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AMC MCQ > November 2024 > Flashcards

November 2024 Flashcards

1
Q

Most common complications of Hypertension (5)

A
  1. CV disease (stroke)
  2. CHD, LVH, AF.
  3. Renal disease: Focal segmental glomerulosclerosis (FSGE)
  4. HT Retinopathy.
  5. Peripheral vascular disease (Aortic aneurism/dissection)
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2
Q

Clinical features of Aortic Dissection

A
  • Diastolic murmur if Aortic Regurgitation occurred
  • Abrupt chest pain, sharpen,
    migrating / irradiating to the
    back.
  • Unequal or absent pulses.
  • Difference of BP in arms (more than 20mmHg).
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3
Q

Aortic Dissection Types

A
  • Type A: Ascending aorta.
  • Type B: Descending aorta.
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4
Q

Aortic Dissection FIRST Investigation

A

Transesophageal Echocardiogram

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5
Q

Aortic Dissection BEST Investigation

A

CT angiogram

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6
Q

Aortic Dissection Treatment

A
  1. Beta blockers (to reduce shear stress)
  2. Immediate Qx for type A
    (ascending aorta)
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7
Q

ABI values

A

> 1.4: Calcification → Refer

1-1.4: Normal

0.9-1: Acceptable

0.8-0.9: Mild Arterial disease → treat risk factors

0.5-0.8: Moderate Arterial disease →
- Treat risk factors
- Refer if signs of gangrene or pain on rest.

< 0.5: Severe → Refer

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8
Q

Aortic dissection/aneurysm vs myocardial infarction investigation

A

Check if patient stable
if stable:
Initial: ECG
Best: CT angio

If unstable: fast US

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9
Q

Cardiac Tamponade classic quartet

A
  • Hypotension
  • Increased JVP
  • Tachycardia
  • Pulsus paradoxus ( ↓ BP after inhalation)
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10
Q

Beck’s triad

A
  • Hypotension
  • Increased JVP
  • Muffled heart sounds
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11
Q

Main cause of dysphagia

A

achalasia

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12
Q

most common oesophageal disorder

A

achalasia

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13
Q

Dysphagia to solids and liquids + Heartburn unresponsive to PPI + Retained food in the oesophagus on upper endoscopy + Unusually increased esophagogastric junction sphincter tone + failure of muscle relaxation + weight loss + regurgitation getting worse at night/lying down

A

Achalasia

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14
Q

Achalasia diagnostic feature

A

Dysphagia for both solids and liquids

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15
Q

Achalasia initial investigation

A

Plain X -ray
- air fluid levels to see absence of gastric bubble
Barium swallow
- Birds beak/rat tail appearance
OGD endoscopy
- exclude other causes of dysphagia

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16
Q

Achalasia best investigation

A

oesophageal manometry
- increased tension in lower end of oesophagus

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17
Q

Achalasia complications

A
  • strictures
  • oesophageal cancer
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18
Q

Achalasia management

A

Mild symptoms
- CCB (Nifedipine)
- nitrates

Young px
- Endoscopic Pneumatic dilation of LES

Old px
- Botulinum injection (may need to be repeated every 3 - 12 months) + mild symptoms management

Best
- Laparoscopic Myotomy (Heller’s)

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19
Q

dysphagia + hoarseness + hx of achalasia + thoracic inlet mass

A

Oesophageal cancer

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20
Q

Progressive dysphagia + Weight loss >10% + Elderly

A

Rule out Oesophageal cancer

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21
Q

Oesophageal cancer features

A

▪ Dysphagia progressive continuous - first solids then liquids → odynophagia
▪ Striking unintentional weight loss ( >10%)
▪ Hiccoughs (early sign – phrenic nerve irritation)
▪ Hoarseness and cough (upper 1/3 cancer – recurrent
laryngeal nerve irritation – vocal cord palsy)
▪ Progressive chest discomfort or pain in locally invasive cancer

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22
Q

Oesophageal cancer types

A

▪ SCC (most common)
▪ Adenocarcinoma

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23
Q

Oesophageal cancer risk factors

A

SCC:
▪ Smoking & OH → Triple S
(smoking - spirits – SCC)

Adeno:
▪ Barrett’s oesophagus & smoking

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24
Q

Oesophageal cancer investigation

A

1st test: Barium swallow to locate lesion
▪ Narrowing of oesophagus
▪ Irregular oesophageal borders
▪ apple core appearance

THEN

Endoscopy w/biopsies
Oesophagogastroduodenoscopy

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25
Q

Oesophageal cancer ddx

A

Dysphagia intermittent = Achalasia

Hoarseness and cough = also in Pancoast tumour but Horner is present and no GI symptoms

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26
Q

Complete oesophageal rupture causes

A

▪ Iatrogenic - 56% due to an endoscopy or
paraesophageal surgery

▪ Boerhaave’s syndrome- 10%

▪ Spontaneous perforation include:
- Caustic ingestion
- Pill esophagitis
-Barrett’s oesophagus
-Infectious ulcers in AIDS patients
- oesophageal strictures dilation

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27
Q

dysphagia + iron deficiency anaemia + glossitis ‘rings’ (oesophageal webs)

A

Plummer Vinson Syndrome/Syderopenic dysphagia

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28
Q

Eosinophilic oesophagitis causes

A

history of atopy (genetic tendency to develop allergic diseases):
- eczema
- asthma
- rhinitis
- hay fever
- cow’s milk allergy
- dietary allergens or aeroallergens
- chronic, immune-mediated esophageal inflammation

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29
Q

Plummer Vinson Syndrome/Syderopenic dysphagia biggest risk factor

A

Oesophageal SCC

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30
Q

Oesophageal varices management

A
  • Prophylaxis: Beta blocker (propranolol or nadolol)
  • Endoscopic variceal/band ligation
  • If failed endoscopic or medical management TIPS (trans-jugular intrahepatic portosystemic shunt)
  • Active bleeding: Octreotide
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31
Q

What is the major cause of morbidity and mortality in patients with cirrhosis?

A

Oesophageal varices 30%-60%

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32
Q

Abdominal aortic aneurysm (AAA) size screening

A

3-3.9cm = 2 yearly US

4-4.5cm = 1 yearly US

4.6-5cm = 6m US

> 5cm = 3m US

> 5.5cm (male) = surgical intervention

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33
Q

Abdominal aortic aneurysm (AAA) screening

A
  • family history 20%
  • >50 years US
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34
Q

Abdominal aortic aneurysm (AAA) investigation

A
  • >50 years fast US
  • CT angiogram (before elective surgical repair)
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35
Q

Acute limb ischaemia causes

A
  • Cardiac/arterial embolus (eg, AF, LV thrombus, IE)
  • Local thrombosis from disruption of a preexisting atherosclerotic plaque (PAD)
  • Iatrogenic/blunt trauma
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36
Q

Arterial emboli origin

A

Cardiac

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37
Q

Acute limb ischemia requiring surgical treatment

A
  • Paralysis
  • Paraesthesia
  • Rest pain
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38
Q

Abdominal aortic aneurysm (AAA) mortality rate

A
  • 80%
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39
Q

Abdominal aortic aneurysm (AAA) surgical intervention

A
  • Rapid growth > 1cm yearly
  • Males > 5.5cm
  • Females > 5cm
  • Symptomatic (abdominal/back pain, tenderness, distal embolization)
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40
Q

Acute limb ischemia treatment

A

embolectomy

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41
Q

Acute limb ischaemia reperfusion syndrome

A

not enough oxygen causes muscles to die releasing potassium outside the cell but restricted to the limb.

When restoriung blood flow all the potassium will get into circulation causing hyperkalaemia in the heart and px dies due to AF/VF

The same thing happens with the myoglobin gets into the circulation and gets into the kidneys causing blockage leading to AKI. Px doesn’t pass any urine.

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42
Q

Patients with PAD and intermittent claudication have the risk of developing which disease in the future?

A
  • nonfatal myocardial infarction and stroke in the next 5 years (20%)
  • death due to cardiovascular causes in the next 5 years (15%—30%)
  • The risk rises exponentially PAD progression 1-year risk of cardiovascular mortality in patients with critical limb ischemia (25%)
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43
Q

Acute limb ischemia reperfusion injury features

A

– Metabolic acidosis
– Acute renal failure
– Hyperkalaemia.
– Myoglobinemia.
– CK elevation

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44
Q

Acute limb ischemia most common cause

A

Thrombosis
- lower limbs 80%

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45
Q

Abdominal aortic aneurysm (AAA) symptoms

A

Triad:
1. abdominal and/or back pain
2. pulsatile abdominal mass
3. hypotension

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46
Q

Acute limb ischemia clinical features/symptoms

A
  • Context of a patient with: Thrombosis (most common cause) or Embolus from AF.
  1. Pain (progressive)
    - Calf: Common femoral art / Superficial femoral art (MC site of occlusion).
    - Buttock: Common iliac/external iliac Thrombosis.
  2. Paralysis - Foot drop = Peroneal nerve paralysis - Most reliable sign requiring Emergency Qx intervention
  3. Pulselessness
  4. Paraesthesia
  5. Pallor
  6. Poikilothermia
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47
Q

Acute limb ischemia investigation

A
  • Measure ABI
  • Doppler US
  • CT angiogram (gold standard) for surgical
    intervention
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48
Q

Acute limb ischaemia initial treatment

A

Golden time: 4 hrs
1. IV Unfractionated Heparin: 5000 IU then 1250IU/hour. APTT guides further adjustment.

  1. Surgical treatment: Embolectomy - Can cause reperfusion injury (HyperK, metabacid, myoglobinuria, increased CK). Keep pt hydrated and perfused.
    - Arterial bypass is helpful if it is chronic limb ischemia.
    - Amputation is required only if there are irreversible ischemic changes.
  2. After acute, give warfarin for 3m

Angioplasty/Catheter

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49
Q

Acute limb ischaemia reperfusion syndrome heart management

A

If Potassium >= 5.5:
- Stop all K+ supplementation
- Stop medication causing hyperK+
- Cardiac monitoring

If px asymptomatic + normal EKG + K >= 5.5 <= 6:
- Consider if treatment necessary.
- ± Salbutamol Neb
- ± Polystyrene sulfonate PR or oral
- ± Bicarbonate IV if metabolic acidosis

Patient Asymptomatic and Normal ECG and K+ >6 <=7mmoI/L:
- Salbutamol NEB
- Insulin/Glucose perfusion IV
- ± Resonium PR or oral
- Bicarbonate IV if metabolic acidosis

Patient unstable or Symptomatic or Clearly abnormal ECG or K+>7mmoI/L:
- Discuss dialysis
- Consider transfer to tertiary centre.

                            ↓
  • Calcium IV
  • Salbutamol Neb
  • Insulin / Glucose IV
  • Bicarbonate IV if metabolic
    acidosis
  • ± Resonium PR or oral
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50
Q

Aortic dissection (AD) confirmation investigation

A

CT angio

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51
Q

Aortic dissection/aneurysm vs myocardial infarction

A

Check if patient stable
if stable:
Initial: ECG
Best: CT angio

If unstable: fast US

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52
Q

Acute limb ischemia LMWH vs UFH

A
  • Preceding surgery/renal impairment: UFH
  • Medical Mangement only: LMWH (enoxaparin)
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53
Q

Pseudoaneurysm management

A

Ultrasound-guided thrombin injection

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54
Q

Pseudoaneurysm complication

A

femoral artery catheterization 7.5%

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55
Q

Clinical features of Chronic Lower Limb Ischemia

A
  • Claudication (pain w/ exercise and relieved by rest)
  • if pain at rest: 🚩🚩🚩
  • Shiny hairless legs
  • Muscles atrophied
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56
Q

Chronic limb ischemia diagnostic symptoms

A
  • Poor pulses (hallmark)
  • Shiny, hyperpigmented skin.
    -Hair loss & ulceration on the legs
    -Thickened nails.
    -Muscle atrophy.
    -Vascular bruits.
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57
Q

Chronic limb ischemia symptoms that require surgical intervention

A

– Rest Pain
– Ischemic ulceration
– Gangrene
– Claudication symptoms limiting day to day life & work, no improvement with risk factor modifications, exercises, medical management > 6 months

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58
Q

Chronic Lower Limb Ischaemia MEDICAL Treatment

A

Measure ABI:

1-1.4: Normal

0.9: Borderline. Nothing

<0.9: Manage risk factors
- Smoke cessation
- Antiplatelets (aspirin or clopidogrel) ONLY if clinically evident CVD
- Statins (even in the absence of dyslipidemia)
- ACE Inhibitors or ARBs.
- Supervised exercise program.

beta-blockers should be avoided until and unless they are commenced for cardioprotection(sys/dia cardia insufficency).

For mixed ulcers (Do not use compression bandage if ABI <0.8)

<0.4: Urgent referral

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59
Q

Chronic Lower Limb Ischaemia SURGICAL Treatment

A

– Endovascular angioplasty or stenting
– Open surgical reconstruction by bypass or endarterectomy

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60
Q

Chronic Lower Limb Ischaemia initial investigation

A
  1. Measure ABI
  2. Duplex US (often the only imaging required to plan endovascular interventions)
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61
Q

Chronic Lower Limb Ischaemia BEST investigation

A

CT Angiography w/contrast (Contraindicated in RF)

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62
Q

Exposure to what can trigger an asthma attack?

A

Sulphites

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63
Q

Prophylactic treatment of asthma in children?

A

Inhaled corticosteroids ICS : Fluticasone

NOTE: Sodium cromoglycate in some cases

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64
Q

Asthma best initial treatment

A

Short-acting β2 agonist (salbutamol)

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65
Q

Asthma treatment progression

A

Oxygen and short-acting beta-2 agonists (salbutamol)
- 6 puffs for children 0-5 and up to 12 puffs for 6 years
- wait 20 mins

If the attack does not subside, up to 6 puffs can be given every 20 minutes for one hour.

