

Autosomal Dominant

95
Q

Malignant hyperthermia

A

Autosomal Dominant

96
Q

Marfan’s

A

Autosomal Dominant

97
Q

Myotonic dystrophy

A

Autosomal Dominant

98
Q

Neurofibromatosis

A

Autosomal Dominant

99
Q

Noonan syndrome

A

Autosomal Dominant

100
Q

Osteogenesis imperfecta

A

Autosomal Dominant

101
Q

Peutz-Jegher’s

A

Autosomal Dominant

102
Q

Retinoblastoma

A

Autosomal Dominant

103
Q

Romano-Ward syndrome

A

Autosomal Dominant

104
Q

Tuberous sclerosis

A

Autosomal Dominant

105
Q

Von Hippel-Lindau

A

Autosomal Dominant

106
Q

Von Willebrand’s disease

A

Autosomal Dominant*

107
Q

Gilbert’s syndrome

A

Autosomal Recessive*

108
Q

Activity - Amber

A

-Not responding normally to social cues

-No smile

-Wakes only with prolonged stimulation

-Decreased activity

109
Q

Activity - Red

A

-No response to social cues

-Appears ill to a healthcare professional

-Does not wake or if roused does not stay awake

-Weak, high-pitched or continuous cry

110
Q

Respiratory - Amber

A

-Nasal flaring
-Tachypneoa
(RR >50 aged 6-12m)
(RR >40 aged >12m)
-Sats =<95% on air
-Crackles in chest

111
Q

Respiratory - Red

A

-Grunting
-RR>60
-Moderate/severe recessions

112
Q

Treatment of epidiymo-orchitis, unknown organism

A

Ceftriaxone 500mg IM + oral Doxycycline 100mcg BD 10-14 days

113
Q

Breast cancer screening programme

A

Women aged 47-73 are offered a mammogram every 3 years.

114
Q

Aneurysm screening

A

All men aged 65 - screen with single abdominal ultrasound

115
Q

Breast cancer screening at younger age due to ONE relative.

A

-one first-degree female relative diagnosed with breast cancer younger than 40 years

-one first-degree male relative diagnosed with breast cancer at any age

-one first-degree relative with bilateral breast cancer where the first primary was diagnosed younger than 50

116
Q

Breast cancer screening at younger age due to TWO relatives.

A

-two first degree relatives, or one first-degree and one second-degree relative diagnosed with breast cancer at any age

-one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative)

117
Q

Breast cancer screening at younger age due to THREE relatives.

A

Three first-degree or second-degree relatives diagnosed with breast cancer at any age

118
Q

POP missed pill >3hrs late

A

Take missed pill asap (only one even if missed several)
Take next pill at usual time (even if taking two pills in a day)
Alternative contraception until normal pill-taking resumed for 48hrs

Exception: desogestrel can be taken up to 12 hours late

119
Q

IUD mode of action

A

Prevent fertilisation by:
-Decreased sperm motility and survival

Effective immediately

120
Q

IUS mode of action

A

Levonorgestrel:
-Prevents endometrial proliferation
-Cervical mucous thickening

Reliable after 7 days

121
Q

COCP absolute contraindications
(UKMEC 4: represents an unacceptable health risk)

A

-Over 35 and smoking more than 15 cigarettes/day

-Migraine with aura

-History of VTE or thromboembogenic mutation

-History of stroke or ischaemic heart disease

-Breast feeding <6 weeks post-partum

-Uncontrolled hypertension

-Current breast cancer

-Major surgery with prolonged immobilisation (stop 4 weeks before elective, restart once mobilising)

122
Q

COCP relative contraindications
(UKMEC 3: disadvantages generally outweigh the advantages)

A

-Over 35 and smoking less than 15/day

-BMI > 35 kg/m^2

-Family history of VTE in first degree relative <45 years

-Controlled hypertension

-Immobility eg wheelchair use

-Carrier of gene mutations associated with breast cancer eg BRCA1/BRCA2

-Current gallbladder disease

123
Q

Contraceptive injection mode of action

A

Depo Provera = medroxyprogesterone acetate 150mg

Inhibits ovulation
Also thickens cervical mucus and thins endometrium

124
Q

Failure rate of female sterilisation

125
Q

Emergency contraception - levornogestrel
(Levonelle)

A

Stops ovulation and inhibits implantation

Must be taken asap, within 72hours of UPSI

1.5mg or 3mg if BMI >26 or weight > 70kg

Repeat dose if vomiting with 2 hours

126
Q

Emergency contraception - ulipristal
(EllaOne)

A

Progesterone receptor modulator. Inhibits ovulation

30mg dose. No later than 120 hours after UPSI.

