PassMed Flashcards
1
Q
Low T3
T4, TSH Normal
A
Sick euthyroid
stress-induced T3 dysregulation (anorexia, pneumonia)
treat the cause, no supplementation needed
2
Q
BMI <17.5 or
wt 15% less than expected
Distorted Body image
Reduce calorie intake, xs exercise, laxatives, diuretics, drugs. Diabetics skip insulin
HPG axis affected - amenorrhoea and infertility in M. Loss libido in both
A
Anorexia Nervosa
3
Q
when to admit pt with anorexia
A
BMI<13.5
extreme rapid wt loss or physical complications
high suicide risk
4
Q
Binge eating (compulsion)
Purging
Body image distortion
BMI >17.5
A
Bulimia Nervosa
5
Q
G’s and C’s raised
growth hormone,glucose, salivaryglands,
cortisol,cholesterol,carotinaemia
A
Anorexia
6
Q
rectal bleeding
offensive stools
child age 2
A
Meckel’s diverticulum
7
Q
episodic crying and drawing legs to chest + become pale mass on ULTRASOUND (target sign) red-currant jelly stool invagination ileo-caecal region child <9m
A
Intususseption
Mx = air insufflation
8
Q
Child should smile by
refer by
A
smile by 6 weeks
refer at 10 weeks
9
Q
Wertheim’s radical hysterectomy
A
removal of lymph nodes for
stage IIB endometrial carcinoma
10
Q
RIF pain
all tests normal
after viral infection
A
Mesenteric adenitis
inflamed lymph nodes within the mesentery.
no Tx needed
11
Q
scaphoid abdomen + bilious vomiting
A
intestinal malrotation and volvulus
High caecum at the midline
urgent upper GI contrast study and ultrasound is required.
Tx = laparotomy. Ladd’s procedure if volvulus present
12
Q
presenting <2 years or >10 years
Male sex
having B or T cell surface markers
and having a WCC > 20 * 10^9/l at diagnosis.
A
Poor prognosis for ALL
13
Q
commonest complication of open myomectomy for fibroids
A
adhesions
others= bladder injury, uterin perforation
14
Q
1t line Tx fibroid
A
IUS (levonogestrel)
others = tranexamic acid, COCP
15
Q
reduce size of fibroids with
A
GnRH agonist
16
Q
Complications fibroids
A
red degeneration
haemorrhage into tumour - commonly occurs during pregnancy
17
Q
Bicuspid aortic valve
ejection systolic murmur
associated with
A
Turner’s
18
Q
lie supine, flexion and abduction of the maternal hips
A
McRobert’s maneouvre for shoulder dystocia
19
Q
agitation, hyperthermia, hyperreflexia, sweating and dilated pupils
A
serotonin syndrome
20
Q
CVS risk of antipsychotics
A
stroke and VTE risk
21
Q
Exrapyramidal SE of antipsychotics
A
Parkinsonism
acute dystonia (e.g. torticollis, oculogyric crisis)
akathisia (severe restlessness)
tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
22
Q
Endrocrine SE of Antipsychotics
A
hyperprolactinaemia
impaired glucose tolerance (diabetes)
23
Q
Mx of akathisia (restlessness)
A
Propranolol
24
Q
Mx of acute dystonia (toricollis, oculogyric crisis)
A
Procyclidine and benztropine
25
Mx severe tardive dyskinesia (involuntary movements)
Tetrabenazine
26
```
hip pain
unable to weight bear
+/- low fever
post viral infection
age 2-10 years
```
transient synovitis
Mx = rest and reassure
27
Lithium therapeutic range
0.4-1.0 mmol/L
28
Lithium excreted in
kidneys
29
Osgood-Schlatter inflammation on which bony prominence
inflammation (apophysitis) at the tibial tuberosity
30
Use cephalosporin e.g. ceftriaxone whilst breastfeeding?
yes
31
Use ciprofloxacin, tetracyclin, chloramphenicol, sulphonamides whilst breastfeeding?
no
32
use BDZ whilst breastfeeding?
no
33
Use sulfonylureas, aspirin or amiodarine whilst breastfeeding?
no
34
Low-pitched sound heard at the lower left sternal edge
Still's murmur
innocent, in children
35
Alcohol withdrawal initial Sx
6-12 hours
| tremor, sweating, tachycardia, anxiety
36
Peak incidence seizures in alcohol withdrawal
36hr
37
Delirium tremens onset
| Sx
```
48-72 hours
coarse tremor
confusion, delusions
auditory and visual hallucinations
fever, tachycardia
```
38
Mx delirium tremens
Chlordiazepoxide (BDZ)
Carbamazepine can also be used
39
pruritis in pregnancy >20 weeks
| no rash
cholestasis of pregnancy
40
jaundice, mild pyrexia
pregnancy >20 weeks
```
hepatitic LFTs - ALT raised
hypoglycaemia
raised WBC
coagulopathy
steatosis on imaging
malaise, fatigue, nausea
```
acute fatty liver
41
maternal pyrexia, maternal tachycardia, and fetal tachycardia
preterm PROM
chorioamnionitis
ascending bacterial infection of the amniotic fluid / membranes / placenta
42
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
hyperemesis gravidarum
43
hyperemesis gravidarum
diplopia and ataxia
Mx?