If the attack still does not subside, ipratropium bromide
- 4 puffs by MDI + mask or 250 mcg by nebuliser for children 0-5 years
- 8 puffs by MDI + mask or 500 mcg by nebuliser for children > 6 years

Oral prednisolone 1 mg/kg for first 3 days after the asthma attack (prophylactic)

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66
Q

Asthma in children definitive dx

A
  • 2 and 5 years
    -Bilateral wheezing
  • viral wheezing, pre-school wheeze, episodic viral wheeze and multiple
    trigger wheeze
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67
Q

Chronic cough cause in children

A

asthma

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68
Q

most common
allergens that can cause allergy and asthma

A

dust mites 90%
sheepskin 2nd most common

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69
Q

Asthma LABA

A
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70
Q

Infrequent Intermittent asthma in children

A
  • less than one episode of asthma in 6
    weeks and no symptoms in between the flare-ups
  • inhaled short-acting beta2 agonist
    (SABA)
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71
Q

indications for preventer therapy in asthma

A

symptoms at night
>1 canister b2 agonists every 3 months
using beta 2 agonists >2days /week
asthma attacks >2/month
infrquent asthma attacks but severe
spirometry with reversible airflow obstruction

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72
Q

Raised JVP is a feature of

A

Right heart failure

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73
Q

Cardiac tamponade in terms of heart pathogenesis

A

fluid accumulation in the pericardial cavity → ↑intrapericardial pressure > diastolic ventricular pressure
↓
This restricts venous return to the heart and lowers right and left ventricular filling →

↓preload ↓stroke volume ↓cardiac output.

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74
Q

Pericarditis Clinical Features

A

Chest pain + SOB+ viral infection

Kussmaul sign.

S4 Gallop: Cardiac Tamponade

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75
Q

Continuous Murmurs List

A

◦ Patent Ductus Arteriosus – Paeds
Has a harsh, machinery-like quality (Gibson murmur)

◦ Pericardial friction rub: Pericarditis or pericardial effusion. Not a real murmur. Has scratchy, scraping quality

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76
Q

Pericarditis Initial Investigations

A
  1. ECG:
    - ST elevation except in AVR & V1
    - Reciprocal PR
  2. CXR:
    - Pericardial fluid
    - Pulmonary congestion
  3. Echocardiogram: Is diagnostic! Chest FAST scan should be done ASAP.
  4. Cardiac CT
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77
Q

Pericarditis Causes

A
  • Viral infection: Coxsackie B, CMV, influenza, EBV, COVID, HIV
  • After a major heart attack or heart surgery: Dressler syndrome.
  • Systemic inflammatory disorders: Lupus, rheumatoid arthritis.
  • Trauma
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78
Q

Pericarditis Best Investigation

A

Echocardiogram with drainage and culture (Pericardiocentesis)

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79
Q

Pericarditis Complications

A

 Constrictive pericarditis.

 Cardiac tamponade

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80
Q

Pericarditis Medical Treatment

A

Mild to moderate Pericarditis

  1. AAS/Ibuprofen (7 to 10 days)
  2. Colchicine x 3 months. Indication: Recurrent symptoms (Side Effects: Diarrhea, abd pain)
  3. Prednisone

If infection: ATBs and drainage

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81
Q

Pericarditis Surgical Treatment

A

Severe Pericarditis, include admision

  1. Cardiac tamponade: Pericardiocentesis
  2. Severe, Recurrent or Constrictive:
    Pericardiectomy
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82
Q

Pericarditis Pathophysiology

A

Restrictive Cardiomyopathy

Diastolic Dysfunction with impaired filling – relaxation

Normal Ejection fraction + S4 gallop

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83
Q

Dressler’s Syndrome risk factors

A
  1. Young age
  2. B-negative blood type
  3. Prior history of pericarditis
  4. Prior treatment with prednisone
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84
Q

Dressler’s Syndrome Treatment

A

1st LINE: NSAIDs in high doses (aspirin, ibuprofen, naproxen) tapered over 4 to 6 weeks.

2nd LINE: Corticosteroids (prednisone) tapered over a 4-week period

3rd LINE: Colchicine.

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85
Q

Dressler’s Syndrome investigations

A

Gold Standard: Echocardiogram

UNSTABLE patient: bedside ultrasonographic (E-FAST)

ECG: Same pattern as pericarditis (global ST segment elevation and T wave inversion)

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86
Q

Dressler’s Syndrome COMPLICATION

A

Cardiac Tamponade

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87
Q

Pericarditis Duration: Acute & Chronic

A

Acute (<6w)
Chronic (>6w).

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88
Q

Kussmaul sign physical exam

A

Paradoxical: ↑ JVP with insp and ↓ JVP with exp)

Means: constrictive and/or cardiac tamponade.

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89
Q

Dressler’s Syndrome definition

A

Pericarditis in the context of major heart attack or heart surgery

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90
Q

Takotsubo Cardiomyopathy ECG:

A

STEMI or pericarditis pattern.

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91
Q

Cardiac Tamponade is an early complication of which surgical procedure post-op?

A

coronary artery bypass grafting

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92
Q

painless + elderly + recurrent pneumonia + dysphagia + solids & liquids undigested food regurgitation + coughing immediately after eating + halitosis

A

Zenker’s diverticulum (pharyngeal pouch)

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93
Q

Zenker’s diverticulum investigation (pharyngeal pouch)

A

Initial: Barium swallow/Contrast oesophagography
Best: Upper gastrointestinal endoscopy

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94
Q

Zenker’s diverticulum management (pharyngeal pouch)

A

Surgery: cricopharyngeal myotomy ± diverticulectomy
Laparoscopic surgery

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95
Q

acquired bleeding disorders other causes

A
  • malignancy
  • infection
  • liver disease
  • DIC
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96
Q

Autosomal dominant haemotological diseases

A
  • spherocytosis
  • hemorrhagic telangiectasia
  • Von Willebrand disease
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97
Q

Autosomal recessive haemotological diseases

A
  • Factor 5 diseases
  • Fanconi’s anaemia
  • haemochromatosis
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98
Q

Coagulation issue + low platelet

A

Immunocompromised - suspect HIV

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99
Q

delayed bleeding in trauma is due to

A

coagulation factor deficiency

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100
Q

DIC causes

A
  • Sepsis
  • Transfusion reactions
  • Neoplasm (adenocarcinoma, leukemia).
  • Trauma.
  • Obstetric complications (placental abruption, preeclampsia, septic abortion, retained dead fetus).
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101
Q

DIC management

A

Treat underlying disorder (see causes)
Platelets
Packed RBC
FFP
Cryoprecipitate
Consider IV heparin for thrombotic complications.

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102
Q

DIC physical symptoms

A

Epistaxis
Petechiae purpura
Bleeding from venipuncture site or incisional wounds
Haematemesis
Tachycardia
Tachypnoea
Respiratory failure

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103
Q

drugs to avoid in haemophilia

A

aspirin
warfarin
heparin

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104
Q

early beeding in trauma is due to

A

platelet issue

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105
Q

Haemophilia features

A

X - linked recessive = only males affected (1 in 5000)
Factor VIII/IX deficiency

Physical symptoms:
Haemarthroses + muscle bleeds + delayed bleeding.
haemoarthrosis: especially knees, ankles, elbows
* Mild/moderate bleeding: after major trauma or surgery.
* Severe: spontanaeous bleeding

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106
Q

Haemophilia management

A

Recombinant factor VIII/IX concentrates infusion

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107
Q

Henoch Schonlein Purpura management

A

Supportive – bed rest and analgesia.
* Corticosteroids – may reduce the duration of abdominal pain, but it is uncertain if they significantly affect other features.
* Refer to a specialist if renal dysfunction, hypertension or surgical complications develop

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108
Q

Henoch Schonlein Purpura features

A
  • Onset 2–8 years most common.
  • lgA—mediated small vessel vasculitis
  • Post URTI
  • Large joint migratory arthritis of variable duration and severity.
  • Fever and fatigue
  • Non-TP
  • Evolving crops of palpable purpura (buttocks and legs)
  • Abdominal pain (occasionally melaena) may precede rash.
  • High risk of Intussusception
  • Nephritis w/ oedema: dorsum of the feet and hands, acute scrotal swelling and bruising
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109
Q

Henoch Schonlein Purpura investigation

A
  • Full blood examination (NO thrombocytopenia).
  • Urinalysis: haematuria/proteinuria.
  • Renal function: urea/creatinine and urinary protein estimation.
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110
Q

ITP adult features

A
  • Nearly always chronic
  • Duration > 14 days
  • 50% associated with HIV, SLE, CLL
  • Rarely recovers without treatment
  • Splenectomy usually required
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111
Q

ITP child features

A
  • Acute onset
  • Follows viral infection or drug hx
  • Nearly always self limiting (90%)
  • 10% pass onto chronic ITP
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112
Q

ITP investigation

A

Exclude ALL/AML
Bone marrow aspiration: increased megakariocytes

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113
Q

ITP management

A

Conservative management:
- platelet count > 20 x 109/L
- no active bleeding
- isolated brusiing and petechiae
- without mucousal, GI or renal tract bleeding

Inpatient management:
- Prednisolone for 2 weeks
- IV Ig
- Splenectomy in chronic cases

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114
Q

Most common cause of acquired bleeding disorder

A

drug therapy (nsaids, anticaogulants)

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115
Q

Prolonged aPTT causes

A

Increased aPTT only:
- Haemophilia A
- Haemophilia B
- Von Willebrand

Increased aPTT + PT:
- DIC
- Heparin/Warfarin
- Vit K deficiency

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116
Q

Prolonged aPTT is due to which pathway deficiency?

A

intrinsic pathway deficiency

Factors:
VIII
IX
XI
XII

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117
Q

prolonged PT causes

A
  • Heparin/Warfarin
  • DIC
  • Vit K deficiency
  • Liver disease
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118
Q

Prolonged PT is due to which pathway deficiency?

A

extrinsic pathway deficiency

Factors:
II
VII
IX?
X

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119
Q

TTP causes

A
  • ADAMTS 13 deficiency
  • bleeding disorders: Von Willebrand
  • cocaine
  • chronic rhinitis/sinusitis
  • nasal cavity ulcers/ perforation
  • nasal polyps
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120
Q

TTP investigation

A

Blood film:
- Prolonged bleeding time
- schistocytes (helmet cells)
- High creatinine
- Normal coagulation profile
FBC:
- anaemia
- thrombocytopenia.

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121
Q

TTP management

A
  • Platelet transfusion is contraindicated.
  • Plasma exchange transfusion
  • FFP (maybe)
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122
Q

TTP symptoms

A

Clinical symptoms:
- Easy bleeding/epistaxis
- Neurological symptoms: confusion, seizures, headache
- Thrombosis
- Renal dysfunction

On examination:
- Fever
- Pallor
- Purpura/petechiae
- Jaundice
- Splenomegaly

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123
Q

TTP triggers

A

ADAMTS 13 deficiency

▪ Haemolytic uraemic syndrome
▪ Drugs (quinine, ticlopidine, clopidogrel,cyclosporine).
▪ SLE
▪ Infections
▪ AIDS
▪ Malignancies

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124
Q

Vit K deficiency management

A

IV Vit K
Severe bleeding: FFP

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125
Q

Vit K deficiency physical symptoms

A

Easy bruising.
Oozing from nose or gums.
Excessive bleeding from wounds, injection or surgical sites.
Heavy menstrual periods.
Bleeding from the gastrointestinal (GI)tract.
Blood in the urine and/or stool.

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126
Q

Vit K deficiency required for & assiciated with

A

Required for the function of factors II, VII, IX, X, protein C, protein S.

Associated with malabsorption, cholestatic disease.

