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PACES Flashcards

1
Q

What is associated with POI?

A

Iatrogenic - chemo/radiotherapy, gnrh analogues, surgery
Genetic - FH, choromosomal abnormalities
Auotimmune - Addison’s, T1DM, thyroid disease
Infection - TB, mumps
Idiopathic

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2
Q

Fertility options for POI?

A

Normally IVF with donor eggs. Can carry pregnancy.
5-10% of women can conceive without medical assistance

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3
Q

Questions to ask with amenorrhoea presentation?

A

Headaches/visual changes/galactorrhoea/changes to smell
Hot flushes/brain fog
Hirstuism/weight gain/acne
Exercise/weight/stress
Hx of autoimmune disease/chemo/radiotherapy

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4
Q

Non-hormal treatments for POI?

A

Lifestyle advice, SSRIs, clonidine, CBT, antidepressants, vaginal moisturisers/lubricants

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5
Q

Couple struggling to conceive - questions?

A

How long have you been trying?
How often sexual intercourse?
Any previous children?
Menstruation - oligomenorrhoea etc.
Endometriosis sx - dymenorrhoea
Visual changes/galactorrhoea
Hot flushes/brain fog
Acne/hirstuism/weight gain
Exercise/stress/diet/smoking/alcohol/occupation
Any PID/previous tubal surgery
Contraception
Vitamin supplements

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6
Q

What are possible complications of assisted conception?

A

Ovarian hypersensitivity syndrome, multiple pregnancy, pelvic infection, ectopic pregnancy

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7
Q

How is ovarian reserve tested?

A

Antral follicle count, AMH, FSH

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8
Q

When is laproscopy and dye done?

A

History of tubal issues

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9
Q

How long can you give clomifene for?

A

6 months? Monitor with USS.

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10
Q

Risks of induction

A

Ovarian hyperstimulation

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11
Q

Risks of prolonged pregnancy?

A

Stillbirth, increased mortality risk, meconium aspiration, prolonged labour, shoulder dystocia, IUGR, obstructed labour, perineal damage, instrumental delivery

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12
Q

Why does PCOS increase risk of endometrial malignancy?

A

A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed estrogen that results from anovulation

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13
Q

PCOS and endometrial cancer link?

A

A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed estrogen that results from anovulation

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14
Q

Side effects of metformin

A

B12 deficiency, diarrhoea, vomitting, nausea

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15
Q

Long term complications of PCOS

A

Metabolic syndrome, endometrial cancer, cardiovascular disease, diabetes, hypertension, impaired glucose tolerance.
Mechanism: Defect in insulin action - insulin resistance combined with abdominal obesity.

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16
Q

DDx for chicken pox?

A

Herpes zoster, impetgo, contact dermatitis, drug eruptions, erythema multiforme

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17
Q

Active third stage of labour treatment?

A

For women without risk factors for PPH delivering vaginally, oxytocin (10 iu by intramuscularinjection) is the agent of choice for prophylaxis in the third stage of labour. A higher dose of oxytocin is unlikely to be beneficial

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18
Q

What can be used to manage women at risk of PPH?

A

Ergometrine–oxytocin may be used in the absence of hypertension in women at increased risk of haemorrhage as it reduces the risk of minor PPH (500–1000 ml)

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19
Q

When to admit a child with febrile seizures?

A

First seizure, on antibiotics, unsure of cause, <18 months old, complex focal seizure

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20
Q

What specific questionnaire can you use to assess anorexia nervosa?

A

SCOFF

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21
Q

Lymphocyte invasion are indicative of what?

A

Chronic inflammation

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22
Q

Erosion definition?

A

Loss of surface epithelium +/- lamina propria (muscularis intact)

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23
Q

What cells are seen in Barett’s oesophagus?

A

Goblet cells (+ve goblet cells has a worst prognosis)

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24
Q

Cause of oesohpagus squamous cell carcinoma?

A

Cigarette and alcohol consumption

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25
Q

Treatment of upper GI variceal bleeding

A

Resuscitate with blood and crystalloids
-Terlipressin
-Score
-Scope
-Infuse with PPI

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26
Q

What cells are not seen in stomach?

A

Goblet cells

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27
Q

Acute gastritis causes?

A

Alcohol consumption, NSAIDs, etc. (H. Pylori), StressStomach is the most sensitive organ in the GI tract to ischaemia

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28
Q

Chronic gastritis causes?

A

A: autoimmune (pernicious anaemia)
B: bacteria (H. Pylori)
C: corrosives (bile reflux, NSAIDs)
CMV (patients on immunosuppression) and Crohn’s

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29
Q

H. Pylori Eradication Tx

A

One-week triple-therapy
-PPI
-Clarithromycin
-Amoxicillin or metronidazole

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30
Q

H. pylori can cause what?

A

MALT (b cell lymphoma)

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31
Q

Most common gastric cancer?

