Paeds 6 Flashcards
What organism causes head lice?
pediculus capitis (obligate ectoparasite)
small insects that live only on humans and feed our blood
diagnosis of pediculosis capitis / head lice
fine toothed combing of wet or dry hair
What is the blood glucose cut-off when you should send to NICU and treat neonatal hypoglycaemia?
<1.5 mmol/L
What is the medical management of neonatal hypoglycaemia?
IV 10% dextrose 2ml/kg bolus
then infusion of 3.6 ml/kg/hr of 10% glucose
-> frequently check blood glucose until stable (aim 3-4 mmol/L)
What medication can be given to manage Mg sulfate induced respiratory depression?
calcium gluconate
Which of the following drugs should NOT be used in breastfeeding women?
1. aminophylline
2. carbamazepine
3. Sodium valproate
4. methyldopa
5. amiodarone
- Amiodarone (antiarrythmic)
What is the commonest heart defect in patientsb with down syndrome?
AVSD
How common are congenital heart defects in patients with down syndrome?
50% of pts have them
What does MCUG stand for?
micturating cystourethrogram
Mx of UTI in children
<3 months: admit, sepsis 6, give IV abx e.g. ampicillin or gentamycin or cefotaxime
3m - 15y: lower UTI give PO abx (trimethoprim, nitrofurantoin (if eGFR >/= 45ml/min); if upper UTI consider paeds referral and cephalexin/co-amoxiclav
if recurrent refer to paediatric specialist for USS, MCUG, DMSA
Medical management of migraines in children and adolescents
- simple analgesia
- nasal sumatriptan (oral triptans are not licensed in people under 16)
- combination therapy with nasal triptan and NSAID/Paracetamol; consider adding an anti-emetic, e.g. metoclopramide or chlorpromazine
F/U in 1 month or sooner if sx worsen
specialists can prescribe prophylactic treatment:
- topiramate (nb high risk of foetal malformations) or propranolol
What medication for bacterial tonsillitis in children
phenoxymethylpenicillin for 5-10 days
clarithromycin if penicillin allergy (macrolide, works by inhibiting 50s subunit in protein synthesis)
What centor / feverpain scores would prompt abx ?
FeverPAIN 4 or 5
CENTOR 3 or 4
What are the features seen in prader willi syndrome?
hyperphagia
obesity
muscular hypotonia
short stature
scoliosis
almond shaped eyes
thin upper lup
developmental delay
behavioural problems (e.g. temper tantrums, stubbornness)
Underlying pathology in Prader-Willi Syndrome?
genetic syndrome caused by a microdeletion at 15q11-q13 in combination with genomic imprinting
in PW-syndrome there is deletion or mutation of the paternal copy and the maternal gene is methylated (silenced)
What are the features of angelman syndrome?
delayed mental development and acquisition of motor skills
intellectual disability
microcephaly
in >80% there are pronounced epileptic seizures
ataxia
fascination with water
hyperexcitability, short attention span
When should children be able to draw a circle?
3 yo
When should children be able to draw a vertical and horizontal line?
veritcal: 2 yo
horizontal: 2.5 yo
When should children be able to draw a square and a triangle, person and cross?
cross: 4 yo
square: 4.5 yo
triangle/person: 5 yo
What is the first line chemotherapy option given in ovarian cancer?
combination of platinum compound and paclitaxel
What is the first line chemotherapy option given in ovarian cancer?
combination of platinum compound and paclitaxel
What are the chemotherpy cycles used in Ovarian cancer?
outpatient
3 weeks apart for 6 cycles
Follow up investigations in ovarian cancer
CT scan following completion of chemotherapy to review the response
clinical examination
Ca-125 (tends to rise before the onset of clinical signs of disease recurrence)
What is the management in recurrence of ovarian cancer?
mainly palliative
RFs for Ov Ca
age
FH
obesity
HRT
endometriosis
smoking
diabetes
what are protective factors for ovarian cancer?
COCP
pregnancy
breastfeeding
hysterectomy
What is the management of stage 1 ov ca?
total hysterectomy with bilateral salpingo-oophrectomy +/- chemo
if fertility needs to be preserved, only one ovary may be removed (only 1a)
What is the management of stage 2 ov ca?
debulking surgery to remove as much as possible
adjuvant or neo-adjuvant chemotherapy
What is the management of stage 3 ov ca?
debulking surgery to remove as much as possible
adjuvant or neo-adjuvant chemotherapy
+ targeted treatment bevacizumab (targets VEGF A)
if surgery not an option, platinum based chemo can be given as well as symptomatic treatment e.g. ascitic drain, mx of constipation
What is the management of stage 4 ov ca?
like stage 3
but palliative care is more likely
What are the components of the RMI for ovarian cancer?
Ca 125 (units/ml)
findings on TVUSS (0,1,2 depending if 0, 1 or 2+ features seen )
menopausal status (1 pre; 2 post)
RMI = U x M x Ca125 -> if >250 refer to gynae
what is the cut off for RMI to refer to gynae?