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127
Q

Von Willebrand disease features

A
  • Autosomal dominant
  • Most common in girls (although genders equal)
  • vWF defect resulting in decreased factor VIII + platelet adhesion to each other/ blood vessel wall
  • bleeding exacerbated by NSAIDs/aspirin

Physical symptoms:
- minor surigcal bleeding: dental, incisions
- epistaxis (common)
- menorrhagia
- bruising
- gingival bleeding

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128
Q

Von Willebrand best investigation

A

Ristocetin co-factor assay (best test)

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129
Q

Von Willebrand treatment

A

SURGERY
- A single dose of DDAVP (Desmopressin)
- vWF concentrate
- Menorrhagia: Tranexamic acid

DENTAL EXTRACTION:
- Tranexamic acid preoperatively and continue for 1-5 days.
- Single dose of DDAVP or/and single dose of vWF concentrate

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130
Q

X-linked recessive

A

Haemophilia A
Haemophilia B
- Glucose-6-phosphate dehydrogenase deficiency

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131
Q

fever + maculopapular rash+ serum AST, bilirubin and alkaline phosphatase elevation post transplant

A

Graft-versus-host disease

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132
Q

B12 deficiency conditions

A
  • Autoimmune gastritis
  • Terminal ileum disease
  • Gastrectomy
  • Metformin therapy
  • Coeliac disease
  • H.pyelori infection
  • Crohn disease
  • Postgastrectomy
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133
Q

B12 deficiency causes what type of anaemia

A

pernicious anaemia

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134
Q

fever + thrombocytopenia + low haemoglobin + acute renal failure + hallucination + haemolytic anaemia

A

Thrombotic thrombocytopenic purpura (TTP)

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135
Q

Thrombotic thrombocytopenic purpura (TTP) treatment

A
  • replacement fluid
  • fresh frozen plasma
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136
Q

decreased serum albumin + hypercalcaemia + anaemia + bony lytic lesions/osteoporosis

A

Multiple myeloma

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137
Q

Multiple myeloma investigation

A

Initial: & diagnostic: serum and urinary
electrophoresis

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138
Q

haemochromatosis investigation

A

Serum transferrin saturation
- >60% men
- 50% women

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139
Q

haemophilia A in pregnancy

A
  • measure Factor 8 level at 1st antenatal
    visit and at 32 weeks
  • majority develop normal level of factor 8 and do not require replacement
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140
Q

congenital developmental anomalies + progressive pancytopenia

A

Fanconi’s anaemia

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141
Q

-Malaise and pallor + Recurrent infection + Gingival hypertrophy + Fever, night sweats + -Normocytic normochromic anaemia + Thrombocytopenia + myeloblasts more than 20%

A

acute myeloid leukaemia (AML)

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142
Q

vegan vegetarian deficiency

A

B12 deficiency

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143
Q

Fanconi anaemia investigation

A

Diagnostic: Chromosome fragility test

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144
Q

rise in platelet count causes

A

– Polycythemia vera.
– Hyposplenism due to splenectomy.
– Iron deficiency anemia.
– Correction of vitamin B12 and folic acid deficiency

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145
Q

pruritis on hot bath + vertigo + tinnitus + headache + visual disturbances + hypertension + transient ischemic
strokes

A

Polycythaemia vera

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146
Q

acute haemolysis following ingestion of cotrimoxazole/primaquine

A

Glucose-6-phosphate dehydrogenase deficiency

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147
Q

sudden onset of jaundice + pallor, +
dark urine + with or without abdominal and back pain + fall in the haemoglobin concentration + “bite” cells

A

Glucose-6-phosphate dehydrogenase deficiency

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148
Q

The outcome of splenectomy in a patient with spherocytosis

A

1- Spherocytosis persists after splenectomy, the cells survive longer in the circulation.
2-Decrease in reticulocytosis.
3- RBC fragility remains high resulting short life span of red blood cells
4- Fall in elevated bilirubin
5- In severely affected patients, life-threatening anaemia

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149
Q

Fanconi anaemia congenital abnormalities

A
  1. Hand and arm anomalies (misshapen,missing or extra thumbs or abnormalities of
    the radius)
  2. Skeletal anomalies of the hips, spine or ribs
  3. Skin discolouration (café au lait spots, hyper-pigmentation,
  4. Small head or eyes
  5. Low birth weight and subsequent short stature
  6. Missing or horseshoe kidney
  7. Gastrointestinal abnormalities including abnormal development of the
    oesophagus
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150
Q

Spherocytosis gene defect

A

spectrin
ancyrin
protein 4.1

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151
Q

CRAB

A

C - hypercalcaemia 13%
R - renal impairment 20–40%
A - anaemia 70%
B - bony lesions

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152
Q

hepatomegaly + weakness+ hyperpigmentation + atypical
arthritis + diabetes + impotence + unexplained chronic abdominal pain +
cardiomyopathy + Decreased production of FSH and LH + gynaecomastia + 90% are C282Y homozygotes

A

haemochromatosis

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153
Q

Vitamin B12 bsorbed by binding to

A

intrinsic factor

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154
Q

conditions which can lead to the development of AML

A

-Trisomy 21 noted in Down syndrome.
-Fanconi anaemia.
-Ataxia-telangiectasia.
-Myeloproliferative syndromes.

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155
Q

urticaria + stridor + hypotension during blood transfusion+ hx of recurrent infections

A

Immunoglobulin A deficiency

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156
Q

> 60y/o + fatigue and weakness, dyspnea, and pallor + dysplasia + Anaemia with/o f bi- or
pancytopenia+ Macrocytosis + absolute neutropenia

A

Myelodysplasia

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157
Q

common feature of autoimmune thrombocytopenia in
childhood

A

Antecedent viral illness

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158
Q

microcytic anemia + increased concentration of hemoglobin A2

A

β-Thalassemia

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159
Q

weakness + fatigue + dizziness + palpitations + exercise intolerance + craving of ice/clay

A

Iron deficiency

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160
Q

increased MCV + neutropenia + thrombocytopenia + history of alcohol abuse + hypersegmentation of
the neutrophils

A

Folate deficiency

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161
Q

Causes of macrocytic anemia

A

High MCV

megaloblastic anemias
- Vitamin B12 (cobalamin)
- folate deficiency
- vigorous reticulocytosis
- hypothyroidism
- chronic liver disease
- myelodysplastic syndrome

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162
Q

Common causes of microcytic anemia

A

Low MCV

iron deficiency
thalassemia,
anemia of chronic disease
sideroblastic anemia

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163
Q

microcytic anemia + . Seizures
+ peripheral neuritis + dermatitis

A

Vitamin B6 (pyridoxine) deficiency

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164
Q

cheilosis (welling and fissuring of the lips) + glossitis+ a variety of ocular problems + hx of biliary atresia/hepatitis

A

Folate deficiency

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165
Q

pallor + sweats + weight loss + bilateral axillary lymphadenopathy + massive Spleen and liver megaly

A

Chronic lymphocytic leukaemia (CLL)

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166
Q

Most common manifestation of cardiac
involvement in hemochromatosis

A

Congestive cardiac failure

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167
Q

difference between hemolytic anemia vs anemia of chronic disease

A

Low hepatoglobin

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168
Q

Glucose-6-phosphate dehydrogenase deficiency dx

A

Heinz Bodies

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169
Q

decreased red cell, white cell and platelets counts

A

pancytopenia/aplastic anemia

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170
Q

aplastic anaemia causes

A

NSAIDs
- Sulfonamides.
– Gold.
– Anti-epileptic drugs (carbamazepine, valproic acid, phenytoin).
– Nifedipine.
– Chloramphenicol.

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171
Q

sickle cell anaemia how to reduce iron overload

A
  • Subcutaneous deferoxamine
  • Splenectomy
  • Erythrocytopheresis
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172
Q

poor prognosis of multiple myeloma

A
  1. higher levels of beta-2 microglobulin
  2. lower levels of albumin
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173
Q

px around 70 + fatigue + tiredness + macrocytic anaemia

A

myelodysplasia

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174
Q

myelodysplasia investigation

A

Bone marrow biopsy

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175
Q

generalised weakness, low-grade fever and sore throat + normal haemoglobin + low neutrophil + low platelets + thyroid medicatiob

A

agranulocytosis

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176
Q

spherocytosis clinical features

A

1-Anaemia and jaundice.
2-Splenomegaly.
3-Positive family history of anaemia, jaundice, or gallstones.
4-Spherocytosis with increased reticulocytes.
5-Increased osmotic fragility.
6-Negative direct antiglobulin test (DAT).

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177
Q

most common cause of death in hemochromatosis

A
  1. Liver disease
  2. cardiomypathy
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178
Q

most profound adverse effect of chronic
transfusional iron overload in children with thalassemia?

A

Progressive hepatic cirrhosis

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179
Q

Long-standing history of prolonged bleeding after trauma and history of menorrhagia in an otherwise healthy woman

A

Von Willebrand disease

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180
Q

earliest complication of sickle cell disease

A

Bone infarction

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181
Q

non-Hodgkin lymphoma features

A

GI tract most common site
- 3% of all malignant gastric tumors
- Surgery alone can be considered adequate treatment that does not infiltrate beyond the submucosa
-

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182
Q

β-Thalassemia investigation

A

diagnostic: hemoglobin electrophoresis

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183
Q

incidence of thrombosis and bleeding in patients with myeloproliferative neoplasms?

A
  • typically mucocutaneous
  • Bleeding is usually less severe and less frequent than thrombosis
  • Arterial
    thromboses are more common than venous thrombosis
  • Strokes are more frequent followed by myocardial infarction and peripheral arterialocclusion
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184
Q

best test to monitor heparin therapy

A

Activated partial thromboplastin time (aPTT)

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185
Q

DVT in the presence of thrombocytopenia

A

heparin induced thrombocytopenia

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186
Q

types of heparin induced thrombocytopenia

A

Type 1 : first 2 days after exposure, platelet count normalizes with continued heparin therapy. non-immune

Type 2: typically occurs 4-10 days after
exposure, immune-mediated disorder
- Venous limb gangrene
- Bilateral adrenal hemorrhagic infarction
- Skin lesions at injection sites
- Acute systemic reactions following an i- ntravenous heparin bolus

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187
Q

heparin induced thrombocytopenia management

A

discontinue and avoid all heparin products immediately

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188
Q

CLL management

A

1st line: corticosteroids such as prednisolone
chemotherapy if needed

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189
Q

immediate hemolytic reaction
secondary to a blood transfusion invesitgation

A

Positive Coombs test

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190
Q

helmet cells + Artificial (mechanical) valves placemenent

A

schistocytes Hemolytic anemia

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191
Q

schistocytes Hemolytic anemia lab findings

A

Decreased serum haptoglobin level

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192
Q

Renal failure reflected by oliguria and abdominal pain following invasive diarrhoea

A

hemolytic uremic syndrome (HUS).

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193
Q

fever, night sweats, weight loss + painless generalized lymphadenopathy which becomes painful after alcohol consumption

A

f Hodgkin lymphoma (HL)

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194
Q

f Hodgkin lymphoma (HL) highest risk of malignanc

A

Supraclavicular lyphadenopathy

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195
Q

Hodgkin lymphoma (HL) diagnostic investigation

A

Lymph node excision biopsy

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196
Q

Normal pH

A

7.35-7.45

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197
Q

CURB-65 Score

A

– Confusion of new onset.
– Urea greater than 7 mmol/l.
– Respiratory rate of 30 breaths per minute or higher.
– Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg
or less.
– Age 65 or older

CURB-65 score equal or >3, an
inpatient treatment for community acquired pneumonia is necessary.

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198
Q

Treatment for community acquired pneumonia

A

IV benzyl penicillin and azithromycin

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199
Q

periodontal disease + cough + foul-smelling sputum + immobilised (hiatal, post-op)

A

Aspiration pneumonia

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200
Q

Aspiration pneumonia treatment

A

1st line: ampicillin-sulbactam (1.5 to 3 g IV every 6 hours)

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201
Q

Aspiration pneumonia pathogen

A

oral streptococci

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202
Q

Bronchiectasis treatment

A

IV ticarcillin-clavulanate

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203
Q

pigmentation of skin + lung mass + hypokalaemia + hirsutism

A

Small cell lung carcinoma
-Ectopic production of adrenal corticotropin (ACTH)

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204
Q

Small cell lung carcinoma complication

A

Ectopic production of ACTH can lead to Cushing’s syndrome
- hypokalaemia

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205
Q

Most common causes pulmonary hypertension and cor-pulmonale

A
  • COPD
  • Emphysema
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206
Q

cough + mucopurulent sputum lasting for months to years + finger clubbing

A

bronchiectasis

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207
Q

Bronchiectasis investigation of choice

A

High-res CT

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208
Q

best bed-side measure to assess the severity of asthma

A

Use of accessory muscles upon inspiration

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209
Q

abdominal / trans-thoracic procedure post-op + cough and fever + within 48 hours

A

Postoperative atelectasis

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210
Q

Postoperative atelectasis management

A
  1. Removal of impacted secretions by coughing, managed by physiotherapists, and involves active chest percussion and breathing exercises.
  2. oxygen supplementation
  3. Passive postural drainage.
  4. bronchoscopy if px still hypoxic
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211
Q

FEV1/FVC ratio

A

0.75-0.85

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212
Q

FEV1/FVC ratio > 0.85

A

Restrictive airway disease

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213
Q

FEV1/FVC ratio < 0.75

A

Obstructive airway disease

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214
Q

dyspnea + cough + fever + productive sputum +
occasionally pleuritic chest pain

A

pneumonia

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215
Q

Small cell lung carcinoma treatment

A

chemotherapy and radiation

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216
Q

pleural fluid analysis

A
  • pH always below 7.30
  • Pleural/serum protein ratio greater than 0.5
  • Pleural/Serum lactic dehydrogenase ratio of greater than 0.6
  • Glucose concentration (30-50 mg/dL)
  • Bloody pleural fluid is strongly suggestive of malignancy
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217
Q

High altitude pulmonary oedema cause

A

Hypoxic pulmonary vasoconstriction

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218
Q

clubbing of nails can be found in

A

– Cystic fibrosis.
– Interstitial pulmonary fibrosis.
– Lung cancer
– Interstitial lung disease

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219
Q

middle/older age + high grade fever + dry cough + severe headache + diarrhoea/vomiting/confusion + hyponatremia + deranged liver function tests

A

Legionnaires disease

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220
Q

recurrent asthma exacerbations + patchy opacities + central bronchiectasis + eosinophilia+ elevated immunoglobulin E

A

allergic bronchopulmonary aspergillosis

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221
Q

latent tuberculosis (LTB) treatment

A

Isoniazid (5mg/kg up to a maximum 300mg daily) for 9 months

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222
Q

superior vena cava syndrome investigation

A

chest CT angiogram

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223
Q

cough + weight loss + lung nodule in X-ray

A

adenocarcinoma

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224
Q

adenocarcinoma investigation

A

FNAC gold standard

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225
Q

Difference between crackles associated with alveolar fluid vs interstitial lung disease

A

Egophony

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226
Q

smoker + pulmonary nodule + hypercalcemia (increased thirst, abdominal pain, constipation, and polyuria)

A

squamous cell carcinoma

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227
Q

(fever, malaise, cough + acute SOB + bilateral crackles + asymptomatic between exacerbations

A

hypersensitivity pneumonitis (alveolitis)

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228
Q

IV drug abuse + dyspnoea + bilateral pleuritic chest pain + multiple partners sex hx + hypoxemic