Wernicke's encephalopathy
thiamine (Vitamin B1) with a vitamin B and C complex (e.g. Pabrinex) is indicated.
44
Mx hyperemesis gravidarum
antihistamines e.g. promethazine, cyclizine is
ondansetron, metoclopramide second-line
ginger and P6 (wrist) acupressure:
45
age sit without support
refer at
7-8m
refer at 12m
46
age squats to pick up ball
18m
47
age pull to standing
8-10m
48
SSRI in kids
Fluoxetine
49
SRI that causes QT prolongation and Torsades de pointes
Citalopram
50
ROM
painless vaginal bleeding
fetal bradycardia
Vasa praevia
51
factor decreases incidence hyperemesis
smoking
52
How long is UPT +ve post-TOP?
up to 4 weeks
53
active Mx 3rd stage labour
1. uterotonic (oxytocin)
2. delayed clamping/cutting of cord (1-5min)
3. controlled cord contraction after placental separation
54
child
pink maculopapular rash on face then to body
disappears day 3-5
sub occipital, postauricular lymphadenopathy
Rubella
55
irritable conjunctivitis fever
then rash behind ears to body
white spots on buccal mucosa
Measles
56
when do USS for lochia
6 weeks post partum
57
Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions
Patau (13)
58
Trisomy 13
Patau
59
Micrognathia
Low-set ears
Rocker bottom feet Overlapping of fingers
Edward (18)
60
Trisomy 18
Edward
61
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
Fragile X
62
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Noonans
63
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
Pierre-Robinson
64
```
Hypotonia
Hypogonadism, infertility
Dysmorphism
Obesity
Short stature
LD
behavioural problems adolescence
```
Mode of inheritance?
Prader Willi
genetic imprinting (long arm Chr 15)
- gene deleted from father = PW
- deleted from mother = Angelman syndrome
65
Short stature
Learning difficulties
Friendly, extrovert personality Transient neonatal hypercalcaemia
Supravalvular aortic stenosi
Williams
66
APGAR
```
Appearance
Pulse
Grimace (cries/grimace/none)
Activity (move/flex/none)
Resp (strong cry/weak irregular/none)
```
67
APGAR score cause to worry
<7
68
pediculosis capitis
head lice
69
school exclusion for head lice?
no
70
Mx pediculosis capitis
malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone
71
herald patch
| oval patches
Pityriasis rosea
?HHV7
self-limiting
72
cause guttate psoriasis
streptococcal sore throat 2-4 weeks
73
Dx Bronchiolitis
fluorescent antibody test on nasopharyngeal secretions
74
CF mutation
delta F508 Chr 7
75
CF carrier rate
1 in 25
76
CF infections
Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus
77
Mx cranial DI
desmopressin
78
Mx nephrogenic DI
thiazide diuretics (increases sodium in urine)
79
high plasma osmolality
| low urine osmolality
DI
Ix = water deprivation test
80
Mx Enterobius vermicularis
threadworms
GIve mebendazole
81
Kid runny nose
temp 37.6
wheeze
Mx?
Paracetomal
| NO bronchodilators in bronchiolitis
82
Knows 2-6 words
| Refer at
12-15m
| refer at 18m
83
vocab 200 words
2.5 years
84
Contraindicatins to MMR
```
immunosuppression
neomycin allergy
another live injection in last 4wk
pregnancy (avoid getting pregnant until >1m post)
Ig therapy in last 3m
```
85
painless limp
juvenile idiopathic arthritis
86
when to admit SCD adult
severe pain
| temp >38
87
when to admit SCD child
severe pain
| temp
88
Sickle sell crisis Mx
```
analgesia e.g. opiates
rehydrate
oxygen
Abx if evidence of infection
blood transfusion
exchange transfusion: e.g. if neurological complications
```
89
Sarcoptes scabiei
| Type hypersensitivity
```
Scabies
Type IV (starts 30 days later)
```
90
```
microcephaly
short palpebral fissures (small eye opening)
hypoplastic upper lip
absent philtrum
reduced IQ
variable cardiac abnormalities.
