OPIC, cancer, paeds Flashcards
Delirium vs dementia
Delirium:
- reversed sleep wake cycle
- acute onset
- fluctuating consciousness
- no autonomic features
Screening tools for pressure ulcers
waterlow
braden
Northton
Grades for pressure ulcers
- non blanching erythema
- partial thickness loss of epidermis/dermis
- full thickness loss loss subcut
- into muscle/ bone
Type dementia if
Cognitive imp then >1yr Parkinsonism
> 1yr = Lewy body
Features of Lewy body dementia
progressive cognitive impairment but day to day fluctuations
parkinsons symptoms after a year
visual hallucinations
First line meds for dementia + MAO
Second line
1st line: acetylcholinesterase inhibitors: rivastigmine, donepezil (not if bradycardia), galantamine
2nd line: NMDA antagonist: memantine
Where in brain does Alzheimers affect
Hippocampus which is in temporal lobe responsible for memory, learning and emotion
Do you routinely offer abx for pressure ulcer
no unless infection signs
just wound dressing, analgesia, nutrition assessment
Differentials for dementia
delirium
hypothyroid
SOL
stroke
depression
Causes of dementia
trauma
infection
h/v impairment
metabolic abnormalities
normal pressure hydrocephalus
What is lying and standing bp
lie down for 5 mins then stand up and measure at 1 min and 3 mins
drop >20 sys or drops <90
or drop >10 diastolic with symptoms
Factors identifying increased risk of frailty
High CFS
Lots admissions
Reduced mobility
No. falls
Incontinence
Delirium
Ix for increased frailty
PRISMA7 questionnaire
Gait speed
Timed up and go test
Incontinence examination
review bowel/bladder diary
Abdo ex
PR ex + prostate
External genitalia
Urine dip + MSU
Post void bladder scan
Invasive urodynamic tests
Aspirin and clopidogrel mx in stroke
Start aspirin 300mg straight away (or 24 hours post thrombolysis) for 2 weeks
then stop after 2 weeks
then start clopidogrel 75mg lifelong
Features of stroke which make it different from a stroke mimic
stereotyped episodes
sudden
focal
symptoms fit into a vascular territory
What is capsular warning syndrome
M/S signs without cortical signs (aphasia/apraxia/agnosia)
What symptoms in a LACs Lacunar stroke + what blood vessel
Either pure sensory
Pure motor
Or ataxic gait
lenticulostriate (to basal ganglia which is in charge of motor control and refinement)
What symptoms in a POCs stroke + what blood vessel
Homonymous hemianopia with macula sparing
Cerebellar dysfunction
Bstem dysfunction (m/s deficit with cranial nerve deficit)
Bilateral m or s loss
Conjugate eye movement disorder
Either vertebral, basilar, cerebellar artery
what is webers syndrome
branch of posterior cerebral artery supplying midbrain
- ipsilat cn3 palsy
- contralat weakness
What is lateral medullary syndrome
- ipsilat face pain + temp
- contralat limb pain + temp
- ataxia / nystagmus
from posterior inferior cerebellar artery
What is lateral pontine syndrome
same as lateral medullary
also ipsilat facial pain + deafness
anterior inferior cerebellar artery
Tumour marker for breast cancer
ca153
Mx for MSCC
Urgent mri spine within 24 hours
Dexameth 16mg stat or 8mg BD + ppi
Oncology assessment for radiotherapy or decompression surgery
Antiemetics for chemo induced N+V
Metoclopramide
Ondanestron
Most common cancer causes of bone mets
Prostate
Breast
Lung
WHO performance status
0= normal activity
1= restrict when strenuous
2= no work activities
3= symptomatic, chair >50%
4= bed bound
What to give if they need pain meds but CKD
oxycodone for mild impairment
fentanyl or buprenorphine if egfr <10
Signs that a pleural effusion is malignant
Unilateral
Exudative
Most common causes of malignant pleural effusion
Lung cancer
Breast cancer
Lymphoma
Ovarian
Mesothelioma
Poor prognostic factors for MSCC
rapid onset
loss sphincters
radiosensitive tumours
Causes of seizures in malignancy
Cerebral mets - inc ICP
Infection
Metabolic abnormalities
Causative organisms of neutropenic sepsis
staph epidermidis
staph aures
ecoli
Metabolic issues in TLS and mx for each
Hyperkalaemia - gluconate, insulin, dextrose
Hyperuricaemia - iv rasburicase
Hyperphosphataemia - pi binders rarely used
Hypocalcaemia - ca gluconate if symptomatic
IV fluids, frequent observations, daily weights, bloods
Diagnostic ix for SVCO
CT contrast thorax
Symptoms and signs of hypercalcaemia
Confusion, depression
Constipation, N+V, thirsty
Bone pain
Abdo pain, renal colic
Dehydrated
Hyporeflexia
Tongue fasciculations
Abdo distension
Bony tenderness
Causes of malignant hypercalcaemia