Caution in asthma.
Delay breastfeeding for 1 week.
Reduces effect of contraeption - use barried methods for 5 days.

127
Q

Emergency contraception - IUD

A

Within 5 days of UPSI

If presents after 5 days, may be fitted up to 5 days after ovulation date

128
Q

Mode of action COCP

A

Inhibits ovulation

129
Q

Mode of action POP
(excluding desogestrel)

A

Thickens cervical mucus

130
Q

Mode of action Desogestrel-only pill

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

131
Q

Mode of action injectable contraceptive
(medroxyprogesterone acetate)

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

132
Q

Mode of action implantable contraceptive
(etonogestrel)

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

133
Q

Mode of action IUD

A

Decreases sperm motility and survival

134
Q

Mode of action IUS
(levornogestrel)

A

Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

135
Q

Mode of action Levornogestrel

A

Inhibits ovulation

136
Q

Mode of action Ulipristal

A

Inhibits ovulation

137
Q

Mode of action IUD (as emergency contraception)

A

Primary: Toxic to sperm and ovum
Also: Inhibits implantation

138
Q

Cancer risk with COCP

A

-Increased risk of breast and cervical cancer
-Protective against ovarian and endometrial cancer

139
Q

Time until IUD effective

140
Q

Time until POP effective

141
Q

Time until COCP effective

A

7 days
(Or immediately if within first 5 days of cycle)

142
Q

Time until contraceptive injection effective

143
Q

Time until implant effective

144
Q

Time until IUS effective

145
Q

Inevitable miscarriage

A

Heavy bleeding with clots and pain
Cervical os open

146
Q

Borderline or mild dyskaryosis

A

Original sample tested for HPV
-if negative > routine recall
if positive > refer for colposcopy

147
Q

Moderate dyskaryosis

A

CIN II
Urgent colposcopy
(within 2 weeks)

148
Q

Severe dyskaryosis

A

CIN III
Urgent colposcopy
(within 2 weeks)

149
Q

Suspected invasive cancer

A

Urgent colposcopy
(within 2 weeks)

150
Q

Inadequate

A

Repeat smear
-if 3 inadequate samples > colposcopy

151
Q

Smear post-treatment for CIN?

A

Invited 6 months after treatment for CIN1, CIN2 or CIN3, for ‘test of cure’ cytology

152
Q

High risk HPV subtypes

A

16, 18 + 33

153
Q

Gardasil protects against HPV serotypes..

A

HPV 6, 11, 16 + 18

154
Q

HPV vaccination UK

A

All 12 + 13 year olds (girls and boys) in school Year 8
2 doses, 6-24months apart

155
Q

Follicular phase (proliferative phase)

156
Q

Ovulation

157
Q

Luteal phase
(secretory phase)

158
Q

Missed miscarriage

A

gestational sac containing dead fetus before 20 weeks, without symptoms of expulsion

159
Q

Type II hypersensitivity: diseases caused by ‘antibody and complement-mediated destruction’

A

-Autoimmune haemolytic anaemia
-Wrong blood transfusion reaction
-Goodpasture’s Syndrome

160
Q

Type II hypersensitivity:
antibody-dependent cell-mediated cytotoxicity

A

-Medication-induced haemolytic anaemia/thrombocytopenia/neutropenia
-Transplant rejection
-Immune reaction to parasites or tumours

161
Q

Type II hypersensitivity:
Target cell dysfunction

A

-Pernicious anaemia

162
Q

Type III hypersensitivity reaction

A

=Immune complex mediated.

eg
- SLE
-Serum sickness
-Post-streptococcal glomerulonephritis
-EAA (acute phase)

163
Q

Type III hypersensitivity reaction

A

=Immune complex mediated.

eg
- SLE
-Serum sickness
-Post-streptococcal glomerulonephritis

164
Q

Type IV hypersensitivity

A

“Delayed” and T-cell mediated

eg
-GVHD
-Allergic contact dermatitis
-Scabies
-MS
-Guillain-Barre Syndrome

165
Q

Type V hypersensitivity

A

Antibodies bind to cell surface receptors and stimulate or block ligand binding

eg:
- Graves’ disease
-Myasthenia Gravis

166
Q

Antibodies in Graves’ disease

A

-TSH receptor stimulating antibodies (90%)
- anti-thyroid peroxidase antibodies (75%)

167
Q

Antibodies in Myasthenia Gravis

A
  • against nicotinic acetylcholine receptors
168
Q

Booking visit - when?