A

Pneumocystis jiroveci pneumonia

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229
Q

family hx of emphysema/liver disease + + weight loss, + jaundice + dyspnoea

A

Alpha-1 antitrypsin (AAT) deficiency

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230
Q

idiopathic pulmonary fibrosis (IPF) treatment

A

Antifibrotic therapy

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231
Q

black + 20-30 years + erythema nodosum + arthritis + hilar lymphadenopathy

A

Sarcoidosis Lofgren syndrome

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232
Q

Unprocessed raw cotton + bacterial endotoxin

A

Byssinosis
doesn’t cause COPD

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233
Q

Normal PaO2

A

75-100 mmHg

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234
Q

Normal PaCO2

A

35-45 mmHg

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235
Q

Normal HCO3

A

22-26 meq/L

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236
Q

black + 20-30 years + fever + parotid gland enlargement + uveitis + facial palsy

A

Sarcoidosis

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237
Q

pneumothorax in the absence of trauma and no history of lung disease

A

Primary spontaneous pneumothorax (PSP)

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238
Q

Pneumothorax management

A

PSP < 15%: observation
PSP > 15%: needle aspiration
SSP: mechanical ventilation (can’t put needle into an already damaged lung)
Symptomatic SSP: Catheter drainage/water sealed thorcostomy

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239
Q

Pneumothorax as well as other lung disease

A

Secondary spontaneous pneumothorax (SSP)

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240
Q

Most common finding in plural effusion

A

Dyspnoea

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241
Q

Most effective preventative therapy for asthma

A

ICS
- fluticasone
- beclomethasone
- budesonide
Montelukast if ICS contraindicated

NOTE: Montelukast is associated with nightmares in children

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242
Q

X-ray pleural thickening + significant weight loss + plural effusion

A

mesothlioma

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243
Q

when to add preventer

A

using preventer if they use salbutamol more than 3x week

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244
Q

Residual lung volume increased

A

obstructive disease

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245
Q

Residual lung volume decreased

A

restrictive disease

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246
Q

Asthma causes

A

emotional changes
gord
allergies
pregnancy
occupational hazards
dust mites

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247
Q

List of restrictive diseases

A
  • pulmonary fibrosis
  • pneumothorax
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248
Q

List of obstructive diseases

A
  • asthma
  • COPD
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249
Q

Asthma dx

A

triad: dyspnoea + wheeze + cough
fev1/fevc ratio < 75
PEF: improvement in fev1 more > 12% after medication (salbutamol)
- prolonged expiration
- resonant
- expiratory wheeze
respiratory acidosis

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250
Q

Types of asthma

A

mild:
moderate:
severe:

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251
Q

4 hallmark indicators of severe asthma

A

altered mental state +effort on breathing + struggling to talk + <94% oxygen saturation

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252
Q

role of oral steroids in asthma

A

can only be used in exacerbation, not for long term
prolonged use of oral steroids (prednisolone):
- Cushing syndrome,
- osteoporosis,
- immunosuppression

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253
Q

Exercised induced asthma management

A

Cromolyn

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254
Q

physical symptoms that are not indicated in assessing severe asthma

A
  • wheezing
  • respiratory rate
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255
Q

fever + malaise + hepatosplenomegaly + exudative pharyngitis + cervical lymphedenopathy

A

Infectious mononucleosis

256
Q

Indications for splenectomy

A
  • Trauma
  • Spontaneous rupture (mononucleosis)
  • Hypersplenism (ITP)
  • Neoplasia
257
Q

Infectious mononucleosis cause

A

EBV

258
Q

Infectious mononucleosis inv

A

Positive heterophile antibody (Monospot) test
Atypical lymphocytosis
Transient hepatitis

259
Q

Infectious mononucleosis management

A

Avoid sports due to risk of splenic rupture

260
Q

Symptoms 1-2 weeks after exposure + Fever + skin rash + polyarthralgia + urticaria

A

Serum sickness

261
Q

Serum sickness sensitivity type

A

type III

262
Q

Serum sickness management

A
  • Remove/avoid offending agent
  • Supportive care
  • Steroids or plasmapheresis if severe
263
Q

Malar rash (butterfly rash),

A
  • highly specific for
    the diagnosis of SLE
  • flat, scaly, non-pruritic and
    characteristically spares the nasolabial fold
264
Q

metacarpophalangeal joint + wrists are warm and tender + swollen

A

RA

265
Q

SLE

A

(ANA) is indicated as the best
initial screening test.
The dsDNA is 90% specific

  • affects women in high estrogen period
  • more common in female
  • weight loss
  • malar rash and oral ulcers
  • most common presentation of this arthritis is symmetrical polyarthritis affecting
    the hands, wrist and knees.
266
Q

highest specificity for rheumatoid arthritis

A

Anti-citrullinated peptide antibody

267
Q

Thrombotic thrombocytopenic purpura

A
  • thrombotic microangiopathy
  • severely reduced activity of the von Willebrand factor-cleaving protease
    ADAMTS13
  • small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia, and sometimes organ
    damage
268
Q

colchicine contraindications

A

1- Renal insufficiency.
2-Cytopenias.
3-Abnormal liver functions.
4-Sepsis.

269
Q

Bradycardia in a patient with SLE antibody

A

Anti-Ro

270
Q

Acute rheumatic fever clinical features

A
  • Peak incidence: age 5-15
  • Twice as common in girls
  • Major symptoms: JONES
    *Joints (migratory arthritis)
  • ❤️ (Carditis)
  • Nodules (subcutaneous)
  • Erythema marginatum
  • Sydenham chorea
  • Minor symptoms: FEAP
  • Fever
  • Arthralgias
  • Elevated ESR/CRP
  • Prolonged PR interval
271
Q

Acute rheumatic fever late sequelae

A

Mitral regurgitation/stenosis

272
Q

Acute rheumatic fever diagnosis

A

group A streptococcal infection along with 2 major
or
1 major plus 2 minor (J❤️NES)

273
Q

ARF can also present with

A

carditis
chorea
elevated ESR

274
Q

Coxsakie virus also known as

A

Hand foot and mouth disease

275
Q

coxsackie can lead to

A

myocarditis

276
Q

Coxsackie seasonal onset

A

late summer early autumn

277
Q

fever + lesions on hands/feet + oral sores/ulcerations

A

Coxsackie (HFM)

278
Q

Rinne test

A

AC>BC = Normal/SNHL
BC>AC= CHL

279
Q

Development of pubic hair

A

Boys: 9 years
Girls: 8 years

280
Q

SIADH in children

A
  • hyponatremia
  • excessive amount of ADH from hypothalamus-pituitary
281
Q

Hyponatremia in children

A

Dehydration: hypernatremia
Cardiac: Pseudohyponatremia
Addisons:
- Low aldosterone
- Hyperkalaemia
- hypotension

282
Q

SIADH in children symptoms

A
  • nausea and vomiting
  • headache
  • problems with balance
  • mental changes (confusion, memory problems)
  • seizures or worst case, coma
283
Q

SIADH in children causes

A
  • type 2 DM medication:
  • antiepileptic
  • antidepressant
  • surgery under general anaesthesia
  • brain disorders, injury, infections, stroke
  • lung disease (pneumonia, tuberculosis, cancer, chronic infections)
  • cancer of lung, small intestine, brain, leukaemia
284
Q

Weber’s test

A

Normal = lateralizes equally to both ears

CHL= lateralizes to abnormal ear

SNHL= lateralizes to the normal ear

285
Q

Acute Otitis media risk factors

A
  • Age (6-18 months)
  • Lack of breastfeeding
  • Day care attendance
  • Smoke exposure
286
Q

Pathogens that give arise to acute otitis media

A
  • Streptococcus pneumoniae (most common)
  • Nontypeable (?) Haemophilus influenzae
  • Moraxella catarrhali
287
Q

Complications of Otitis media

A

Acute mastoiditis

288
Q

Acute mastoiditis initial treatment

A

sample from the ear discharge should be taken for culture DONE BY ENT

flucloxacillin + a third-generation cephalosporin

289
Q

Acute otitis media treatment

A
  • Amoxicillin 1st choice (used for 1 week)
  • 2nd line: amoxicillin-clavulanate
290
Q

Acute otitis media treatment px that’s allergic to penicillin

A
  • clindamycin
  • azithromycin
291
Q

Chronic suppurative otitis media treatment

A

Assess if tympanic membrane intact or perforated:
If intact: ciprofloxacin ear drops to treat on going infection
If perforated: initial treatment ear toilet with povidone-iodine solution, followed by
dry mopping with rolled toilet papers2 to 3 times a day using 20ml syringe with plastic tubing. In addition, ciprofloxacin ear drops

292
Q

Untreated a tympanic membrane perforation secondary to chronic otitis media

A
  • Marginal perforation with discharge
  • Perforation that is surrounded by granulation tissue
  • Continuously discharging central perforation
  • Perforation associated with a cholesteatoma
293
Q

Cholesteatoma risk factors

A
  • history of recurrent acute otitis media
  • chronic middle ear effusion
  • tympanostomy tube placement
  • history of cleft palate
294
Q

Lymph nodes red flags

A

Weight loss
Sustained fever
Night sweats Generalized lymphadenopathy
Signs and symptoms of pancytopenia
Mass persisting> 6 weeks
Lymph node> 3 cm
Thyroid mass
Supraclavicular mass
Hard, irregular mass
Fixed mass

295
Q

1 standard deviation above/below the 50th percentile

A

Weight: overweight/underweight

296
Q

2 standard deviation above/below the 50th percentile

A

Weight: obese/severely underweight

297
Q

Marfan’s syndrome (MFS) features

A
  • autosomal dominant connective tissue
    disorder (FBN1)
  • affects height
  • does not affect weight
  • aortic aneurysm
    dissection, aortic regurgitation (Decrescendo high-pitched diastolic murmur at the left sternal edge)
  • Myopia and ectopic ocular lens.
298
Q

Most common neurological symptoms in children with cancer

A
  • Nausea
  • Vomiting
299
Q

Most common neurological cancers in children

A
300
Q

Lymphadenopathy in children

A

viral upper respiratory tract infection

TB, Infectious
mononucleosis cytomegalovirus infection
Cat scratch disease
haematological and nonhematological malignancies, Kawasaki
disease.

301
Q

Growing pains

A

Growing pains refers to pain in the lower
extremities of growing active children.

children between 2 and 12 years with the peak
incidence in preschool children.

mostly felt in the thighs, calves and
behind the knee.

intermittent and in mostly present in the afternoon and evening after activity during the day.

Pain may also wake up the child at night.

302
Q

Perthes

A
  • avascular necrosis of the femoral head.
    4 -8 years of age
    associated with hip pain and intermitent limp.
303
Q

Transient synovitis

A
  • 3-8 years
  • URTI hx
  • sudden onset unilateral hip or groin pain most common sx
  • medial thigh or knee
    pain 2nd common sx
    Arthralgia and arthritis secondary to synovium inflammation
  • no fever, or only a mild fever
304
Q

Features of Epiglottitis

A

– H. influenzae
High fever, sore throat,
dysphagia, odynophagia,
drooling due to inability to swallow the saliva because swallowing
is painful and difficult.
child miserable adopts a tripod position with a hyperextended neck to maintain the airway open. Muffled voice (hot potato voice)
Lungs are clear on auscultation initiallt later expiratory stridor (ominous sign.)

305
Q

age of epiglottitis

A

more common between
ages 2 and 4 years;

306
Q

Foreign body

A

U/L wheeze

307
Q

Asthma in children definitive dx

A
  • 2 and 5 years
    -Bilateral wheezing
  • viral wheezing, pre-school wheeze, episodic viral wheeze and multiple
    trigger wheeze
308
Q

CXR in bronchiolitis

A

B/L perihilar infiltrates

309
Q

Croup management

A

mild: no treatment
moderate/severe:
-Dexamethasone 0.3 mg/kg orally (first-line);
- Prednisolone 1mg/kg orally, or
- Budesonide 2mg by nebulizer
most severe with significant airway obstruction/fatigue: Adrenaline 1% (1:100, 10mg/ml) solution 0.05ml/kg/dose

310
Q

Cervical masses in children

A
  1. Congenital
  2. Inflammatory/ infective
  3. Neoplastic
311
Q

Posterior triangle of the neck mass

A

CCP
- Cystic hygroma
- Cervical rib
- Pancoast tumour
- (Naso/oropharyngeal squamous cell carcinomas)

312
Q

Cervical masses in neonatal period

A
  • thyroglossal duct cyst (TDC)
  • teratomas
  • sternocleidomastoid tumours of infancy
  • vascular or lymphatic malformations.
313
Q

Anterior triangle of the neck mass

A

BCC
- Branchial cyst
- Carotid body tumour
- Carotid aneurysm

314
Q

Midline of the neck mass

A

**TTD **
- Thyroid nodule
- Thyroglossal cyst
- Dermoid cyst

315
Q

Acute rheumatic fever high risk population (JONES)

A

Major criteria:
- Carditis
-Polyarthritis
-Chorea.
-Subcutaneous nodules.
-Erythema marginatum
- Polyarthritis or aseptic mono-arthritis or
polyarthralgia

Minor criteria
-Fever more than 38c
-Previous rheumatic fever
-Arthralgia
-Raised ESR/CRP more than 30
-ECG shows prolonged PR interval

316
Q

Perthes features

A
  • 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
317
Q

Features of Acute rheumatic fever (ARF)/ erythema marginatum.