How is RMI calculated?
if >250 refer to gynae
RMI = U x M x Ca125
how does platinum based chemotherapy work?
causes cross-linkage of DNA strands leading to cell cycle arrest
Which platinum based chemotherapy agent is mainly used in ov ca and why?
carboplatin
it is less nephrotoxic than e.g. cisplatin and causes less nausea
dose of carboplatin is calculated using the GFR
How does Paclitaxel work?
causes microtubular damage
prevents replication and cell division
steroids can be given to reduce hypersensitivity reactions and reduce side effects
causes total loss of body hair
what medication is used to treat threadworms?
mebendazole
everyone in the household should be treated.
At what age does biliary atresia present?
a few weeks
blood findings in biliary artresia
Conjugated hyperbilirubinemia
↑ Aminotransferases and alkaline phosphatase
↑ GGT
What is the procedure called that is used to correct biliary artresia?
Kasai hepatoportoenterostomy
-> involves ligating the fibrous ducts above the join with the duodenum, dissecting proximally to the portal hepatis (from which the bile usually flows from the liver), facilitating bile duct drainage
Complications of HSP
GI
- intussusception
- bowel ischaemia/perforation
Renal
- progressive kidney involvement (e.g. nephrotic syndrome)
- CKD
What is the minimal acceptable level of observation in psychiatric inpatients?
every 60 minutes (Level 1)_
What is the minimal acceptable level of observation in psychiatric inpatients?
every 60 minutes (Level 1)
What are the different levels of observation in psychiatry?
Level 1 - General observation observation every 60 minutes (minimum required)
Level 2 - intermittent observation every 15-30 minutes
Level 3 - 1-2-1 within eyesight
Level 4 - 1-2-1 observation within arms reach. sometimes may need more than 1 person, people on Level 4 observation cannot go to the bathroom alone.
What is the first line antibiotic used in PPROM?
- erythromycin 250 mg QDS for a max of 10d or until in established labour
- line: oral penicillin
What is the risk of giving steroids in premature labour?
increased risk of learning difficulties
some research showing that there may be issues with wellbeing later on in life.
what supplement should be prescribed in hyperemesis gravidarum?
thiamine (vitamin B1)
What chronic infectious conditions are women screened for in early pregnancy?
HIV
Hep B
Syphilis
A woman in her 1st pregnancy develops an itchy rash on her abdomen that spares the umbilical area - dx?
polymorphic eruption of pregnancy
a benign, inflammatory condition that most commonly affects primiparous women in the 3rd TM or immediately PP.
the lesions last for 4-6 weeks and then resolve spontaneously.
lesions spare the face, palms and soles.
What site is most commonly affected by cephalohaematoma?
parietal bone
(does not cross suture lines)
what is a cephalohaematoma?
swelling on newborns head
typically develops hours after birth
is due to bleeding between the periosteum and the skull
What is a possible complication of cephaloheamatoma?
jaundice
in what timeframe to cephalohaematoma and caput succedaneum develop?
cephalohaematoma: a few hours after delivery
caput succedaneum: generally present at birth
where is caput succedaneum generally found?
over the vertex
crosses suture lines
in what timeframe cephalohaematoma and caput succedaneum resolve?
cephalohematoma: can take up to 3 months
caput succedaneum: resolves within days
What enzyme should be measured in children with ?muscular dytrophy?
creatine kinase (elevated in 50% cases)
but also elevated in 50% female carriers
minimum duration to diagnose schizophrenia
1 month of sx
What is pemphigoid gestationis
a rare skin blistering condition associated with pregnancy
usually presents in mid to late pregnancy (13-40w) with an itchy rash that develops into blisters
What skin areas does pemphigoid gestationis affect?
commonly starts in the periumbilical region during the 2nd/3rd TM
pruritic, mostly non-blistering lesions
grouped vesicles with herpetiform appearance
Management of pemphigoid gestationis
usually self-limiting
heals spontaneously after delivery
what complications is pemphigoid gestationis associated with?
premature labour
increased lifetime risk of autoimmune disease
What is the chance of developing T2DM in women who had GDM?
30% in 5 years
70% in 10 years
-> according to Chat GPT
How long after LLETZ for CIN 1/2 should you have a smear?
6 months
(wait for discussion with girls before being sur ere this Q)
When following a sensitising event should you give anti-D?
within 72h
What are the cut-offs for iron supplementation in pregnancy?
<110 g/L in the 1st TM
<105 g/L in the 2nd/3rd TM
<100 g/L PP
How does iron supplementation in pregnancy work?
100-200 mg oral iron (ferrous sulphate)
re-chech Hb in 2-3 weeks
once hb is normal, continue oral iron for 3 months or 6 weeks PP
give dietary advice (e.g. leafy greens, nuts, beans, seeds)
Intrapartum advice for pregnant women with anaemia
- give birth on LW
- have a cannula
- G&S on arrival
- active management of the 3rd stage of labour
- consider prophylactic syntocinon infusion in the 3rd stage of labour (to prevent PPH)
active mx of PPH if occurs
Do you need scan confirmation for management of ?VTE in pregnancy
no
you should start LMWH management immediately (unless it is contraindicated)
What location would prompt a GP to refer someone with molloscum contagiosum onwards
eye or eyelids
What virus causes molloscum contagiosum?
molloscum contagiosum virus
What is the scoring system used for croup?
Westley Croup Score
What are the best opioid replacements to use in pregnancy?
methadone
or
buprenorphine
(double check this)
