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4th Year > PALS > Flashcards

PALS Flashcards

1
Q

What 8 sections are there to an annual review?

A 
Symptoms
Targets
Emotions
Medications
Blood tests
Lifestyle
Extra info
Demographics
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2
Q

What 4 questions come under ‘symptoms’?

A
  1. What symptoms were you diagnosed with?
  2. Any new symptoms?
  3. Ask about specific complications of condition
  4. Any hospital admissions?
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3
Q

What is Stage 1 hypertension?

A

BP >140/90
AND
>135/85 ambulatory

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4
Q

How do you manage stage 1 HTN?

A

Lifestyle and diet

Follow up in 2-4 weeks

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5
Q

What is Stage 2 HTN?

A

BP >160/100
AND
>150/95 ambulatory

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6
Q

What happens at stage 2 HTN?

A

Start antihypertensives

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7
Q

When do you start statins?

A

If QRISK >10-20%

OR if secondary prevent, have CKD/T1DM

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8
Q

What 5 sections are there to ‘medications’?

A
  1. Drugs - dose, frequency, durations
  2. Compliance
  3. Side effects
  4. Safety net complications
  5. Re-iterate interactions
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9
Q

What are the 6 sections of lifestyle advice?

A 
Smoking
Alcohol
Diet
Exercise
Pregnancy eg. DM need 5mg folic acid daily
Extra eg. avoid caffeine in AF
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10
Q

What 4 extra things should you check with DM?

A
  1. Retinal screen
  2. Foot screen
  3. Urine ACR
  4. Injection sites
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11
Q

What 5 things come under ‘demographics’?

A
  1. Height
  2. Weight
  3. BMI
  4. Waist circumference
  5. BP
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12
Q

How much blood is lost in Stage 1 shock?

A

<750ml

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13
Q

How are the obs in Stage 1 shock?

A

Normal

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14
Q

How much blood is lost in Stage 2 shock?

A

750-1500ml

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15
Q

What are the obs of Stage 2 shock like?

A

HR <120, BP reduced

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16
Q

How much blood is lost in Stage 3 shock?

A

1500-2000ml

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17
Q

What are the obs of Stage 3 shock like?

A

HR <140, confused

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18
Q

How much blood is lost in Stage 4 shock?

A

> 2000ml

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19
Q

What are the obs for Stage 4 shock like?

A

HR >140, lethargic

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20
Q

When do you consider transfusing blood?

A

Stage 3 shock

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21
Q

What are the 5 criteria for the Major Haemorrhage Protocol?

A 
HR >110
BP <90
Blood loss >5L in 24hrs
Blood loss >2.5L in 2hrs
Blood loss >150ml/min
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22
Q

What is the Major Haemorrhage Protocol?

A

Call blood bank
4 units RBC
4 units FFP
Tranexamic acid - factor 2 activator

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23
Q

What is placenta accreta?

A

Placenta attached to the myometrium, often follows LSCS

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24
Q

What is placenta increta?

A

Placenta invading the myometrium

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25
Q

What is placenta percreta?

A

Placenta invading the serosa

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26
Q

How does a placenta praevia present?

A

Painless vaginal bleeding

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27
Q

What is the management of placenta praaevia if shocked or >37wks?

A

LSCS + X-match 4-6 units

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28
Q

What is the management of placenta praaevia if not shocked or <37wks?

A

Admit
Give steroids and Anti-D
Elective LSCS at 39wks

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29
Q

How does a vasa praaevia present?

A

Vaginal bleeding following SRoM

Fetal bradycardia from torn fetal blood vessels

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30
Q

What is the management of vasa praaevia?

A

Continuous CTG +/- FBS in bradycardia continues

pH <7.2 = LSCS

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31
Q

How does a placental abruption present?

A

Painful vaginal bleeding with a tense woody uterus

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32
Q

What is the management of a placental abruption?

A

Admit
Give steroids and Anti-D
CTG

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33
Q

What is the management of a placental abruption with a CTG showing 1) distress 2) no distress >37wks 3) distress <37wks?

A

1) Distress = LSCS
2) No distress >37 wks = amniotomy to induce
3) No distress <37wks = conservative Mx, may discharge as high-risk

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34
Q

How does a uterine rupture present?

A

Very painful, less vaginal bleeding

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35
Q

What is the management of uterine rupture?

A

Surgery

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36
Q

What is the Save the Baby 5 for worrying CTGs?

A
  1. Left Lateral position
  2. STOP syntocinon
  3. Give Mum fluids
  4. Fetal scalp stimulation
  5. FBS - pH <7.20 = LSCS
37
Q

What is fetal scalp stimulation?

A

Stroke baby’s scalp for 15 seconds

Well baby will show 15 second acceleration on CTG

38
Q

What is a primary PPH?

A

> 500ml blood loss within 24hrs of delivery OR >1L blood loss within 24hrs of LSCS

39
Q

What is a secondary PPH?

A

> 500ml blood loss 24hrs - 6wks post-delivery

40
Q

How much blood is lost due to inefficiently contracting uterus?

A

700ml ish

41
Q

What are the 4 T’s (causes) of PPH?

A

Tone - uterus doesn’t contract
Tissue - retained placenta
Tears - perianal, vaginal, cervical
Thrombin - clotting dysfunction

42
Q

What would you perform in ‘C’ of ABCDE during a PPH?