A

Adenocarcinoma

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32
Q

Types of adenocarcinoma gastric cancer?

A

Diffuse and intestinal

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33
Q

Describe diffuse adenocarcinoma of the stomach

A

Diffuse: single-cell architecture, no gland formation, contain signet ring cell

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34
Q

what type of cell lines the stomach?

A

Parietal cells

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35
Q

Most common cause of duodenal ulcers?

A

H. Pylori

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36
Q

Complication of anterior duodenal ulcers?

A

Peritonitis

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37
Q

Complication of posterior duodenal ulcers?

A

Haemorrhage

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38
Q

What is Lymphocytic duodenitis?

A

Distinct from coeliac disease but usually a continuum
Increased intraepithelial lymphocytes = CD8+ T Cells
(20: 100 lymphocytes: enterocytes)
Architectural villous structure normal = normal villi, normal crypts
-Many have mild coeliac disease

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39
Q

Most common colorectal cancer?

A

Adenocarcinoma

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40
Q

Which polyps of the large bowel have higher risk of cancer?

A

Higher risk of cancer:
-Larger polyps
-More polyps
-Higher villous component
-Dysplastic features

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41
Q

Which zone of the liver is most metabolically active?

A

Zone 3

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42
Q

Histology of acute hepatitis?

A

Spotty necrosis, foci of inflammation

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43
Q

Rhodanine” stain used for what?

A

Wilson’s disease

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44
Q

Discuss Wilson’s disease

A

Wilsons disease
Cannot excrete copper
Genes on Chromosome 13
AR
Parkinons, ‘aggressive behaviour’

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45
Q

Chromosome involved in haemachromatosis?

A

6
Leads to cardiomyopathy

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46
Q

Piecemeal necrosis describes what?

A

Interface hepatitis - chronic hepatitis

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47
Q

Signs of alcoholic hepatitis?

A

Ballooning of cells
Mallory Denk Bodies (pink material within cells)
Apoptosis
Pericellular fibrosis
Zone 3 – acetaldehyde highest, and relatively hypoxic

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48
Q

Commonest liver cancer?

A

Mets

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49
Q

What do alpha cells produce?

A

Glucagon

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50
Q

What do beta cells produce?

A

Insulin

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51
Q

What do delta cells produce?

A

Somatostatin

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52
Q

Peri-ductal acute pancreatitis - cause?

A

obstructive
Acinar cells adjacent to the ducts undergo necrosis

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53
Q

Peri-lobular acute pancreatitis - cause?

A

Vascular cause

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54
Q

Complication of acute pancreatitis?

A

Haemorrhagic pancreatitis

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55
Q

Dx of acute pancreatitis?

A

Serum lipase

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56
Q

Pancreatic pseudo-cyst?

A

collection of fluid without an epithelial lining

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57
Q

Most common tumour of the pancreas?

A

Ductal carcinoma

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58
Q

Mutation in pancreatic ductal carcinoma?

A

Kras mutation

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59
Q

Most common location of ductal carcinoma?

A

Head of the pancreas

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60
Q

Most common location of neuroendocrine tumour?

A

Tail of the pancreas

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61
Q

Most common neuroendocrine tumour and association

A

MEN1, non-secretory

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62
Q

Most common secretory neuroendocrine tumour?

A

Insulinoma (beta cells)

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63
Q

Mechanism of HPV causing cervical cancer?

A

Inhibiting TSGs (E6 and E7 enzymes)

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64
Q

Most common cyst?

A

Follicular cyst

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65
Q

What is hyperplasia?

A

Increased number of cells

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66
Q

Differentiated VIN Risk factors?

A

Lichen sclerosis - can progress to SCC

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67
Q

Vulval cancer is normally what type?

A

SCC

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68
Q

Risk factors for clear cell vulval cancer?

A

Teenagers, COCP

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69
Q

Cervical cancer is normally what type?

A

SCC (80%)

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70
Q

E6 inactivates which gene?

A

P53

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71
Q

E7 inactivates which gene?

A

Retinoblastoma (Rb)

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72
Q

Most common endometrial cancer?

A

Adenocarcinoma
(80% endometroid)

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73
Q

Histology of fibroids?

A

Bundles of smooth muscle cells

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74
Q

Endometrial tissue within the myometrium?

A

Adenomyosis

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75
Q

Signs of endometriosis histology?

A

Chocolate cysts, powder burns

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76
Q

Mutation in endometroid endometrial cancer?

A

PTEN

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77
Q

Subtypes of endometroid endometrial cancer?