A

8 - 12 weeks (ideally <10 weeks)

169
Q

Booking visit components

A

-diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
-BP, urine dipstick, check BMI
-Booking bloods

170
Q

Booking bloods

A

-FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
-hepatitis B, syphilis, rubella
-HIV test offered
-urine culture for asymptomatic bacteriuria

171
Q

Early scan

A

10 - 13+6 weeks
Confirm dates, exclude multiple pregnancy

172
Q

Down’s syndrome screenig + nuchal scan

A

11 - 13+6 weeks

173
Q

16 week appointment

A

Information on anomaly and blood results
If Hb <11g/dl iron
BP + urine dipstick

174
Q

Anomaly scan

A

18 - 20+6 weeks

175
Q

25 week appointment

A

Primip only
BP, dipstick, SFH

176
Q

28 week appointment

A

BP, dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies
If Hb <10.5 consider iron
First dose anti-D prophylaxis for rhesus negative women

177
Q

31 week appointment

A

Primip only
Routine care

178
Q

34 week appointment

A

Routine care
Second dose of anti-D prophylaxis to rhesus negative women
Information on labour and birth plan

179
Q

36 week appointment

A

Routine care
Check presentation - offer ECV if indicated
Information on breast feeding, vitamin K, ‘baby-blues’

180
Q

38 week appointment

A

Routine care

181
Q

40 weeks

A

Primip only
Routine care
Discussion options for prolonged pregnancy

182
Q

41 weeks

A

Routine care
Discuss labour plans and possibility of induction

183
Q

Antitbiotics safe in breastfeeding

A

-Penicillins
-Cephalosporins
-Trimethoprim

184
Q

Antibiotics to be avoided in breastfeeding

A

-Ciprofloxacin
-Tetracycline
-Chloramphenicol
-Sulphonamides

185
Q

Anti-epileptic drugs acceptable in breastfeeding

A

-Sodium valproate
-Carbamazepine

186
Q

Psychiatric drugs acceptable in breastfeeding

A

Tricyclic antidepressants
Antipsychotics

187
Q

Pyschiatric drugs avoided in breastfeeding

A

Lithium
Benzodiazepines

188
Q

Warfarin and heparin in breastfeeding?

A

Acceptable

189
Q

Aspirin in breastfeeding?

190
Q

Carbimazole in breastfeeding

191
Q

Methotrexate/cytotoxics in breastfeeding

192
Q

Sulfonylureas in breastfeeding

193
Q

Digoxin in breastfeeding

194
Q

Beta-blockers in breastfeeding

195
Q

Amiodarone in breastfeeding

196
Q

Levothyroxine in breastfeeding

197
Q

Group B strep full name

A

Streptococcus agalactiae

198
Q

Earliest time anomaly scan can be done

199
Q

Earliest time dating scan can be done

200
Q

Earliest time nuchal scan can be done

201
Q

Sodium valproate in pregnancy

A

Avoid - associated with neural tube defects

202
Q

Carbamazepin in pregnancy

A

Avoid - teratogenic

203
Q

Phenytoin in pregnancy

A

Avoid - associated with celeft palate

204
Q

Lamotrigine in pregnancy

205
Q

Metformin and breastfeeding

206
Q

Congenital rubella triad

A

-Sensorineural deafness
-Eye abnormalities
-Congenital heart disease

207
Q

Congenital CMV

A

-Sensorineural deafness
-Cerebral calcification
-Microcephaly

208
Q

Congenital parvovirus B19

A

Hydrops fetalis + death

209
Q

Congenital toxoplasmosis

A

-Intracranial celcification
-Hydrocephalus
-Epilepsy in child

210
Q

Down’s syndrome combined test

A

Include nuchal scan
11 - 13+6 weeks

211
Q

Triple or quadruple test

A

Between 15 and 20 weeks

212
Q

Chickenpox during pregnancy - maternal disease

A

Increased maternal morbidity, pneumonia, hepatitis, encephalitis

Oral aciclovir if present within 24hr of rash onset and >20 weeks gestation

213
Q

Chickenpox during pregnancy - fetal disease

A

-Skin scarring
-Limb hypoplasia
-Microcephaly
-Eye defects

Greatest risk before 20 weeks

MRCP/MSRA (15 decks)

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