A

2 major and 2 minor criteria
- history of sore throat 3 weeks
-migratory arthralgia/arthritis
- Erythema marginatum - well demarcated bright red/pink macules rash

318
Q

Treatment of Perthes disease

A

Conservative: Splinting
Surgery: osteotomy

319
Q

Initial ARF dx

A

2 major criteria OR one major and two minor criteria + Evidence of preceding GAS infection

320
Q

recurrent attack of ARF dx

A

Two major criteria OR one major and two minor criteria OR three minor criteria + Evidence of preceding GAS infection

321
Q

ARF dx

A

Cultures for GAS are the gold standard (Throat swab)

322
Q

Most common cause of vaginal bleeding in children

A

vaginal foreign body

323
Q

Causes of vaginal bleeding in children

A
  • Vaginal foreign body
  • Severe vulvovaginitis
  • Trauma (including straddle injury and sexual
    abuse)
  • Excoriation associated with threadworms
  • Onset of first menstruation
  • Haematuria
  • Urethral prolapse
324
Q

Complications of thyroglossal duct cyst (TDC)

A
  • Infection
    -Malignancy 1%
  • Overgrowth and pressure of the underlying
    structures.
  • Rupture and fistula formation
325
Q

nonspecific vulvovaginitis

A
  • caused by chemical
    irritants such as bubble baths or by poor hygiene
  • stop bubble baths and use only cotton underwear
326
Q

Enuresis management in children

A
  • Spontaneous resolution <5 years (84%)
  • Bed wetting alarms >5 years and conservative methods (fluid
    intake, toileting, reward system) failed + wetting >2 per week
  • nasal desmopressin alternative bed wetting alarm.
327
Q

Gastroenteritis in children causes

A
  • Norovirus 95% aus
  • faecal–oral route
  • Contaminated food and water (cold meats)
  • 12 to 24/48 hour incubation period
  • noninflammatory, nonbloody, non-mucoid
328
Q

Norovirus Gastroenteritis in children dx

A

PCR stool

329
Q

Gastroenteritis in children clinical features

A

Common:
- Nausea
- Vomiting
- Diarrhoea
- Abdominal cramps

Not common:
- Headache
- Low-grade fever
- Chills
- Muscle aches
- Malaise

330
Q

Gastroenteritis in children management

A

Symptomatic

331
Q

Proteinuria in children

A

> 1+ protein on urine dipstick exam
- perform urinalysis for confirmation

332
Q

Causes of obesity in children

A
  • Hypothyroidism (check TSH)
  • Excessive caloric intake
  • Cushing’s disease (ACTH, cortisol)
333
Q

Acute mastoiditis pathogen

A

Streptococcus pneumoniae

334
Q

Autistic disorder features

A
  • preoccupations with activities
  • objects
  • delayed speech language development
  • Aggression and irritability
  • poor communication with friends and avoiding eye contact
335
Q

Characteristic features of autistic disorder

A
  1. Onset during infancy and early childhood
  2. Lack of socila interactions
    least two of the following:
    - No awareness of the feelings of others
    - No or abnormal comfort seeking in
    response to distress
    - No imitation
    - No social play
    - cannot socialize, (no eye contact )

3- Impaired communication
least one of the following:
- No babbling, gesture, mime or spoken
language
No non-verbal
communication
- abnormal form of
speech
- inability to make conversation
-abnormal speech

4- Restricted or repetitive activities, interests and
imaginative development, shown in at least one of
the following:
- stereotyped body movements
- persistent preoccupations and
rituals with objects or activities
- gets troubled over changes in routine or
surroundings
- No imaginative and symbolic play

5- Behavioral problems:
- tantrums
- hyperactivity
- risk-taking activity

336
Q

kidney scarring features in children

A
  • one kidney smaller than the other
337
Q

nutshell diagnosis of autistic disorder requires
the presence of core features by the
age of 3 years:

A
  1. Impairment of social interaction
  2. Impairment of communication
  3. Restricted, repetitive and stereotyped patterns of activities, behavior and interest
338
Q

kidney scarring investigation of choice in children

A

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
339
Q

Encoperesis

A

voluntary or involuntary passageof stools
- place
other than the toilet
- >1/month for 3months
- >4years

340
Q

Social & emotional developmental milestones

A
341
Q

Emotional development milestones

A
342
Q

Cognitive development milestones

A
343
Q

Language development milestones

A
344
Q

2 years child expected to

A
  • walking upstairs
  • Scribbling
  • points to body part
  • knowing 2 pronouns
    -Toilet trained
  • self feeding by spoon/cup
345
Q

8 months

A
  • sits without support
  • repeats syllables ‘mama/dada’
  • enjoys peekaboo
346
Q

9 months

A
  • crawls
  • stranger anxiety
347
Q

12 months

A
  • ‘Cruises’
    -thumb grasp
  • imitates speech with meaning
  • waves goodbye
348
Q

14 months

A
  • pulls string on toy
349
Q

15 months

A
  • neat pincer grasp
350
Q

18 months

A
  • walks without support
  • can build 2 tower blocks
  • say 3 words
  • drinks from cup
351
Q

2.5 years

A
  • runs/jumps
  • throws ball
  • build 4 blocks
  • 2 word sentences
352
Q

3 years

A
  • ride tricycle
  • copes vertical line/ circle
  • can use scissors
  • 3-word sentences
353
Q

4 years

A
  • learns bicycle
    -copies square
  • first and last name
  • dress with supervision
354
Q

5 years

A
  • hops on one foot
  • draw a person with 3 parts triangles
  • knows colours
  • dress without supervision
355
Q

Types of encoperesis

A

primary- child has never been
continent

secondary- previously
continent.

356
Q

With constipation and overflow
Incontinence:

A

<3/week bowel movements
-stool partially emptied remaining
- stool leak out, often during the child’s daily
activities.
- if constipation resolves encoperesis resoleves

357
Q

Encoperesis with No constipation overflow Incontinence:

A

there’s no constipation, and the child’s faeces have normal consistency. Unlike in cases associated with constipation and overflow, soiling of this type is intermittent. Feces may be emitted in
a prominent location (e.g., as an act of defiance) or
may be an unintentional consequence of anal selfstimulation (e.g., a variety of masturbation).
Encopresis without constipation and overflow
incontinence is less common than the first type of
encopresis, and is often associated with
oppositional defiant disorder and conduct disorder.
It has been estimated that 3% of children with
psychiatric issues may have encopresis.

358
Q

Oppositional Defiant Disorder (ODD) in Children

A
  • 10-12 years
359
Q

Conductive disorder

A
  • 12-18
360
Q

Bilateral sensorineural deafness in children

A

Congenital sensorineural deafness.

361
Q

‘hand, foot
and mouth (HFM) disease’

A
  • Self-limiting
  • Coxsackie A virus. - Erythematous macular rash,
    progressing to gray
    vesicles
    vesicles seen in buccal mucosa,
    gums and tongue.
  • doesn’t involve the buttocks and the genitalia
  • no scarring.

School Exclusion: until lesions dried up

362
Q

Features of partial seizures

A
  • no loss of consciousness
  • no pos ictus
363
Q

vertigo in children

A
  • CNS tumours (medulloblastoma)
  • temporal lobe epilepsy
364
Q

Absent seizures ion children

A
  • loss of consciousness
    -pos ictus
  • 30-60s duration
365
Q

Temporal lobe seizures in children

A
366
Q

Features of infantile spasms

A
  • 3-7 months
    sudden bending of the trunk and flexion of upper limbs
  • Corticosteroids (prednisolone) 1st line for 8 to 10 week. Vigabatrin
  • Clonazepam for acute presentation?
367
Q

BPPV child

A
  • variant of migraine
    preceeds - migraine in future
368
Q

Roseola infantum

A

exanthem subitum/sixth disease/three-day
fever

369
Q

Roseola infantum features

A

3 to 5 days of high
fever may exceed) 40°C.
fever resolves abruptly
macular papular rash (trunk extremities) after 3 days

370
Q

Roseola infantum causes

A

human herpes virus 7 (HHV-7),
enteroviruses (coxackievirus A and B, echovirus),
adenovirus, and parainfluenza virus type 1.

371
Q

Features of diarrhoea

A
  • opposite of vomiting
372
Q

Austin-Flint murmur

A

mid-diastolic
rumbling murmur best heard over the apex.
In Severe Aortic Regurgitation
In MFS

373
Q

MFS treatment

A

1st -beta blockers
2nd- verapamil, ACEinhibitors

374
Q

Marfan’s syndrome (MFS) investigation

A

echocardiogram

375
Q

most
common cause of failure to breastfeed?

A

Reduced frequency of
breastfeeding.

376
Q

ureteropelvic junction (UPJ)
obstruction features

A
  • most common cause
    of paediatric hydronephrosis
  • periodic abdominal pain with vomiting
  • exacerbation on UPJ can also lead to pelvic distention, flank pain or even tenderness
377
Q

COUGH

A

acute (<3 weeks),
subacute (3-8 weeks)
chronic or persistent (>8
weeks).

378
Q

ureteropelvic junction (UPJ)
obstruction diagnosis

A

US during painful episode

379
Q

Isolated thrombocytopenia features

A
  • following an URTI
  • acute (~90%) or chronic (~10%)
  • no pallor, lymphadenopathy
    or hepatosplenomegaly.
  • if platelets > 20 x 109/L: bed rest
  • if platelets < 20 x 109/L: oral steroids (prednisolone)
380
Q

Colon polyp

A
  • benign hamartomas
  • ages 2 and 8 years, peak at 3 to 4 years
  • mostly painless
    rectal bleeding
    palpable polyp
    on rectal examination >60%
381
Q

anal fissure

A
  • 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
382
Q

retinoblastoma

A
  • most common intraocular tumor in children
  • Leukocoria (white cornea or Cat’s eye)
    -strabismus
  • initial: US (intraocular calcification)
  • best dilated indirect
    ophthalmoscopic examination under anesthesia
383
Q

Chronic cough cause in children

A

asthma

384
Q

acute or subacute cause of cough

A

Post viral cough

385
Q

diagnosis and staging of the VUR.

A

Voiding cystoureterogram

386
Q

Bordetella pertussis (whooping cough) hospital admission

A
  • Infants less than 6 months of age
  • Any child with complications (i.e. apnoea,
    cyanosis, pneumonia, encephalopathy, pneumothorax)
387
Q

Bordetella pertussis (whooping cough) school exclusion

A

3 weeks start of symptoms
2 weeks start of cough
<5 days of antibiotics

388
Q

Choanal atresia features

A
  • failure of canalization of the bucconasal membrane.
    CHARGE SYNDROME
  • coloboma
  • heart defect,
  • atresia choanae
  • retarded growth
  • genital abnormality
  • ear abnormality
389
Q

CHARGE SYNDROME

A

-bilateral choanal atresia

coloboma
- heart defect,
- atresia choanae
- retarded growth
- genital abnormality
- ear abnormality

390
Q

Choanal atresia dx

A

pass nasogastric tube (also managment)
no use in giving oxygen

391
Q

Choanal atresia management

A

Mild hypoxemia: nasogastric tube
Severe hypoxemia: intubation and ventilation

392
Q

Noonan’s (Male Turner’s) syndrome features

A
  • Affects males
  • An autosomal disorder involving mutation in chromosome 11
  • Pulmonary valve stenosis
  • Webbed neck
  • Abnormalities in cardiac conduction and rhythm
  • flat nasal bridge
  • single palmar crease
  • protruding tongue
  • eyes that are apart more than usual
  • low set ears
393
Q

Perthes disease management

A
  • refer to surgeon

Surgeon will make call on conservative or surgical
- conservative: brace
- surgical: osteotomy/femoral head fixation, hip replacement worst case

394
Q

Transient synovitis

A
  • NSAIDs 48 hours
  • bed rest
395
Q

Developmental dysplasia (DDH) of the hip features

A
  • 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
396
Q

Developmental dysplasia (DDH) of the hip dx

A

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

397
Q

vesicoureteral reflux (VUR)

A

Grade I: Reflux into the nondilated ureter
2. Grade II — Reflux into the ureter and renal calyces without dilation
3. Grade III — Reflux with mild to moderate dilation
and minimal blunting of the fornices
4. Grade IV — Reflux with moderate ureteral
tortuosity and dilation of pelvis and calyces
5. Grade V — Reflux with gross dilation of ureter,
pelvis and calyces, loss of papillary impressions,
and ureteral tortuosity NEED SURGERY

398
Q

cyanosed baby + No murmur at birth

A

Transposition of great vessels

399
Q

vesicoureteral reflux (VUR) management

A

management depends on grading:

Grade I-IV: continuous antibiotics
Grade V: Surgery

400
Q

Tetralogy of Fallot (TOF)

A

4 defects
- blood going from left to right ( acyanotic)
- all have VSD (systolic murmur)
- pulmonary stenosis
- right ventricle hypertrophy
- overriding aorta

401
Q

Patent ductus arteriosus. (PDA)

A

-acyanotic
- pansystolic machinery murmur (harsh) at the left sternal border
- wide pulse pressure.
- Definite treatment surgical closure

402
Q

cyanosed baby + murmur at birth

A

Tetrology of fallot

403
Q

cyanosed baby + No murmur at 2-7 days of life

A

Hypoplastic left heart

404
Q

Ventricular septal defect (VSD)

A
  • holosystolic murmur at left sternal border
  • acyanotic
405
Q

Atrial Septal Defect (ASD)

A
  • 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

406
Q

Transposition of the great arteries (TGA)

A
  • 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
407
Q

Drugs closing ductus arteriosus

A

NSAIDS

408
Q

Drug keeping the ductus arteriosus open or patent

A

PGE2

409
Q

Idiopathic (immune) thrombocytopenic purpura (ITP)

A
  • preceding viral infection
  • s frequently < 20,000/μL
  • ## other lab tests normal
410
Q

Innocent murmur

A

7S
-soft
- systolic
- short duration
- sounds (S1 &S2)
- symptomless
- Special tests normal (X-ray, ECG)
- Standing/Sitting changes (not fixed) (increased when supine)

411
Q

Pathological murmurs

A

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.)
412
Q

murmurs that increase in
intensity when the venous return to the heart is
decreased:

A
  1. hypertrophic obstructive
    cardiomyopathy (HOCM)
  2. mitral valve prolapse
  3. venous hum (low-pitched continuous
    murmurs produced by blood returning from
    the great veins to the heart)
413
Q

most common
allergens that can cause allergy and asthma

A

dust mites 90%
sheepskin 2nd most common

414
Q

Duodenal atresia features

A
  • 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)
415
Q

2 months

A

social smile 6 weeks

416
Q

3 months

A
  • hold the neck
  • recognize mother’s face
417
Q

6 months

A
  • Sits without support
  • Rolls from prone to supine vice versa
  • palmar grasp
  • hand to hand transfer
  • turns head to loud noise
  • understands bye bye and no
  • puts object to mouth (stops at 1 year)
  • shakes rattle
    reaches for bottle/breast
  • Ability to explore things by holding, looking at them and putting them in mouth
418
Q

separation anxiety in child features

A
  • Want to stay at home with parents
  • Get upset about going to school
    aches or headaches, or do
    not feel well without a physical cause -Do not have any serious behavior problems
  • Do not try to hide their wish regarding not going to school from their parents
  • Are more likely to be the youngest memberof a family
419
Q

Bordetella pertussis (whooping cough) investigation

A

Children: Nasopharyngeal aspiration
Adults: nasopharyngeal swab

420
Q

Lobar Pneumonia in children

A
  • streptococcus pneumoniae
  • high fever
  • chest auscultation
    deceitfully normal
    -high fever
  • pallor
    -respiratory distress
421
Q

Oxygen saturation in children

A
  • > 93%
  • RR 50
422
Q

Bronchiolitis

A
  • acute LRTI <12 months (2 weeks to 9 months)
  • respiratory syncytial virus (RSV)
  • irritating cough and rhinorrhoea
  • distressed wheezing breathing
  • Hyper-inflated chest (barrel-shaped)
  • Use of accessory muscles and subcostal
    recession
  • fine inspiratory crackles
  • supportive with oxygen and hydration
  • bilateral perihilar congestion on X-ray (not necessary)
423
Q

Laryngomalacia in children

A
  • congenital softening of the tissues of the larynx
  • **noisy breathing ** worsens when agitated, feeding, crying or sleeping
    on back
  • High pitched sound
  • symptoms present at
    birth, can become more obvious within the first
    few weeks
  • outgrow by 18 to 20 months
424
Q

expiratory stridor

A
425
Q

inspiratory
stridor

A

suggests obstruction above the glottis.

426
Q

most common cause of failure to thrive

A

inadequate caloric intake

427
Q

Lobular (atypical) Pneumonia in children

A
  • fever is not often that high.
  • insidious onset
  • prodromal
    state
428
Q

Pneumonia in children investigation

A

initial step: chest X-ray (to see consolidation)

429
Q

Bronchiolitis management

A

100% oxygen via nasal prongs.
- severe bronchiolitis and requires rehydration
using intravenous fluids or nasogastric tube.

430
Q

tonsillectomy in children

A
  • Hemorrhage common complication, also life thereatening
  • bleeding may occur in the early post-operative
    period or may be as delayed as 5 to 10 days
  • bleeding secondary to tonsillar fossae infection
431
Q

post-tonsillectomy haemorrhage management

A
  • Resuscitation - 2 large bore cannula with
    bloods
  • Reservation of cross-matched packed red
    cells
  • IV antibiotics: with 1.2g Benzyl Penicillin, 6-hourly + 500mg of metronidazole, 12-hourly
  • NSAIDs
  • Hydrogen peroxide gargle - 20mls of
    hydrogen peroxide diluted with water in a
    ratio of 1:6.
432
Q

Hirschsprung disease (HD)

A
  • 15-20 % of newborn intestinal obstructions
  • 80% in the first 6 weeks of life
  • male > female
  • congenital anomaly by absence of ganglia in a segment of colon and paralysis of this aganglionic segment
    -starts at the anus and progresses up
    the rectum towards the colon. (Delayed meconium passage)
  • Failure to pass meconium in the first 24 hours but w/ gradual
    onset of abdominal distension of days to weeks.
  • Persistent and progressive constipation
    -Vomiting late
433
Q

Hirschsprung disease (HD) complication

A

enterocolitis

434
Q

Hirschsprung disease (HD) Dx

A

Rectal suction biopsy – Gold standard

435
Q

Hirschsprung Disease (HD) Mx

A
  • Laxatives (mild cases)
  • Surgery
436
Q

UTI in children investigation

A
  • suspect vesicoureteric reflux
  • < 3 years (2-36 months) US of the kidney, ureter & bladder
  • If US normal then voiding cystoureterogram (VCU)
437
Q

Renal scarring in children

A
  • Recurrent urinary tract infections (more than
    2 times during childhood)
  • Dimercaptosuccinic acid scintigraphy (DMSA) - Gold Standard
438
Q

DMSA indications

A
  • Clinical suspicion of renal injury
  • Reduced renal function
  • Suspicion of VUR
  • Suspicion of obstructive uropathy on ultrasound in older toilet-trained children
439
Q

UTI hospital admission indication

A
  • Most of children less than 3 months.
  • Children who are seriously unwell such as
    those with toxic appearance or
    dehydration.
  • Oral antibiotics cannot be tolerated.
440
Q

UTI in children

A
  • Fever, nausea, vomiting
  • abdominal pain
  • Leukocytes and nitrites on urinalysis
441
Q

slipped capital femoral
epiphysis (SCFE)

A
  • 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.
442
Q

slipped capital femoral epiphysis (SCFE) management

A
  • 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
443
Q

Henoch-Schönlein purpura (HSP) in children

A
  • Autumn, winter and spring months
  • IgA mediated vaculitis
  • anaphylactoid purpura
  • arthralgia (not arthritis),
  • non-thrombocytopenic purpura (the purpura is vascular due to leukocratic activity)
    -typical symmetrical distribution over legs and buttock.
  • colicky abdominal pain 2 to 4 weeks
  • melena
  • ankle swelling
  • nephritis
444
Q

Henoch-Schönlein purpura (HSP) in children Dx

A

-Clinical presentation + urinalysis for nephritis

445
Q

What Vitamin is given to babies after birth?

A
  • Vitamin K IM injection to avoid intercranial haemorrhage
446
Q

Aboriginal Australians are deficient in what vitamin

A

Vitamin D

447
Q

Abnormal UA in children

A
  • Asymptomatic microscopic hematuria
  • Repeat UA after fever settles if no UTI (2 positive UA)
448
Q

umbilical granuloma

A
  • most common umbilical mass
  • overgrowth of tissue during the healing process
  • soft pink or red lump
  • leaks small amounts of clear or yellow fluid
  • presence of non-purulent discharge
449
Q

umbilical granuloma management

A

topical silver nitrate
- cauterisation may need to be repeated at 3-day intervals if drainage persists

450
Q

Asthma short-acting beta2 agonist SABA

A

salbutamol

451
Q

Asthma LABA

A
452
Q

Infrequent Intermittent asthma in children

A
  • less than one episode of asthma in 6
    weeks and no symptoms in between the flare-ups
  • inhaled short-acting beta2 agonist
    (SABA)
453
Q

intestinal malrotation with volvulus

A
  • 6 months
    -bilious vomiting
  • crampy abdominal pain
  • abdominal distention
  • bloody, mucoid stool
454
Q

3 months

A
  • hold the neck
  • recognize mother’s face
455
Q

4 months

A
  • eye contact with people
  • look for mother when she speaks
  • happy or settled most of the time
    -follow activities with eyes
456
Q

Hypertrophic Pyloric Stenosis features in children

A
  • 2 and 6 weeks of age
  • gastric outlet narrowing
  • projectile vomiting a few minutes after feeding
  • non bloody, non bilious vomiting
  • delayed capillary refill > 2 seconds
457
Q

Hypertrophic Pyloric Stenosis risk factors in children

A

-Formula feeding
-Male
-Caucasian background
-Firstborn
-Maternal smoking during pregnancy
-Positive family history
-Both erythromycin and azithromycin < 2weeks

458
Q

Bacterial conjunctivitis in children

A
  • gonorrhoea: fast and aggressive (3 and 7 days after birth)
  • chlamydia: slow and less aggressive (end of 1st week - 1 month after birth)
459
Q

congenital adrenal
hyperplasia (CAH)

A
  • ## 21-hydroxylase deficiency
460
Q

congenital adrenal
hyperplasia (CAH) dx

A

Palpable gonads:
-Pelvic ultrasound
-Testosterone and dihydrotestosterone (DHT) ratio.
-LH and FSH.
-ACTH stimulation test.
-hCG stimulation test

No palpable gonads:
- markedly elevated 17-hydroxyprogesterone 90%
-Serum electrolytes.
-Plasma renin activity

461
Q

Hereditary angioedema

A
  • recurrent angioedema without pruritis in:
  • upper respiratory tract
  • gastrointestinal tract
  • subcutaneous tissues
  • autosomal dominant reduced C-1 esterase
    inhibitor levels (HAE type I) or poorly functional (HAE type II)
462
Q

post-streptococcal Glomerulonephritis (PSGN) in children symptoms

A
  • hypertension 50-90%
  • haematuria 30-50%
  • oedema 60%
  • Decreased complement (C3) levels
463
Q

post-streptococcal Glomerulonephritis (PSGN) management

A
  • Fluid restriction
  • Loop diuretics/dialysis
  • Steroids (caution, could be wrong)
464
Q

Meningitis management in children

A

CSF analysis/Lumbar puncture FIRST:
- turbidity
- low glucose (less than 1.7 mmol/L)
- elevated proteins
- elevated white cells (20 to 30 cells/microL)
- Gram stain may be negative 60%

> 7 days E. Coli most
common

IF signs of ICP (seizure, papilledema) then CT head

465
Q

Minimal Change Disease (MCD) in Children

A
  • nephrotic syndrome
  • <6 years
  • Absence of hypertension
    Absence of hematuria by Addis count
  • Normal complement levels
  • Normal renal function
466
Q

Nephrotic disease management

A
  • Corticosteroid (Prednisolone)
467
Q

Minimal Change Disease (MCD) in Children dx

A

1. Nephrotic range proteinuria-urinary protein excretion greater than 50 mg/kg per
day.
2. Hypoalbuminemia-serum albumin
concentration less than 30 g/L.
3. Edema.
4. Hyperlipidaemia

468
Q

Aortic coarctation in children

A
  • 90% of blood is shunted across ductus arteriosus (well tolerated)
  • low cardiac output and shock once the ductus arteriosus closes
469
Q

Aortic coarctation symptoms in children

A
  • hypotension,
  • cyanosis,
  • respiratory distress,
  • **shock with normal or weak upper extremity pulses **
  • absent femoral pulses
  • Metabolic acidosis is seen as compensation to respiratory alkalosis
  • prostaglandin E1 infusion to maintain a patent ductus
    arteriosus and surgical repair
470
Q

Kawasaki disease features

A
  • acute onset of fever more than 39C
    -inadequate response to paracetamol
  • sole, palm and tongue erythema
  • desquamation of fingertips (vasculitis)
  • tender mass in the right hypochondrium
  • elevated CRP and ESR
471
Q

Kawasaki disease in children management

A
  • aspirin and immunoglobulins
    -Steroids must be avoided
472
Q

Kawasaki disease in children complications

A
  • vasculitis leading to coronary artery aneurysm 17-31% (second week and second month
    of illness)
    -
473
Q

incidence of congenital heart disease in children

A

1 child: 2% to 6%
2 children: 20% to 30%

474
Q

most common congenital heart disease in infants?

A

Ventricular Septal Defect (VSD) 1 in 100 Australian infants

475
Q

Hepatoblastoma

A

-<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)

476
Q

most common cause of sinus bradycardia in
neonates

A

secondary to Respiratory failure and hypoxia

477
Q

anal fissure management in children

A
  • anusol cream (lignocaine)
  • pain for anal fissure is under control, laxatives and fibre diet
478
Q

anal fissure features

A
  • passage of hard stools
479
Q

Most common allergy in children

A

Food allergy 80%

480
Q

most common cause of short stature in children

A

Constitutional delay of growth and puberty
- lack of breast development-thelarche in girls above 13 years
- testicular volume less than 4ml by the age of 14 years

481
Q

Chronological age and bone age

A

-should be equal
- difference <2 years = normal (reassure)
- difference > 2 years = constitutional delay

482
Q

Unknown seizures

A
  • resistant to
    treatment with
    intravenous calcium
  • test Serum magnesium level
483
Q

Febrile seizures/ convulsions

A

Simple:
- duration of less than 15 minutes
- do not occur more than once in 24 hours

Complex seizures:
- MAY last for longer than 15 minutes
- recur in
the course of 24 hours

484
Q

6 weeks

A
  • good head control
  • head stabilises when sitting
  • track objects
  • startes at loud noise
  • social smile
485
Q

indications for preventer therapy in asthama

A

symptoms at night
>1 canister beta 2 aginists every 3mon
using beta 2 agonists >2days /week
asthma attacks >2/month
infrquent asthma attacks but severe
spirometry with reversible airflow obstruction

486
Q

Lymphoblastic leukaemia in children

A
  • Live-attenuated vaccines contraindicated (MMRV, rotavirus, yellow fever)
487
Q

Guillain-Barré syndrome in children

A
  • Campylobacter infection
  • 10 days after a nonspecific viral illness
  • acute polyneuropathy
  • progressive, mostly symmetric muscle weakness (days or weeks) beginning in the lower
    extremities and progressing toward the trunk
  • absent or depressed deep
    tendon reflexes
488
Q

Guillain-Barré syndrome dx in children

A
  • spinal fluid protein measurement (elevated protein 2x normal)
  • glucose and cell counts are normal
489
Q