A

Endometroid, serous, mucinous

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78
Q

Subtypes of non-endometroid endometrial cancer?

A

papillary, clear cell, serous

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79
Q

Violin strings and pre-hepatic lesion?

A

Fitz-Hugh Curtis syndrome. Adhesions around the liver. Associated with PID.

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80
Q

Causes of PID?

A

TB, schistomiasis, staph aureus, gonorrhoea, chlamydia

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81
Q

Most common ovarian cancer?

A

Epithelial (90%)

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82
Q

Most common malignant ovarian cancer in young women?

A

Dysgerminoma

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83
Q

What is associated with Rokitansky’s protuberance?

A

Dermoid cyst

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84
Q

Micro-calcifications on non-invasive breast screening

A

Ductal carcinoma situ

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85
Q

Most common breast cancer?

A

Invasive ductal carcinoma

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86
Q

single best prognostic indicator of breast cancer?

A

Lymph node

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87
Q

USS of the breast age?

A

<35

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88
Q

B5a = what diagnosis?

A

Ductal carcinoma in situ

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89
Q

B5b = what diagnosis?

A

Invasive ductal carcinoma

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90
Q

What does B4 mean?

A

suspicious

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91
Q

What does B3 mean?

A

Uncertain

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92
Q

Stromal and epithelial?

A

Fibroadenoma
Phyllodes tumour is malignant version

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93
Q

Lumpiness, transilluminable?

A

Fibrocystic disease

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94
Q

Stellate area

A

Radical scar

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95
Q

Which proliferative breast condition has highest rate of turning malignant?

A

In situ lobular neoplasia

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96
Q

Breast cancer grading system?

A

Nottingham grading system

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97
Q

What part of brain is affected first in alzheimer’s

A

Hippocampus

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98
Q

Most common tumour in children

A

Pilocytic astrocytoma

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99
Q

Intraparenchymal haemorrhage site most common?

A

Basal ganglia
HTN

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100
Q

Hyperattenuation within the circle of willis?

A

SAH

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101
Q

Lemon shape bleed?

A

extradural haemorrhage

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102
Q

most common cell in the brain?

A

Astrocytes

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103
Q

Near the surface brain tumour?

A

Meningioma

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104
Q

Cancers that metastasise to the brain?

A

Lung, skin, breast

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105
Q

Most aggressive brain tumour?

A

Glioblastoma multiforme (grade 4)

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106
Q

Grade 2/3 tumour?

A

Diffuse glioma

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107
Q

Craniopharyngioma buzzwords?

A

Inferior bitemporal hemianopia (grow downwards)

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108
Q

Pituitary tumour

A

Superior bitemporal hemianopia

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109
Q

Ependyoma buzzword?

A

Posterior fossa, Tuberous sclerosis

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110
Q

Medulloblastoma?

A

In the cerebellum, squinting child

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111
Q

Meningioma?

A

Psomomma bodies

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112
Q

Order of dementias?

A

Alzheimer’s > vascular > Lewy-body dementia > frontotemporal dementia

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113
Q

Alzheimer’s aetiology

A

Beta amyloid plaques
Hyperphosphorylation of tau

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114
Q

Pathophysiology of Frontotemporal dementia?

A

Pick bodies

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115
Q

Staging for alzheimer’s

A

BRAAK

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116
Q

Alpha synuclein mutation?

A

Parkinson’s, lew-bodies

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117
Q

Most common malignant bone cancer in adults?

A

Osteosarcoma

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118
Q

Café au lait spots, Chinese letters, difficulty walking, shepherd’s crook deformity

A

McCune-Albright syndrome
(also associated with precocious puberty)

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119
Q

Genetic predisposition of RA?

A

HLA DR4

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120
Q

First stage of TB infection?

A

Ghon focus

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121
Q

Rat bite erosions?

A

Gout

122
Q

White lines of chrondrocalcinosis?

A

Pseudo-gout

123
Q

Signs of malignant bone disease?

A

Acute periosteal rection, irregular bone formation, extraosseous and irregular calcification

124
Q

When is osteosarcoma seen?

A

Osteosarcoma
Often at the knee

125
Q

Signs of osteosarcoma?

A

Codman’s triangle
Sunburst appearance

126
Q

Signs of chondrosarcoma?

A

Fluffly calcifications

127
Q

Ewing’s sarcoma?

A

Small round cells
Onion skinning of periosteum

128
Q

Soap bubble appearance?

A

Giant cell (borderline malignancy)

129
Q

McCune Albright syndrome?

A

Triad of cafe au lait spots, fibrous dysplasia, precocious puberty
Chinese letters, Shepherd’s crook deformity

130
Q

Which cells drive RA?