```
foetal alcohol syndrome presents
91
risk of miscarriage, stillbirth, pre-term labour, IUGR
smoking
92
cataract + deafness + cardiac abnormalities
Possible features: jaundice, hepatosplenomegaly, microcephaly, reduced IQ
Rubella
most at risk first 16 wks
93
skin scarring
eye defects (small eyes, cataracts or chorioretinitis)
reduced IQ, abnormal sphincter function, microcephaly
1% foetuses affected if mother has primary infection in 3-28wk
(due to deactivation in utero)
Foetal varicella syndrome
94
```
Rhinitis
saddle shaped nose
deafness (sensorineural)
Hutchinson’s incisors
Hepatosplenomegaly, lymphadenopathy, anaemia, jaundice
```
Maternal syphilis infection
95
```
2 wk old
abdominal distension, tenderness
blood in her nappy
bilious vomit
decreased movement
struggling to feed
```
premature baby
NEC
Ix = abdo Xray - pneumatosis intestinalis (gas in gut wall)
96
Mx NEC
stop oral feeds, barrier nurse and give antibiotics (cefotaxime and vancomycin
97
distended abdomen ed current jelly stool children (5m-12m)
Intususseption
Ix = abdo USS
98
Causes gross motor developmental delay
```
variant of normal
cerebral palsy
neuromuscular disorders (e.g. Duchenne muscular dystrophy)
```
99
Causes child Speech and language problems
always check hearing
| other causes include environmental deprivation and general development delay
100
still births + neonatal deaths in 7 days per 1,000 births after 24 weeks gestation
around 8 per 1,000
Perinatal mortality rate
101
deaths in pregnancy, labour & 6 weeks afterwards / total maternities * 1000
Maternal mortality rate
102
babies born dead after 24 weeks / total births (live + stillborn) * 1000
Stillbirth rate
103
babies dying between 1-28 days / total live births * 1000
Neonatal death rate
104
Neonate
```
visual and hearing loss
microcephaly
long-term neurodevelopmental disability
hydrocephalus
IUGR
```
NO congenital heart defects
Cytomegalovirus (CMV)
commonest congenital infection
60% mums had a prior infection
If contracted in pregnancy 40–50% risk foetal transmission
105
```
Mum: mild infection in pregnancy/ASx
neonate:
chorioretinitis
macro- or microcephaly
convulsions
long-term neurodevelopmental delay
```
Toxoplasma gondii
undercooked meat and cat faeces
106
organism in pregnancy
| increases risk miscarriage, stillbirth or preterm delivery
Listeria monocytogenes
unpasteurized cheeses and patés
107
SE oxybutinin for urge incontinence
dry mouth
constipation
urinary retention
108
white offensive discharge
fishy odour
clue cells
loss of vaginal acidity
Bacterial vaginosis
109
vaginal discharge- offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Trichomonas vaginalis (STI)
microscopy -motile trophozoites
110
Mx BV and trichomonas
Metronidazole
111
crackles and wheeze and less than 1yr supportive care only (oxygen/optiflow/cpap/intubation/NG feeds)
Bronchiolitis
112
>1 yr, wheeze but less crackles
| treat with bronchodilators
Wheeze
113
Mx Gonorrhoea
IM ceftriaxone 1g
114
Mx Chlamydia
Doxycycline or Azithromycin
| Azithro if pregnant
115
```
Rash
Koplik spots (like tiny grains of salt on the buccal mucosa)
```
MEasles
116
Childhood rash
| Cervical lymphadenopathy and arthralgia
Rubella
117
Childhood rash
bright red cheeks
maculopapular rash limbs - lacy patterm after physical activity
Erythema infectiosum (parvovirus)
118
Fever then rash 12-48 hr later
starts on neck/groin then spreads
sandpaper texture
rash spare mouth/nose (circumoral pallor)
rash initially chest/stomach -> other parts
temperature, headache, vomiting and malaise
increased rash intensity in the axillae and groins in a linear distribution (Pastia’s lines)
tongue - white coated with red oedematous papillae (white strawberry)-> five days the coating peels off to leave a red strawberry tongue
skin begins to peel + rash fades after four to five days - Desquamation of hands and feet
Scarlet fever
10 days penicilliv V
azithromycin if allergic
complications = glomerulonephritis, rheumatic fever
DDx - Kawasaki if fever > 5 days
- necrotising fasciitis/ toxic shock strep
PAIN
119
cause scarlet fever
group A beta haemolytic streptococcal
120
Mx Kawasaki
IVIG and aspirin
121
erythematous rash that is polymorphous and can be urticarial, scarlatiniform or morbilliform; there may be small aseptic pustules
Cervical lymphadenopathy
Oedema (may be subtle)
Erythema palms and soles + desquamation of the hands and feet occurs
Bilateral conjunctival injection
Change in mucous membranes in the upper respiratory tract (eg injected pharynx, dry cracked lips, or strawberry tongue).
Kawasaki
122
cause roseola infantum/exanthum subitum
HHV6
123
need school exclusion for roseola infantum?
no
124
high fever
then develop rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions
diarrhoea and cough are also commonly seen
Roseola infantum (HHV6)