Guillain-Barré syndrome management in children

A
  • observation (24-48 hours)
  • intravenous immunoglobulin,
    steroids, or plasmapheresis (respiratory failure)
490
Q

Charcot-Marie-Tooth disease in children

A
  • peroneal and intrinsic foot muscle atrophy (strange feet)
  • extending to the intrinsic hand muscles and proximal leg
491
Q

Fragile X syndrome in children

A
  • inherited disorder
  • Fragile X Mental Retardation 1 (FMR1) gene expansion
  • associated primary ovarian
    insufficiency & tremor ataxia syndrome
  • All males with the full mutation
  • Relative macrocephaly
  • Strabismus
    *Pale blue irises
    *Midface hypoplasia with sunken eyes
    *Arched palate
    *Mitral valve prolapse (seemingly benign)
    *Joint hyperlaxity (particularly of the thumbs, fingers, and wrists)
    *Hypotonia
    *Doughy skin over the dorsum of hands
    *Flexible flat feet
492
Q

Tay Sachs disease in children features

A
  • 2 to 6 months
  • Retinal cherry red spots 90%
  • progressive weakness and loss of motor skills
  • with hypotonia
  • hyperreflexia
  • retinal ganglion cells become distended with glycolipid
493
Q

Mumps meningitis in children

A
  • occurs in the post-pubertal male 25%, usually unilateral
  • Paramyxovirus isolated from CSF,
    saliva and nasopharynx
  • fever,
  • lethargy,
  • bilateral parotid swelling
  • parasternal oedema
494
Q

Mumps meningitis in children complications

A
  • Aseptic meningitis
  • testes causing orchitis, usually unilateral,
495
Q

most common cause of hyponatremia in children

A
  • diarrhoea
496
Q

hyponatremia in children

A

-Gastrointestinal fluid losses.
-Administration of hypotonic fluids.
-Severe infections-meningitis, encephalitis, pneumonia, bronchiolitis, sepsis etc can lead to SIADH

497
Q

persistent hyponatremia in children

A

– Congenital Adrenal Hyperplasia.
– Addison’s Disease.
– Psychogenic polydipsia.
– Obstructive uropathy

498
Q

Thumb sign in X-ray

A

Acute epiglottitis
- intubation at hospital

499
Q

Tics in children

A
  • also known as habit spasms
  • individually recognisable, intermittent movements
  • aware in the urge to perform the movement
  • blinking,
  • facial grimacing,
  • shoulder shrugging,
  • head jerking
500
Q

best method of anaesthesia for neonatal circumcision

A

Dorsal penile nerve block

501
Q

Tetanus vaccinations in children

A
  • 3 vaccinations at 2,4 and 6 months
  • 1st booster at 4 years
  • 2nd booster between 12-17 years
502
Q

Clean laceration tetanus

A
  • no immunoglobulins required
  • check to see vaccination status and vaccinated in indicated
503
Q

Dirty laceration tetanus

A
  • immunoglobulins required
504
Q

Oral polio vaccine (OPV) in children

A

Preterm babies should not get vaccinated until after leaving hospital (might spread the live vaccine virus to other babies in the hospital)
- inactivated polio vaccine can be used instead

505
Q

Epiglottitis treatment

A
  • supplemental oxygen
  • intubate
506
Q

Hydrocele in children

A
  • scrotal swelling
  • A bluish discoloration of the skin if the hydrocele is large.
  • Fluctuation in the size of the swelling (mainly in infants).
  • The area of the hydrocoele is clearly defined.
  • Hydroceles are not painful but may cause discomfort if they are large.
507
Q

Hydrocele in children management

A
  • wait until 18 months (resolve spontaneously)
  • surgery if not resolved after 18 months
508
Q

Hydrocele in children investigation

A

positive transillumination test

509
Q

Hyponatraemic seizures in children

A
  • increasing irritability
  • increasing lethargy, - increasing tonic-clonic generalised
    seizures
  • respond poorly to conventional anticonvulsants (phenytoin, phenobarbitone)
  • address hyponatraemia by 3% NaCl solution
510
Q

cystic fibrosis in children

A
  • autosomal recessive
  • 1:3700
  • Sweat chloride test
  • DNA testing (CFTR) diagnostic 72%
511
Q

Kernicterus in children

A

pathogenic sign of bilirubin staining of the brain stem nuclei and
cerebellum

– Athetoid cerebral palsy with or without seizures.
– Developmental delay.
– Hearing deficit.
– Oculomotor disturbances including paralysis of upward gaze.
– Dental dysplasia.
– Intellectual impairment.

512
Q

Febrile seizures/ convulsions management

A

If seizure is of short duration and doesn’t reoccur = reassurance
if the following situations:
1. A child with a pattern of prolonged seizures (usually longer than ten mins.) which
have previously responded to intravenous or rectal diazepam.
2. A child with clusters of repeated seizures in whom oral treatment is inappropriate.
3. A child with severe epilepsy who is remote from emergency services.
=
Rectal diazepam

513
Q

Duchenne’s muscular dystrophy in children

A
  • X-linked recessive trait
  • after
  • deficiency of dystrophin
    beginning to walk features become more evident
  • Pseudohypertrophy limited to the calf muscle
  • hip girdle weakness at 2 years
  • Gower sign (use of the hands to “climb up” the legs in order to assume the upright position) at 3-5 years
  • use of a wheelchair after 12 years
  • mental impairment and cardiomyopathy
  • Death respiratory failure, heart failure, pneumonia, or aspiration
514
Q

Neonatal hypoglycaemia features

A
  • Mid-line defects (Congenital pituitary deficiency)
  • Hepatomegaly (glycogen storage diseases and fatty acid oxidation
    disorders)
  • Micro penis (congenital gonadotropin deficiency, possible pituitary, cortisol deficiency)
    abnormalities
  • Macrosomia (maternal history of
    gestational diabetes)
515
Q

benign haemangioma

A
  • strawberry naevus
  • around 1 to 4 weeks of age, then get bigger, for a few months
  • stop growing between 6-12 months
  • gradually disappear over the next few years
  • if naevus at eyes, nose, ears or trachea then laser therapy
  • If anywhere else, then observation
516
Q

most common cause of jaundice in a neonate
within 24 hours after birth?

A

Haemolysis due to ABO incompatibility
- always pathological

517
Q

bronchiolitis high risk of airway compromise

A
  • Infants younger than 3 months of age
  • Preterm or low birth weight infants.
    – Infants with chronic lung disease.
    – Infants with congenital acyanotic heart disease.
518
Q

Brain tumours in children

A
  • account for 25% -
    30% of all paediatric malignancies
  • 1 to 10 years infratentorial (posterior fossa)
  • After 10 years of age, supratentorial tumour’s (eg, diffuse astrocytoma)
519
Q

bacterial balanitis ( bacterial infection of the
foreskin) treatment

A
  • topical antibiotics mupirocin
  • mild inflammation without pus or other signs of cellulitis = topical
    steroids
520
Q

infratentorial tumours in children

A

cerebellar and brainstem tumours (medulloblastoma, cerebellar astrocytoma)
- ICP
- nausea
- vomiting,
- ataxia,
- vertigo,
- papilloedema
- Cranial nerve VI to X palsies

521
Q

supratentorial tumours in children

A
522
Q

Seborrheic dermatitis in children

A
  • Erythema toxicum 50% of term newborns
  • commonly greasy, scaly, and erythematous rash
  • face, neck, axilla, and diaper area
523
Q

Mongolian spot in children

A
  • a bluish-grey lesion over
    buttocks, lower back, and occasionally extremities extensor surfaces
  • blacks, Asians, and Latin Americans
  • tend to disappear by
    1 to 2 years
524
Q

Meningitis in children features

A
  • < 1 month old
  • fever
  • poor feeding
  • jaundice
  • bulging fontanelle
  • seizures
  • nuchal rigidity
  • irritability/lethargy
  • Usually GBS
525
Q

Sickle cell anaemia in children

A
  • pneumonia,
  • pulmonary thromboemboli
  • sepsis

NOTE: with sickle-cell anaemia, these can be rapidly progressive and quickly fatal
- require hospitalisation

526
Q

Bacterial conjunctivitis in children school exclusion

A
  • Excluded until discharge has resolved
527
Q

Hypernatremia in children

A
  • “doughy” skin
  • Isotonic (normal) saline for an initial bolus
528
Q

Diaphragmatic hernia in children

A
  • Mortality 50%
  • transmittal of abdominal contents across a
    congenital or traumatic defect in the diaphragm
  • profound respiratory distress
  • birth at a tertiary-level
    centre
  • scaphoid abdomen
  • bowel sounds in the chest
529
Q

Diaphragmatic hernia in children management

A
  • high-frequency oscillatory ventilation
  • extracorporeal membrane oxygenation (ECMO)
530
Q

Addison’s disease in children

A
  • hyponatraemia with hyperkalaemia
  • 21-hydroxylase deficiency
  • Dehydration, hypotension, and shock
531
Q

Opioid intoxication in children

A

maternal analgesic narcotic drug (meperidine)
- depression of the newborn via crossing of the placenta
- administration
of naloxone, 0.1 mg/kg, IM, IV, or endotracheal

532
Q

Rickets in children

A
  • failure of bone mineralization
  • Vitamin D deficiency
  • a flattened occiput
  • prominent forehead
    -significant dental caries,
  • bumpy ribs
  • bowed extremities
533
Q

Tay Sachs disease in children investigation

A

Fundoscopy: retinal cherry red spots in 90%

534
Q

Tay Sachs disease in children blood test

A

Hexosaminidase A & B enzyme

535
Q

Down syndrome in children

A
  • 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
536
Q

Vitamin C deficiency

A
  • irritability
  • low-grade fever
  • swelling
  • tachypnoea
  • and poor appetite
  • impaired wound healing
  • diffuse tenderness, worse in legs
537
Q

Idiopathic (immune) thrombocytopenic purpura (ITP) in children management

A
  • If not bleeding: monitoring/observation
  • If bleeding: IVIG and corticosteroids (prednisone)
538
Q

Pulmonary hypoplasia

A
  • Oligohydramnios
  • Kidney US (bilateral renal agenesis)
539
Q

Turner Syndrome features

A
  • Affects females
    -Madelung deformity
  • short stature,
  • webbed neck
  • low-set ears
  • low hairline at the back of the neck
  • epicanthal folds
540
Q

prominent ulnar head and apparent volar subluxation of the wrist on the forearm

A

Madelung deformity

541
Q

Turner Syndrome complications

A
  • aortic coarctation
  • Complete atrioventricular septal defect (CAVSD) – 37 percent
  • Ventricular septal defect (VSD) – 31 percent
  • ASD – 15 percent
  • Partial atrioventricular septal defect (PAVSD) – 6 percent
  • Tetralogy of Fallot (TOF) – 5 percent
  • PDA – 4 percent
542
Q

DTPa minimum dose
duration

A

4 weeks
- booster doses 10 years and 20 years after primary course

543
Q

Klumpke paralysis

A
  • C7, C8 & T1 injury
  • affects elbow
  • hand palsy
544
Q

Vitamin A deficiency

A

night blindness
drying of the conjunctivas and sclera
dry skin
Poor growth and impaired cognition

545
Q

Acute disseminated encephalomyelitis (ADEM)

A

autoimmune-demyelinating
<10 years of age
preceeding URTI
high-dose corticosteroids to treat

546
Q

Neurocysticercosis (NCC)

A
  • raw meat consumption
  • Tapeworm Taenia solium
  • MRI single focal white matter lesions
  • Blood test serology
  • Albendazole
547
Q
A
548
Q

ABO hemolytic disease in this infant

A

positive direct Coombs test

549
Q

Coombs test

A

Direct = autoimmune haemolytic anaemia
Indirect = antibodies in blood to see if there’s reaction to blood transfusion

550
Q

Phenylketonuria,

A
  • autosomal recessive
  • absence of an enzyme that metabolizes
    phenylalanine to tyrosine
    mental retardation
  • Treatment consists of a diet that maintains phenylalanine at levels low enough to
    prevent brain damage but adequate to support normal physical and mental
    development.
551
Q

Galactosemia in children

A
  • galactose-l-phosphate uridyl transferase enzyme deficiency
  • ## serious damage to liver, brain, and eyes after being fed lactose milk
552
Q

Galactosemia in children symptoms

A

-lethargy,
vomiting and diarrhoe,
-hypotonia,
-hepatomegaly
- jaundice (liver failure)
-failure to thrive
- cataracts

553
Q

Biotinidase

A

autosomal
recessive trait
dermatitis, alopecia, ataxia,
hypotonia, seizures, developmental delay, deafness, immunodeficiency, and
metabolic acidosis
Treatment is lifelong administration of free biotin.