A

Lymphocytes

131
Q

Layers of the epidermis?

A

Corneum, granulosum, spinosum, basale

132
Q

What mutation is associated with eczema?

A

Fillagrin

133
Q

Auspitz sign?

A

rubbing causes bleeding

134
Q

Koebner’s phenomenon

A

Plaques form at sites of skin injury

135
Q

Parakeratosis is a buzzword for what?

A

Psoriasis
Spongiosis on histology

136
Q

Bullous pemphigoid

A

IgG and C3 to hemidesmosomes
Basement membrane

137
Q

Pemphigus vulgaris

A

IgG to desmoglein 1&3 (acantholysis)
Stratum spinosum

138
Q

Pemphigus foliaceous

A

IgG against desmoglein in epidermis
Stratum corneum

139
Q

Most common melanoma?

A

Superficial spreading

140
Q

Marjolin’s ulcer?

A

SCC

141
Q

Precursor to BCC?

A

Nevoid basal cell carcinoma
Gorlin-Goltz syndrome

142
Q

Most common skin cancer?

A

BCC (70%)

143
Q

Signs of chronic stable liver disease?

A

Palmar erythrema, dupytren’s contracture, spider naevi and gyaecomastia

144
Q

Signs of portal hypertension?

A

Splenomegaly, ascites,

145
Q

C1q deficiency can cause what?

A

SLE

146
Q

ICD-10 criteria for PTSD

A

(hyper arousal, avoidance, flashbacks, emotional blunting)

147
Q

Most common causes of ckd?

A

Diabetes (most common) and hypertension

148
Q

Causes of rapidly progressive (crescentric) glomerulonephritis?

A

Goodpasture’s, immune complexes, Pauci-immune

149
Q

What is associated with membranous glomerulonephropathy?

A

Spikey immune complex deposits, diffuse basement thickening
Associated with SLE, anti-phospholipase A2 antibodies

150
Q

FSGS hisotlogy?

A

Focal scarring, loss of foot processes

151
Q

What is seen in renal diabetes disease?

A

Kimmelstiel Wilson antibodies

152
Q

Red cell casts?

A

Nephritic syndrome

153
Q

Commonest worldwide nephritic syndrome?

A

IgA nephropathy

154
Q

IgA nephropathy

A

IgA deposits in mesangium

155
Q

Raised O titre, reduced C3, IgG deposits?

A

Post-streptococcal glomerulonephritis

156
Q

Goodpasture’s imnnunofluorescence findings?

A

Linear deposition of IgG

157
Q

Immune complex mediated rapidly progressive imnnunofluorescence findings?

A

Bumpy deposition of immune complexes in GBM/mesangium

158
Q

Pauci-immune mediated

A

No/scanty immune complexes.
Associated with pulmonary haemorrahge and skin rash

159
Q

Granulomatosis with polyangitis antibodies?

A

C-ANCA (disease also known as Wegner’s

160
Q

Microscopic polyangitis antibodies?

A

P-ANCA

161
Q

Alport’s syndrome inheritance pattern

A

X-linked recessive, problem with type 4 collagen

162
Q

Alport’s syndrome

A

X-linked recessive, problem with type 4 collagen

163
Q

Brown casts is indicative of what?

A

Acute tubular necrosis

164
Q

Acute interstitial nephritis?

A

Eosinophil infiltrate, white cell casts in urine but no infection. normally after starting a drug.

165
Q

PKD inheritance and gene involved?

A

AD inheritance, mutation in PKD gene encoding polycystin

166
Q

Lupus nephritis signs?

A

Wire loop capillaries

167
Q

How. many stages of lupus nephritis?

A

6

168
Q

Last stage of lupus nephritis?

A

> 90% sclerosis

169
Q

Micronodular cirrhosis?

A

Caused by alcohol

170
Q

Signs of extrahepatic shunting?

A

Oesophageal varices, anorectal varices, caput medusae

171
Q

PSC antibodies?

A

P-ANCA

172
Q

PSC signs?

A

Fibrosis

173
Q

Stain for Wilson’s?

A

Rhonadine

174
Q

Alpha-1-antitrypsin deficiency

A

Schiff stain

175
Q

Most common benign liver problem?

A

Hemangioma

176
Q

What is liver cell adenoma associated with?

A

COCP

177
Q

Tumour marker for hepatocellular carcinoma?

A

AFP

178
Q

Signs of stable liver disease?

A

Spider naevi, gynaecomastia, duputryen’s contracture, palmar erythema

179
Q

Mainstay of histological staining?

A

Haematoxylin and eosin

180
Q

Lynch syndrome?

A

AD inheritance with mutation in DNA mismatch repair gene
Also known as HNPCC

181
Q

Familial adenomatous polyposis inheritance?