squamous cell lung ca
acc
myeloma mets
breast cancer mets
What to rule out in malignant patient with constipation
MSCC
Metabolic abnormality in pyloric stenosis
hypochloraemic metabolic alkalosis
Gold standard ix for pyloric stenosis
Abdominal USS
When to vaccinate pregnant woman for whooping cough
16-32 weeks
How long to stay off school if whooping cough
48 hours post abx
Or 21 days post onset symptoms
Mx of minimal change disease in child
Admit
Monitor fluid status
7 days prednisolone
Penicillin 5 + pneumococcal
Check VZV status
What is in the 6in1 vaccine
Dip
tetanus
pertussis
polio
haem influ
hep b
Gold standard ix for duchennes
genetic testing
Biggest complication of duchennes
dilated cardiomyopathy
Red traffic light signs for febrile child <5
Chest wall recession
Not wakening
Reduced skin tugor
Mottled skin
Grunting
Complications of GORD in infant
Recurrent chest infections
Faltering growth
Sandifer syndrome (dystonic neck posturing)
Where is hypospadias located
On distal ventral surface of penis
Mx for neonatal sepsis
IV benzylpenicillin + gentamicin
Check CRP 18-24 hours later
If CRP + cultures neg then stop abx at 36 hours
When to refer to hospital for bronchiolitis
rr>60
feeding 50%
clinical dehydration
Murmur in Turners
Ejection systolic murmur - bicuspid aortic valve
Complications of Turners
Ovarian degenesis
Hypothyroidism
Coeliac
Aortic dilatation + dissection
Horseshoe kidney
Features of fetal alcohol syndrome
microcephaly
short palpebral fissures
hypoplastic upper lip
absent philtrum
reduced IQ
cardiac abnormalities
Contraindication to CF lung transplantation
burkholderia cepacia
When to treat bed wetting
5 years
Big risk factor for surface deficient lung disease
Diabetes
Mx of surfactant deficient lung disease
fluids
endotracheal surfactant
cpap
prevention: antenatal betamethasone 24-25 weeks IM + mg during labour
Fragile X syndrome features
big bollocks large eared autistic man
Learning difficulties
Low set ears
Hypotonia
Autism
Mitral valve prolapse
Causative organism for threadworms
enterobius vermicularis
Mx for threadworms
mebendazole single dose if >6 months
Neck masses in children:
- thyroglossal
- brachial
- dermoid
- lymphatic malformations
- haemangioma
- thyroglossal : ant triangle - anechoic uss
- brachial : ant to scm, anechoic on uss
- dermoid: midline, supra hyoid, heterogenous + multiloculated
- lymphatic malformations: cystic hygroma is from occlusion of lymphatic channels - hypoehoic on uss + transilluminates
- haemangioma : grows rapidly
Features of roseola infantum
human herpes 6
fever then rose pink papule rash days later
school exclusion not needed
can cause convulsions, gbs, thrombocytopenia, myocarditis
<3 months old + fever
urgent referral to paeds!!
Murmur in TOF
Ejection systolic murmur left sternal edge (pulmonary stenosis)
What to screen for in Kawasaki disease
ECHO due to coronary artery aneurysms
Newborn hearing tests
Otoacoustic emission test
If abnormal then auditory brainstem response test
Features of vesicoureteric reflux
recurrent utis
raised creatinine
Cephalohaematoma vs caput succedaneum
Cepahlo: doesn’t cross suture lines, takes months to resolve
Caput: crosses suture lines, resolves in days
How to tell difference between androgen insensitivity and CAH
CAH diagnosed early with ambiguous genitalia
Androgen insensitivity key symptom is primary amenorrhoea + undescended testes
Staging for HIE
sarnat staging:
mild: poor feeding, hyperalert
mod: lethargic, hypotonic, seizures
Sev: flaccid, reduced reflexes
Big risk factor for pneumothorax in neonate
mechanical ventilation
Complication of jaundice in neonate
kernicterus
Gold standard ix + finding for intussusception
Abdo uss - target sign
Risk factors for dehydration
<1
>5 d in 24 hours or >2 vomits
lbw
malnutrition
stopped b feeding
Signs of dehydration shock in kids
tachyc/pnoea
dec consciousness
mottled skin
inc crt
weak pulse
hypotensive
Gold standard diagnostic ix for biliary atresia
percutaneous cholangiography
1st line vs definitive mx for hirschprungs
1st line: colon irrigation
definitive: surgical resection
What is kocher criteria
For septic arthritis in children
WCC>12
CRP>20 / ESR >40
Temp 38.5
Can’t weight bear
Ix for dysplasia of hip + when to screen
if <4.5 months uss
if >4.5 months xray
Screen 6 week uss:
1st degree fx
breech after 36 weeks
multiple preg
Xray findings for JIA
soft tissue swelling
joint effusion
osteopenia
Symptoms of HSP
Abdo pain
Hematuria/proteinuria
Oligoarthritis