A

IV access with 2x large bore cannulas in ACF
500ml 0.9% NaCl
Bloods = FBC, U&E, LFT, Clotting, G&S/X-match depending how unstable

43
Q

What are the 11 risk factors for VTE in pregnancy?

A 
Obesity
Age >35yrs
P3
Smoking
Varicose veins
Pre-eclampsia
Immobility
Fix in 1st degree relative
Low-risk thrombophilia
Multiple pregnancy
IVF/ART
44
Q

What are the 7 pre-pregnancy risk factors for VTE in pregnancy?

A 
Obesity
Age >35yrs
Smoking
P3
Varicose veins
Low-risk thrombophilia
Fix in 1st degree relative
45
Q

What are the 4 intra-pregnancy risk factors for VTE in pregnancy?

A

Immobility
Multiple pregnancy eg twins
Pre-eclampsia
IVF/ART

46
Q

What is the management if 2 or less risk factors for VTE in pregnancy are present?

A

Mobilise and hydrate

47
Q

What is the management if 3 risk factors are present for VTE in pregnancy?

A

LMWH from 28wks to 6wks postpartum

48
Q

What is the management if 4+ risk factors are present for VTE in pregnancy?

A

LMWH from 1st trimester to 6wks postpartum

Stockings also useful

49
Q

What is the management if the patient has previously had an unprovoked VTE?

A

LMWH from 1st trimester to 6wks postpartum
Stocking
Referral to obstetric haematologist

50
Q

What are cafe au lait spots associated with?

A

NF2 = neurofibromatosis type 2

51
Q

What is NF2 associated with?

A

Bilateral vestibular schwannomas (accoustic neuromas)

52
Q

When do milia resolve?

A

In a few weeks

53
Q

When do haemangiomas arise?

A

After 1st month of life

54
Q

Do haemangiomas need treatment?

A

They regress spontaneously at 2-4yrs

May need propranolol if in eye field

55
Q

When do you need to investigate a port win stain?

A

If in the ophthalmic branch of the trigeminal nerve

56
Q

What investigations need performing on a port wine stain?

A

Retinal exam and MRI head - associated with Sturgge-Weber syndrome

57
Q

What is Sturgge-Weber syndrome?

A

Intracranial angiomas

Causes LD and focal epilepsy

58
Q

What is erythema toxicum?

A

Confluent pink macular rash with overlying pustules on otherwise well baby
Arises about day 2-5, goes away about 2-3wks

59
Q

There is a lump following a ventuose delivery that dose not cross suture lines, what is it?

A

Cephalohaematoma

60
Q

What may a cephalohaematoma be associated with?

A

Jaundice due to RBC breakdown from haematoma

61
Q

How will RDS appear on a CXR?

A

Ground glass appearance

62
Q

What is the management of RDS?

A

ET tube with surfactant replacement + O2

Prevented with steroids/tocolytics

63
Q

What is the correct name for clubfoot?

A

Talipes equinovarus

64
Q

What is the management of clubfoot?

A

Ponseti method

65
Q

What do you need to do if a pregnant women comes into contact with chicken pox?

A

Confirm immunity status

Consider immunoglobulins

66
Q

When is cow’s milk protein allergy usually outgrown by?

A

5 years

67
Q

When do non-IgE-mediated hypersensitivity reactions present?

A

2-7 days following exposure

Consider patch test

68
Q

How does foreign body inhalation show on CXR?

A

Affected lung will be inflated during expiration as doesn’t change size during respiratory cycle

69
Q

What is the management of testicular torsion?

A

Urgent scrotal exploration and fixation of BOTH testicles

70
Q

When will cryptorchidism likely correct itself by?

A

6 months

71
Q

When should you refer a child with undescended testes to the surgeons?

A

3 months

72
Q

When do you need to refer a suspected indirect inguinal hernia to the surgeons?

A

Urgent <4wks

High risk of incarceration

73
Q

What presents at 6m with sudden onset severe abdominal pain and drawing up of legs?

A

Intussusception

74
Q

What in the management of intussusception?

A

Air enema

75
Q

How does mesenteric adenitis present?

A

7yo with central abdominal pain and preceding URTI
Fever + malaise
Other causes excluded

76
Q

What is the management of DDH?

A

Pavlik harness

77
Q

What are the 7 risk factors for DDH?

A 
Female
Breech
Multiple pregnancy
Fix
Oligohydramnios
1st born child
Cerebral palsy
78
Q

Teenager with 2 stiff joints in the morning for >6wks?

A

JIA

79
Q

What is the management of impetigo?

A

Topical fusidic acid or oral flucloxacillin

80
Q

What factor is involved in Haemophilia A?

A

Factor 8

81
Q

What factor is involved in Haemophilia B?

A

Factor 9

82
Q

How much more common in HA than HB?

A

5x more common

83
Q

What is the inheritance of the haemophilias?

A

X-linked

84
Q

What clotting test is prolonged in Haemophilia?

A

APTT

85
Q

What is the most common childhood cancer?

A

ALL

86
Q

What is the most common childhood brain tumour?

A

Astrocytoma

87
Q

What is the most common monogenetic condition?

A

SCD, Glut -> Val

88
Q

What is Ricketts?

A

Vitamin D deficiency

89
Q

What are 3 features of Ricketts? FFBB

A

Frayed metaphyses
Frontal bossing
Bowing of long bones

4th Year (15 decks)

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