A

AD mutation in APC suppressor gene
10,000 polyps

182
Q

What is Gardner’s syndrome?

A

AD mutation with skull osteomas, epidermoid cysts, desmoid tumours, dental caries, adrenal gland tumours

183
Q

Cells in medullary thyroid?

A

Parafollicular C cells. Secrete calcitonin

184
Q

Treatment for low libido?

A

Sensate focus therapy, timetabling sex

185
Q

Hypersexuality treatment?

A

CBT - can also use SSRIs, GnRH therapies

186
Q

Hypersexuality treatment?

A

CBT - can also use SSRIs, GnRH therapies

187
Q

Recommeded SSRIs with breastfeeding?

A

Sertraline and paroxetine

188
Q

PND treatment

A

CBT and SSRI (sertraline or paroxetine). Involve home treatment team and health visitor. Post natal community mental health team will be involved

189
Q

Puerperal psychosis treatment?

A

Depending on the presentation, antipsychotics, antidepressants, or lithium may be needed Benzodiazepines may be needed for agitation. MAINLY ANTIPSYCHOTICS

190
Q

Treatment for tic disorder?

A

Clonidine

191
Q

Section 2 - who makes the decision?

A

Made by an AMHP or nearest relative (NR) on behalf of TWO doctors, one or whom should be section 12 approved (usually SpR or consultant) and one of whom should know the patient in professional capacity (e.g. GP)

192
Q

Cognitive assessment tools?

A

MMSE (scored out of 30), AMTS (scored out of 10), montreal cognitive assessment (MoCA) (out of 30), Addenbrookes cognitive examination (ACE-R) (scored out of 100)

193
Q

Tetragenic effects of phenytoin and carbamazepine?

A

Cleft palate

194
Q

Tetragenic effects of phenobarbital and phenytoin?

A

Cardiac malformations

195
Q

Tetragenic effects of sodium valproate?

A

Neural tube defects, facial cleft and hypospadias

196
Q

Endometritis treatment?

A

IV Clindamycin and IV Gentamicin

197
Q

Medications for acute mania?

A

Antipsychotics and short course of benzos

198
Q

Antidote for paracetamol OD?

A

N-acetylcysteine

199
Q

Normal ranges for ABG

A

pH: 7.35 – 7.45

pO2: 11 – 13 kPa (82.5 – 97.5 mmHg)

pCO2: 4.7 – 6.0 kPa (35.2 – 45 mmHg)

HCO3: 22 – 26 mmol/L

Base excess: (-2 to +2 mmol/L)

200
Q

Normal ranges for calcium, phosphate, sodium and potassium?

A

Na+: 133–146 mmol/L
K+: 3.5–5.3 mmol/L
Ca2+(adjusted): 2.2-2.6 mmol/L
Mg2+: 0.7–1.0 mmol/L
Chloride: 98-106 mmol/L
Phosphate: 0.74 – 1.4 mmol/L
Urea: 2.5 – 7.8 mmol/L

201
Q

LFTs normal range?

A

Alkaline phosphatase (ALP): 30–130 U/L
Alanine aminotransferase (ALT):
♂ <41 U/L
♀<33 U/L
Aspartate aminotransferase (AST): 1 – 45 U/l
Bilirubin: <21 μmol/L
GGT:
♂ <60 U/L
♀<40 U/L
Albumin: 35–50 g/L

202
Q

Signs of serotonin syndrome?

A

mild (shivering and diarrhoea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.
diarrhoea, headache, sweating, dilated pupils, fever, insomnia
1. Autonomic disturbance - namely:

Hypertension.
Tachycardia.
Hyperthermia.
Hyperactive bowel sounds.
Mydriasis.
Excessive sweating.
2. Neuromuscular dysfunction - namely:

Tremor.
Clonus - inducible or spontaneous.
Ocular clonus.
Hypertonicity.
Hyperreflexia (this symptom can be masked if there is severe muscle rigidity).
3. Altered mental state - namely:

Anxiety.
Agitation.
Confusion.
Coma.

203
Q

SSRI discontinuation syndrome

A

Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Electric shock type sensations

204
Q

Neuroleptic malignant syndrome

A

Neuroleptic malignant syndrome is a rare but potentially life-threatening idiosyncratic reaction to antipsychotic drugs[1]. It causes fever, muscular rigidity, altered mental status and autonomic dysfunction. The syndrome is usually associated with potent neuroleptics such as haloperidol and fluphenazine.

205
Q

When to do an USS after UTI?

A

During the acute infection in children aged under 6 months with recurrent UTI.
Within 6 weeks for children aged 6 months and over with recurrent UTI.
Within 6 weeks, for all children younger than 6 months of age with first-time UTI that responds to treatment.

