One last push

Question 1

What are Thrombolysis contraindications

Answer 1

• ICP neoplasm
• Active bleeding
• GI bleeding within 3 weeks

Question 2

How do triptans work ?

Answer 2

• 5-HT agonists

Question 3

What are contraindications for triptans ?

Answer 3

• IHD
• Cerebrovascular disease

Question 4

5. What are common side effects of triptans ?

Answer 4

• Flushing
• Chest and throat tightness
• Tingling

Question 5

6. What is ALL ?

Answer 5

• Acute lymphoblastic leukaemia
• The most common malignancy in children

Question 6

7. ALL features that suggest bone marrow failure

Answer 6

• Anaemia – lethargy and pallor
• Neutropenia – frequent or severe infection
• Thrombocytopenia: easy bruising, petechiae
• Bone pain

Question 7

8. Other features of ALL

Answer 7

• Bone pain
• Splenomegaly
• Hepatomegaly
• Fever
• Testicular swelling

Question 8

9. Types of ALL

Answer 8

• Common ALL (75%) CD10 present, pre-B phenotype
• T-cell ALL (20%)
• B-cell ALL (5%)

Question 9

10. Poor prognostic factors of ALL

Answer 9

• Age <2 or > 10 years
• EBC > 20*10(9)/l at diagnosis
• T or B cell surface markers
• Non-Caucasian
• Male sex

Question 10

11. When is jaundice pathological in a newborn ?

Answer 10

• First 24 hours

Question 11

12. Causes of pathological jaundice

Answer 11

• Rhesus haemolytic disease
• ABO haemolytic disease
• Glucose-6-phosphodehydrogenase

Question 12

13. What could jaundice developing between 2-14 days be ?

Answer 12

• Physiological
• More fragile red blood cells
• Less developed liver function
• More common in breastfed babies

Question 13

14. When does jaundice become prolonged ?

Answer 13

• 14 days in term
• 21 days in preterm

Question 14

15. Prolonged jaundice investigations

Answer 14

• Conjugated and unconjugated bilirubin
• Coomb’s test
• TFTs
• FBC and blood film
• Urine
• U&E and LFTs

Question 15

16. Causes of prolonged jaundice

Answer 15

• Biliary atresia
• Breast milk jaundice
• Prematurity
• Congenital infection
• UTI

Question 16

17. What is a big worry with jaundice in newborns ?

Answer 16

• Kernicterus
• Bilirubin levels so high it becomes neurotoxic

Question 17

18. Surgical management of biliary atresia

Answer 17

• Kasai procedure

Question 18

19. What causes bronchiolitis ?

Answer 18

• MCC RSV
• Adenovirus

Question 19

20. Features of Bronchiolitis

Answer 19

• Coryzal symptoms and fever precede
• Dry cough
• Increasing breathlessness
• Wheezing with find inspiratory crackles
• Feeding difficulties

Question 20

21. Call 999 if

Answer 20

• Apnoea
• Child looks unwell to a HCP
• RR of more than 70
• Grunting or marked chest recession
• Central cyanosis
• Oxygen sats below 92%

Question 21

22. Bronchiolitis investigate

Answer 21

• Immunofluorescence of nasopharyngeal secretions which will show RSV

Question 22

23. Management of bronchiolitis

Answer 22

• Humidified oxygen given via a headbox if below 92%
  NG feeding if child cannot take enough fluid
• Suction for upper airway secretions

Question 23

24. When is it more likely viral induced wheeze than asthma ?

Answer 23

• Presenting before 3
• No atopic history
• Only occurs during viral infections

Question 24

25. What are fibroids ?

Answer 24

• Benign smooth muscle tumours of the uterus
• Develop in response to oestrogen

Question 25

26. Features of symptomatic fibroids ?

Answer 25

- Menorrhagia - Bulk related symptoms  Lower abdominal pain, cramping pains - Bloating and urinary symptoms - Subfertility

Question 26

27. Diagnosis of fibroids

Answer 26

- Transvaginal ultrasound

Question 27

28. Management of symptomatic fibroids (typically menorrhagia

Answer 27

- Levonorgestrel intrauterine system - NSAIDs e.g. mefenamic acid - Tranexamic acid - COCP - Oral progesterone - Injectable progesterone

Question 28

29. Treatment to remove or shrink fibroids

Answer 28

- GnRH agonists - Surgical – myomectomy - Hysteroscopic endometrial ablation - Uterine artery embolization

Question 29

30. Endometriosis

Answer 29

- The growth of ectopic endometrial tissue outside the uterine cavity

Question 30

31. Features of endometriosis

Answer 30

- Chronic pelvic pain - Secondary dysmenorrhea – pain starts days before bleeding - Deep dyspareunia - Subfertility

Question 31

32. Gold standard investigations

Answer 31

- Laparoscopy is gold standard

Question 32

33. Management of endometriosis

Answer 32

- NSAIDs or paracetamol 1st line - COCP or progesterone’s

Question 33

34. Paed UTI management

Answer 33

- Less than 3 months then admit - More than 3 months with upper UTI should be considered or given cephalosporin or co-amoxiclav 7-10 days - More than 3 months and lower UTI then trimethoprim - Bring back if still unwell 24-48 hours

Question 34

35. Pathophysiology of VUR

Answer 34

- Ureters are displaced laterally entering the bladder in a more perpendicular fashion than at an angle - Therefore shorter intramural course of the ureter - Vesicoureteric junction cannot therefore function adequately

Question 35

36. Vesicoureteric Reflux investigations

Answer 35

- Micturating cystourethrogram - DMSA scan can look for scaring