554
Q

Galactosemia in children treatment

A
  • elimination
    of lactose-containing milk from the diet
  • exclusion of foods that contain casein, dry milk solids, whey, or curds
555
Q

Holt-Oram syndrome

A

hypoplastic radii, thumb abnormalities, and cardiac anomalies.
pectoralis major muscle is missing

556
Q

Edwards syndrome in children

A
  • Mortality is 50% in the first week and 90% in the first year
  • low-set ears,
  • a prominent
    occiput,
  • a short sternum,
  • a closed hand with overlapping fingers,
  • cardiac defects,
    rocker-bottom (rounded) feet,
  • cleft lip and/or palate
557
Q

maternal infection with mumps or rubella virus

A

may produce aqueductal stenosis hydrocephalus

558
Q

Müllerian agenesis

A
  • Female gonads do not secrete Müllerian-inhibiting factor (MIF)
  • Male testes secrete MIF
  • empty scrotum
  • testes are impalpable in inguinal canal
559
Q

Pseudohematuria

A

beets, blackberries, and rhubarb
chloroquine
metronidazole
phenytoin
rifampinsulfasalazine

560
Q

Night terrors

A
  • 5 and 7 years
  • awaken suddenly, appear frightened and unaware of surroundings
  • cannot recall the
    event in the morning
  • Sleepwalking is common
  • reassurance
561
Q

Prader willi syndrome

A
  • hypotonia, hypogonadism
  • hyperphagia after the newborn period - hypomentia
  • obesity
  • deletion of a
    portion of chromosome 15
  • Feeding difficulties and failure to thrive in 1st year
  • defect in the satiety center in the hypothalamus.
  • Stringent caloric
    restriction is the only known treatment
562
Q

Tonsillitis management

A
  • Perform throat swab+ start antibiotics
  • If swab+ve = continue antibiotics
  • if swab-ve = discontinue antibiotics
563
Q

Retropharyngeal abscess

A
  • inflamed prevertebral soft tissue
  • inability to extend the neck
  • lateral neck film demonstrates a widened prevertebral soft tissue strip
  • typically not present with airway compromise and hypoxia
564
Q

Staphylococcal scalded skin syndrome

A

known as Ritter disease
commonly in children less than 5 years of age
fever,
irritability, erythema,tender skin
Circumoral
erythema
crusting of the eyes, mouth, and nose
blisters on the skin
Postive Nikolsky sign- Peeling of the epidermis in
response to mild shearing forces

565
Q

Abetalipoproteinemia in children

A
  • Microsomal triglyceride transfer protein (MTP) gene mutation
  • impaired VLDL formation
  • decreased
    vitamin E delivery to PNS/CNS
    -
566
Q

Tanner stages

A

I:
- 0–15 years
- None
II:
- Commencement of puberty
-8–15
- Pubic hair first, along with breast budding
- Scrotal/Testicular growth, penis growth after a year
III:
- Increase in hair and pigmentation

567
Q

Parvovirus B19

A
  • Fifth disease (erythema infectiosum)
  • Low haemoglobin patients with
    haemolytic conditions (such as sickle-cell anaemia) thus develop a transient aplastic
    crisis
  • poorly functioning bone marrow (for a week or more)
568
Q

Laurence-Moon-Biedl syndrome

A
  • autosomal
    recessive
    -Obesity
  • mental retardation
  • hypogonadism
  • retinitis
    pigmentosa with night blindness
  • polydactyly
569
Q

Fröhlich syndrome

A
  • adiposogenital dystrophy
  • obesity associated with a hypothalamic tumour
570
Q

Pseudohypoparathyroidism

A

(low serum calcium and high serum phosphorus
levels
- high
levels of endogenous parathyroid hormone
short,round-faced, and mildly retarded.
- Metacarpals and metatarsals are shortened
- subcutaneous and basal ganglia -
- calcifications
- cataracts can be present.
- Treatment: large doses of vitamin D and reduction of the
phosphate load.

571
Q

Duchenne dystroph

A
  • Pseudohypertrophy routinely is limited to the calf muscles
  • lordotic posture as weakness evolves in the hip girdle
    musculature
  • ## waddling gait
572
Q

normal infants show the following

A
  • Coarse, tremulous movements accompanied by ankle
    clonus
  • harlequin color change (a
    transient, longitudinal division of a body into red and pale halves)
    softness of
    parietal bones at the vertex (craniotabes)
    a liver that is palpable down to 2 cm
    below the costal margin
573
Q

septic arthritis in children

A
  • S aureus
  • joint aspiration
574
Q

congenital motor neuron disease in newborn/infant

A

Werdnig-Hoffmann disease
hypotonia, and muscle atrophy
Anterior horn cell
disease

575
Q

congenital motor neuron disease in older children

A

Kugelberg-Welander disease
Anterior horn cell
disease
hypotonia, and muscle atrophy

576
Q

Wiskott-Aldrich syndrome

A
  • X-linked recessive
  • Thrombocytopenia
  • Eczema
  • Increased susceptibility to infection
  • bloody diarrhea and easy bruising
  • impaired humoral
    immunity
  • low serum IgM and a normal or slightly low IgG
  • low T cells and lymphocyte
  • Few live past their teens, frequently succumbing to malignancy caused by
    EBV infection.
577
Q

Adenosine deaminase (ADA)
deficiency

A
  • Type of severe combined immunodeficiency (SCID)
  • Lymphopenia from birth
  • Platelets are not affected
578
Q

Autosomal dominant

A

Most are affected: males and femailes

579
Q

Autosomal recessive

A

A few are affected: males and females

580
Q

X- linked recessive

A

A few are affected: only males

581
Q

Toxic shock syndrome (TSS) in children

A
  • S aureus
  • “menstrual” TSS (associated with
    intravaginal devices like tampons, diaphragms, and contraceptive sponges)
  • “nonmenstrual” TSS associated with pneumonia
  • skin infection
  • bacteremia
  • osteomyelitis
582
Q

List of autosomal dominant diseases

A

D -dystrophy myotonia
O - osteogenisis imperfecta
M - Marfan’s
I - intermittent porphyria
N - Noonan’s
A - achondroplasia, familial adenomatous polyposis (FAP)
N - neurofibromatosis
T - Tuberous sclerosis

V- Von Willebrand
H - Huntington’s HNPCC
H - hereditary spherocytosis
H- familial hypocholesteraemia
R - retinoblastoma

583
Q

List of autosomal recessive diseases

A

A - albinism
B - thalassaemia
C - cystic fibrosis
D - deafness
E - emphysema
F - Friederich’s ataxia (trinucleotide test, repeat GAA)
G - Gaucher’s disease
H Hemochromatosis, homocystinuria

S - sickle cell
P - phenylketonuria
N - Wilson’s
X - xeroderma pigmentosa

584
Q

List of X-linked recessive diseases

A

D- diabetes insipidus
D - Duchenne’s
C - colour blindness
C - chronic granulomatous disease (membranous type)
F - Fabry’s disease (alpha- glucosidase deficiency)
F - fragile X syndrome (Martin Bell Syndrome)
2 blood - haemophilia. G6PD
2 syndrome Lesch Nylon syndrome, Wiskots Aldrich yndrome

585
Q

Toxic shock syndrome (TSS) in children treatment

A

Antibiotics against S aureus (penicillin)

586
Q

Epstein-Barr virus (EBV) in children

A

PE:
- diffuse adenopathy
- tonsillar enlargement
- enlarged spleen
- small haemorrhages on the soft palate
- periorbital swelling
Blood:
- predominance of atypical lymphocytes with at least 10%
- heterophil antibodies present (may not be present in young
children)

587
Q

Epstein-Barr virus (EBV) in children management

A
  • Self-limiting symptomatic management
  • avoid contact sports to protect spleen
588
Q

VATER/VACTERL

A

V- vertebral defect,
A- anal atresia,
C- cardiac defects,
TE- tracheoesophageal fistula
-R renal/radial defect
L- limb defects

589
Q

Undescended testes

A

descend into the scrotum during the
first two weeks of life
- the descent is unlikely to take place after the age of 1year
- 20 percent of premature males
- Orchidopexy is best performed by 12-18 month
- 5-10 times greater risk of developing a malignancy

590
Q

Hx of travel to South Asia + fever + dry cough + dull frontal headache + gastroenteritis

A

Salmonella Typhi

591
Q

Acute rheumatic fever treatment

A
  • benzathine penicillin IM
    -Roxithromycin if allergic to penicillin/NSAIDs
592
Q

Autism treatment

A

Atypical antipsychotics (Risperidone)

593
Q

tachycardia + sunken eyes + >3 sec capillary resuscitation

A

severe dehydration

594
Q

severe dehydration management

A

10-20ml/kg boluses of 0.9% normal saline

595
Q

inguinal hernia ‘6-2’ rule

A

birth to 6 weeks, surgery is recommended within 2 days, 6 weeks to 6 months-surgery within 2 weeks and over 6 months surgery within 2 months

596
Q

Most common organism causing ophthalmia neonatorum

A

Chlamydia trachomatis
- notifiable disease

597
Q

ophthalmia neonatorum treatment

A

oral erythromycin and sulfacetamide eye drops

598
Q

< 6 months + > 7 days fever + systemic
inflammation but no other explanation for febrile illness

A

Atypical Kawasaki

599
Q

Salmonella Typhi treatment

A
  • South/South East Asia: azithromycin 1 g (child: 20 mg/kg up to 1 g)
    Not India: ciprofloxacin 500 mg
600
Q

infant < 2 years + low-grade fever + abdominal distension + loss of appetite + limb pain + abdominal mass that crosses the midline

A

Neuroblastoma
- originates from adrenal glands

601
Q

3-4 years of age + kidney claw sign + abdominal mass does not cross midline

A

nephroblastoma (Wilm’s tumour)

602
Q

Early onset neonatal sepsis risk factors

A

– Maternal group B streptococcus colonization in current pregnancy.
– A previous baby with GBS infection.

603
Q

Late onset neonatal sepsis risk factors

A

– Artificial ventilation with an endotracheal tube.
– Extreme prematurity.
– Total parenteral nutrition.
- Central catheter

604
Q

Coeliac disease assessment

A

gluten challenge for 4-6 weeks and then should have coeliac serology performed

605
Q

Hypoglycaemia IV infusion

A

2ml/kg of 10% dextrose IV

606
Q

Diabetic ketoacidosis in a young patient

A
  • type 1 diabetes mellitus
  • autoimmune (diseases celiac, autoimmune thyroiditis)
607
Q

HPV contraindications

A
  • egg and yeast allergy
608
Q

adolescent + fever >38.5C + ↑WBC, ESR, CRP + Acute painful, tender and warm joint + limited movement + refusal to bear weight

A

Septic arthritis

609
Q

septic arthritis management

A
  • Joint drainage & debridement
  • IV antibiotics
  • orthopaedic surgeon referral
610
Q

UTI in children Managment

A

1st line: trimethoprim
cephalexin

611
Q

Hypertrophic Pyloric Stenosis in children mananament

A

Initial: Fluid resuscitation
Best: Ramstedts Pyloromyotomy

612
Q

Indication for urgent referral in children

A
  • Green vomiting: gangrene of
    the bowel
613
Q

male adolescent athlete + pain below the knee + tenderness

A

Osgood-Schlatter disorder

614
Q

Osgood-Schlatter disorder management

A

Gentle quadriceps stretching exercises
- self limiting up to 12 months

NOTE: Corticosteroids are absolutely contraindicated

615
Q

Growth investigations to consider prior to referral

A
  • FBC
  • urea & electrolytes
  • ESR
  • Coeliac serology

NOTE: GH is pulsatile therefore not diagnostic

616
Q

strawberry like red mass on cheek

A

infantile haemangioma

617
Q

infantile haemangioma management

A

reassure
-Gradual regress in size

618
Q

Immediate management of acute meningitis in chidren

A

-Airway, Breathing, Circulation, Disability, Exposure (Primary Survey).
-Obtain immediate intravenous access (an intraosseous needle may be required).
-Administer intravenous dexamethasone (0.15 mg/kg).
-Intravenous ceftriaxone (100 mg/kg).
-Take blood cultures.

619
Q

causes of iron deficiency anaemia in
children

A

– Excessive intake of cow’s milk.
– Prematurity.
– Low birth weight.
– Coeliac disease.
– Lead poisoning.

620
Q

< 8 girl + tall + pubic hair & breast development Tanner stage 3 + inappropriate sexual behaviour

A

Precocious puberty

621
Q

Precocious puberty investigation

A
  • serum FSH & LH estradiol
  • MRI
  • Bone age
622
Q

UTI in infants < 1 year

A
  • 1st: US
  • micturating cystourethrogram (MCU): rule out vesicoureteric reflux
623
Q

vulvovaginitis management in children

A

no voiding difficulties: reassure
voiding difficulties: topical oestrogen or oestradiol cream applied twice daily
severe obstruction to urinary flow with retention or recurrent infections: Manual or surgical separation

624
Q

Neisseria gonorrhoea infection in a child

A

Vaginal non-bloody pus-like discharge 95%

625
Q

dry eyes and mouth + low urine output + dilated pupils + decreased bowel sounds/constipation + sinus tachycardia + QRS interval
prolongation

A

anticholinergic toxicity (TCA)

626
Q

anticholinergic toxicity (TCA) managment

A

Sodium bicarbonate Sodium bicarbonat

627
Q

Most common long-term complication of streptococcus pneumonia meningitis in children

A

Deafness 11%

Intellectual disability (mental retardation)-4%.
-Spasticity and/or paresis-4 %.
-Seizure disorder-4 %

628
Q

Expiratory wheeze + RSV URTI + barking cough

A

Croup

629
Q

Relationship between ADHD & ODD

A

In more than 50% of px with ADHD, ODD is also a part of the clinical picture

630
Q

Oppositional Defiant Disorder (ODD) in Children Treatment

A

1st line: Antipsychotics (risperidone)
2nd line: mood stabilisers (sodium valproate) SSRIs

631
Q

Henoch-Schönlein purpura (HSP) in children complication

A

Intussusception (due to intestinal oedma and bleeding)

632
Q

Eye Discharge

A

1st day - chemical irritation
6 days - Gonorrhoea
14 days- Chlamydia

633
Q

IgA deficiency

A

increased frequency
* bronchitis,
* chronic diarrhoea,
* conjunctivitis
* otitis media in children

634
Q

Babies are at increased risk of contracting meningitis or septicaemia

A

(a)they are low birth weight.
(b)premature.
(c)born after prolonged labour.
(d)premature rupture of membrane.

Streptococcus B Group

635
Q

Erythema infectiosum

A

Fifth disease
Parvo B 19
slapped cheek
macular papular rash
Myalgia / Arthralgia

AMC MCQ (50 decks)

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