206
Q

When to do a DMSA?

A

Ensure that a dimercaptosuccinic acid scintigraphy (DMSA) scan to detect renal parenchymal defects is carried out within 4–6 months following the acute infection in:
All children aged under 3 years with atypical or recurrent UTI.
All children aged 3 years or over with recurrent UTI.
This investigation should be arranged by paediatric specialists when appropriate.

207
Q

Counselling of UTI in children

A

Safety net!!: Advise the parents or carers to bring the child for reassessment if they do not respond to treatment within 24–48 hours.
Outline the importance of completing any course of treatment.
Advise use of paracetamol for pain relief where required.
Advise on adequate fluid intake to avoid dehydration.
Advise that children who have had a UTI should have ready access to clean toilets when required and should not be expected to delay voiding.
Ensure that they are aware of the possibility of a UTI recurring and the need to seek prompt treatment from a healthcare professional should this occur.
Patient information leaflets on UTI in children are available at NHS and Patient.Info.

208
Q

Signs of an atypical UTI?

A
  • During the acute infection in allchildren with atypical infection, indicated by:
    • Poor urine flow.
    • Abdominal or bladder mass.
    • Raised creatinine.
    • Sepsis.
    • Failure to respond to treatment with suitable antibiotics within 48hours.
    • Infection with non-E. coliorganisms.
    • Note: infants and children with abnormal imaging results should be assessed by a paediatric specialist.
209
Q

Jittery baby – what should your first test be?

A

Capillary blood glucose

210
Q

6 year old kid with Down’s syndrome with bilious vomiting and distended abdomen, patent anus

A

Volvulus

211
Q

Girl goes to Pakistan. Develops macular rash. High fever for 5 days. HR was 70bpm. Cause?

A

Typhoid

212
Q

Difficult balance, cannot build block of towers, hyperreflexia (description of ataxic CP). Where is lesion?

A

Cerebellum

213
Q

Cannot examine ear directly, lump behind ear causing ear to stick out

A

Mastoiditis

214
Q

You are in GP, Child with mild croup comes in?

A

Dexamethasone + review in 48 hours

215
Q

Child with 6 month history of loose stools. Passed one hard blood streaked stool 10 days ago. What investigation?

A

No investigation needed

216
Q

Sickle cell anaemia patient with Hb of 40 and low reticulocyte count with Howell-Jolly bodies

A

Parvovirus B19

217
Q

Kid with hepatomegaly and breathlessness (?heart failure)

A

CXR

218
Q

Maternal T1DM increases risk of what condition in newborn?

A

Neural tube defects

219
Q

Kid has a hearing test at age 3 - which one?

A

Pure tone audiometry

220
Q

When is distraction testing done?

A

6-9 months

221
Q

5 year old with nocturnal enuresis every single night

A

Enuresis alarm?

222
Q

Kid with limp

A

Transient synovitis

223
Q

Maintenance fluid to give to kid with diabetes mellitus?

A

In DKA: 0.9% saline, not in DKA: 0.9% saline with 5% dextrose

224
Q

Child with mild croup symptoms comes into GP, RR of 65. What is your management?

A

Keep child calm and get them urgently to hospital

225
Q

Kid with spiral fracture. What do you do?

A

Admit and investigate for NAI

226
Q

Kid with petechial rashes, low RBC and raised WBC with a limp and sick?

A

ALL

227
Q
  1. Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give?
A

Repeat dexametasone

228
Q

Foreign kid that is drooling and unvaccinated

A

Epiglottitis

229
Q

Kid with delayed milestones in language, GP clicked his fingers and she turned to look, what’s the next step?

A

Refer to SALT?

230
Q
  1. Kid with globally delayed milestones, started to walk at 18 months, saying 2 word phrases at 3 years, 50 word vocabulary at 3 years. What would be the most useful investigation?
A

MRI

231
Q
  1. Kid with a strawberry tongue, what was the likely diagnosis?
A

Scarlet fever (caused by group A haemolytic strep)

232
Q
  1. Kid with anal itch, what do you give?
A

Mebendazole cream for whole household

233
Q
  1. Kid with impaired taste stuff, then awareness and then goes to sleep for like an hour and back to normal. No memory of event?
A

Focal seizure?