Purpuric rash lower limbs
Low grade fever
What is not in the PEWS chart
bp
temp
Causative organisms of epiglottitis
haem influ b
strep progenies
strep pneumoniae
Features of Edwards syndrome
trisomy 18
micrognathia
rocker bottom feet
Mx for undescended testes
if unilat refer around 3 months (before 6 months)
if bilat refer within 24 hours
When to return to school after scarlet fever
24 hours post abx
Mx if UTI + <3 months old
urgent paeds referral
When to refer child for USS urinary tract
<6 months
6 months ->3 years +:
1. sepsis
2. abx not working
3. non secoli
4. abdo mass
5. creatinine inc
recurrent: >3 lower, 2 lower + 1 upper, 1 upper + 1 lower
Rash for rubella
pink maculopapular rash on face then spreads to body
suboccipital + post-auricular lymphadenopathy
Features of congenital hypothyroidism
prolonged jaundice
delayed milestones
macroglossia
short
hypotonia
Features of rickets
dental problems
craniotabes (soft skull)
rachitic rosary
bowing legs in infant + knock knees in child
On xray penia/cupping/fraying/metaphyseal widening
Most common cause of headache in child
migraine without aura
Adrenaline doses in child
> 12: 500
6-12: 300
<6years: 150
Mx of asthma in child
ICS + SABA
low dose MART + Saba
mod dose MART + saba
Referral
Features that suggest bacterial vs viral LRTI
Bacterial:
>2 years
High temp 38.5
Pain
More acute onset
less wheeze/rhinorrhoea
When to admit for croup
mod-sev
<3 months
known upper airway abnormality
uncertain about diagnosis
What is in Westley croup score
stridor
recession
air entry
cyanosis
conscious
If >6 severe
Features of meckels diverticulum
Painless rectal bleed
Intestinal obstruction
technetium scan if stable, if not mesenteric angiography
Omaphalocoele (exophalocoele) vs gastroschisis
omaphalocoele: still in sac, associated with downs. Needs c section + staged repair
gastroschisis: ant wall defect where vag delivery and then repair asap
ALP rises in abdo wall defects!!
Features of patau
13 fingers
trisomy 13
small eyes
cleft lip
polydactyly
Features of Williams syndrome
friendly little boy who eats starbursts
short
learning difficulties
friendly
starbursts in eyes
aortic stenosis
Mx for DDOH
pavlik harness if <6 months old
If thats failed or >6 months old thenspica cast in flexion + abduction
Diagnostic ix for whooping cough
per nasal swab
Triad of shaken baby syndrome
retinal haemorrhages
subdural haematoma
encephalopathy
Glomerular haematuria vs non glomerular haematuria
Glomerular:
- dark red
- painless
- oliguria/htn
- small dysplastic abcs + red cell casts with blebs + spikes
Non:
- fresh
- painful
- monomorphic rbc
ASD features
ejection systolic murmur
fixed splitting of s2
big stroke risk
VSD features
pan systolic murmur louder in smaller defects
Murmur in TOF
pan systolic murmur left sternal edge (pulmonary stenosis)
Features of TOGA
rv heave
loud s2
weak femoral pulses
Limp <3 years old
urgent specialist assessment
Features of benign rolandic epilepsy
seizures at night
eeg centrotemporal spikes
great prognosis
Most common complication of measles vs most common cause of death
otitis media - most common
pneumonia - death
Ages for precocious puberty
9 males
8 females
live vaccines
BCG
MMR
oral polio
yellow fever
oral typhoid
Immediate TIA mx
if <7 days 300mg aspirin + 300mg clodiogrel + review within 24 hours
then 21 days of 75mg clopidogrel + 21 days aspirin 75mg
then 75mg lifelong clopidogrel
Complication of stroke
haemorrhagic, cerebral oedema, seizures, bowel/bladder dysfunction, aspiration pneumonia, spasticity, immobility/ulcers, cognitive impairment
When to refer for bowel cancer
+ FIT
Occult bleeding
Rectal mass
Artery supply of GI
Coeliac trunk t12 - splenic, common hepatic, left hepatic
SMA - right colic, ileocaecal, middle colic
IMA - left colic, rectosigmoid, superior rectal
Types of thyroid cancer
papillary - most common, lymph node spread
follicular - haematogenous spread
medullary - MEN2, calcitonin secreting hence hypocalcemia
anaplastic
Mx malignant ascites
low fluid, salt low
drain
perito venous shunt if recurrent
Mx malignant bowel obstruction
stent
hyoscine hydrobromide
steroids
SVCO mx
sit up
oxygen
secure airway
stent
morphine
dexamethasone
Symptoms of TLS
n+v
diarrhoea
muscle cramps
AKI
arrythmias
Symptoms MSCC
back pain (earliest symptom)
lower limb weaness
sensory loss
umn signs
incontinence
Palliative hiccups
chlorpromazine or haloperidol
Chemo man
Mucositis mx
Benzydamine hydrochloride mouthwash
continuing disability post stroke
barthel