234
Q

Another kid that would fall down and scream and stuff but was completely fine afterwards

A

Temper tantrum

235
Q
  1. Kid with bouts of crying and episodes where they flex their knees and hips and red stool
A

Intussception

236
Q
  1. Kid with yellow and grey stools and was like 4 weeks old or something. What do you test for?
A

Split bilirubin levels

237
Q
  1. Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it?
A

Correct electrolyte imbalance. Then it’s Ramstedt’s pyolorotomy

238
Q
  1. 7 year old kid headache and secondary nocturnal enuresis. He’s lost 1.5kg. Urine dipstick normal (i.e. no glucose, proteins, blood. Urine specific gravity 1.010 to 1.030) What is the likely diagnosis?
A

Diabetes insipidus

239
Q
  1. Voraciously hungry kid, hypotonia and feeding difficulties as a neonate, and almond eyes what was the diagnosis?
A

Prader-willi

240
Q
  1. 7 year old kid has an accident and needs to have his leg amputated below knee. He says no and wants to wait for his mum to approve first but she’s on a business trip, dad says go for it. What do you do?
A

Proceed with the dad’s consent

241
Q
  1. 9 months old not feeling well, temperature was 38, comes into the GP. What should you do?
A

Tell him to go to hospital

242
Q
  1. Another neonate with reduced leg movements and fever?
A

Osteomyelitis

243
Q
  1. Kid who had rashes which had crusted over and he was also scratching them and now he had a fever and cool peripheries. What is the cause for his acute presentation?
A

Varicella zoster viraemia?

244
Q
  1. 3 year old kid with unilateral nasal discharge with bleeding and crust, what was the most likely cause?
A

Foreign body insertion

245
Q
  1. Kid had been coughing for 2 months, during winter season. He coughs a lot in night. Hx of atopy and he’s been recently getting some new wheezes. He was stable, so what should you do at the GP?
A

Give salbutamol as a trial

246
Q
  1. Neonate with cardio problem. Systolic murmur loudest at the left sternal edge 2/6. What was it, PDA, ASD, VSD, tetralogy of Fallot
A

(either pulmonary stenosis or ASD or VSD depending on other factors in the question)

247
Q
  1. Kid growing along the 55th centile and is vomiting after food. He was bottle and breast-fed. What is the cause?
A

GORD

248
Q
  1. Kid who basically had ADHD. What is the initial management?
A

Parental training

249
Q
  1. 14 year old kid who thieves, got into fights (basically conduct disorder). What is 1st Mx?
A

Multisystemic family therapy

250
Q
  1. Baby who just started solid foods and was being weaned and has become constipated. What do you do?
A

Encourage more fluids

251
Q
  1. Child who has a hx of very dry skin, rash over arms, getting worse & spreading. Sister has itchy rash on ankles and wrists. (Sounds like Eczema) What would be the management?
A

emollients+1% hydrocortisone

252
Q
  1. Child is 12 weeks old, what would be an absolute contraindicated for vaccination?
A

Acute fever <38.4oC

253
Q
  1. Hip pain on exercise and climbing stairs. Prolonged history, otherwise well
A

Perthe’s disease

254
Q
  1. 3 year old female child with intermittent limp, otherwise well
A

DDH?

255
Q
  1. Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do?
A

Start anti-TB treatment (the kid has TB with those diameters and risk factor of living with someone with TB, plus his age if he’s under 4)

256
Q
  1. Precocious puberty (5yo and has sparse axillary and pubic hair as well as breast bud development) and high centile growth parents are along some lower centile. What definitive diagnostic test do you do?
A

Gonadotropin stimulation test

257
Q
  1. Fussy eater who drinks a lot of cows milk and was tired. What is the cause?
A

Iron-deficient anaemia

258
Q

3 year old Kid with hypochromic microcytic anaemia and low ferritin. What could be the cause?

A

fussy eater common in this age, they take less iron and get anaemia, which explained the hypochromic microcytic anaemia blood film)

259
Q
  1. Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected?
A

Pyramidal tracts

260
Q

Kid with rough (i.e. sandpaper) rash on face & trunk, flushed face. No rash around mouth

A

Scarlet fever

261
Q

Kid with 2cm mass (inframandibular) on left side, painful – blood film shows: toxic left shift with reactive neutrophilia?

A

Lymphadenitis

262
Q

Girl with sickle cell, has 0 reticulocytes

A

Parvovirus B19

263
Q
  1. Newborn with purple spot on face, what is the best approach?
A

GP follow up

264
Q
  1. Young child (non obese) with issues with internal rotation of the hip?
A

Perthe’s

265
Q
  1. Kid needs fluids, but you can’t get standard IV access. Where do you go?
A

Intraosseus

266
Q
  1. Kid with symptoms of nephrotic syndrome – 1st line treatment?
A

Steroids

267
Q
  1. A newborn appears to be in severe respiratory distress and appears blue. Despite being given high flow O2, his saturations remain at 65%. What is the next best step to take with regards to his management?
    a. Chest X-Ray
    b. Infusion of Prostaglandin
    c. Surgery
    d. Indomethacin
A

Infusion of Prostaglandin

268
Q
  1. 3 months old baby with signs of HF, systolic murmur that radiates over the praecordium
A

VSD??

269
Q

What is the most important thing to look at in follow up of HSP?

A

Urine protein and RBCs

270
Q

15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis?

A

Chronic renal failure

271
Q

6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation?

A

CT of nasal orbits

272
Q
  1. Infant with episodes of throwing arms forward with fists clenched
A

Infantile spasms

273
Q
  1. Child with episodes of smelling strange things, hard to communicate with during these episodes, falls asleep for an hour after and doesn’t remember anything. Diagnosis?
A

Focal seizure

274
Q
  1. Baby is almost a month old and jaundiced. Parents say has been jaundiced since day 2. Stools are grey or white. Diagnosis?
A

Biliary atresia

275
Q
  1. 4 year old girl with a high fever that was followed by a rash. What is the most likely Dx?
A

Roseola infantum

276
Q
  1. Kid with temp of 39, cap refill 6s, generally unwell + bulging fontanelles, no description of rash.
A

Meningiococcal septicaemia

277
Q

Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have?

A

Scarlet fever

278
Q
  1. Woman who had bulimia. What gives it away?
A

Dental enema caries

279
Q
  1. 4yo kid having acute asthma attack, given iv salbutamol and hydrocortisone. Sats still low, no chest sounds on auscultation. What do you do/give next? IM adrenaline, call for senior help, start Atrovent (Ipratropium bromide)
A

Call for senior help

280
Q
  1. 4-month-old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine? Confirmed history of pertussis as a baby, currently ill with a fever of 38.5?, got a rash at site of last vaccination, severe cow’s milk allergy?
A

Currently ill with a fever of 38.5

281
Q
  1. Kid with URTI and generalised abdo tenderness
A

Mesenteric adenitis

282
Q

Posterior rib fractures

A

NAI

283
Q

Treatments of Rashes
1. Nappy rash flexure sparing?

A

Zinc and castor oil barrier cream (eczema or irritant)

284
Q
  1. Nappy rash with satellite lesions treatment
A

Clomitrazole (candidiasis)

285
Q

Scabies - treatment?

A

Permethrin

286
Q

Treatment for chicken pox?

A

None required

287
Q

Heart sounds not heard in left chest, scaphoid abdomen - diagnosis?

A

Diaphragmatic hernia

288
Q
  1. Baby was born at 41 weeks via emergency C section due to foetal distress. Needed ventilation straight away. X ray showed hyper inflated lungs with areas of consolidation
A

Meconium aspiration

289
Q

Prem baby, resp distress, CXR looks like ground glass

A

Respiratory distress syndrome (surfactant deficiency)

290
Q

Impetigo measuring 8mm treatment?

A

Fusidic acid

291
Q

Child suffers from fever. The fever disappears but she has now developed a rash. She subsequently has febrile convulsions

A

Roseola infantum

292
Q

Child appears severely unwell with a non-blanching rash

A

Neisseria mengitidis

293
Q

Mother with cold sores has been kissing her child who has a background of eczema?

A

Eczema herpeticum

294
Q
  1. Child has an URTI 2 weeks ago. Has now developed a rash over the back of the legs along with joint and abdominal pain?
A

HSP

295
Q

What are some organisation in the UK that can help with abortions?

A
  • British Pregnancy Advisory Service
  • Marie Stopes UK
  • National Unplanned Pregnancy Advisory Service
  • Brook (<25)
296
Q

What is the differential for small for gestational age (<10th centile)?

A

IUGR – infection,
placental insufficiency, undernutrition, normal constitutionally small for gestational age so just a small baby, small parents, genetic disorders, multiples like twins

297
Q

Consequence of heroin use in pregnancy?

A

– placental abruption, LBW, premature, neonatal abstinence syndrome, stillbirth.

298
Q

Neonatal treatment if HIV positive mother?

A

Neonatal:
All neonates should be treated with anti-retroviral therapy within 4 hours of birth until they are 4-6 weeks.
Infants should be tested for HIV DNA and RNA at 1 day, 6 weeks and 12 weeks of age. If all these tests are negative and the baby is not being breastfed, the parents can be informed that the child is not HIV-infected. A confirmatory HIV antibody test is performed at 18 months of age.

299
Q

When is mode of delivery finalised in HIV positive women?

A

Based on viral load at 36 weeks. Make sure on ART by 24 weeks.

300
Q

What would happen if placenta praevia was diagnosed at 20 weeks on the routine scan?

A

Repeated at 32 weeks to see if placenta has moved. Only 1 in 10 will still be low lying at term

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