Passmed, Quesmed, Passtest Flashcards
When should children be able to smile? when to refer?
6w -> refer @10w
ambiguous genitalia + testes in adbo + internal reproductive tracts exhibit the normal male phenotype, what is cause?
5α-reductase deficiency
Components of APGAR score? + points for each
Appearance = Cyanotic / pale (0), Peripheral cyanosis (1), Pink (2)
Pulse = 0 (0), <100 (1), >100 (2)
Grimace (reflex irritability) = no response to stim (0), grimace / weak cry on stim (1), cry when stim (2)
Activity (tone) = Floppy (0), some flexion (1), well flexed + resisting extension (2)
Resp = Apneic (0), slow + irregular (1), strong cry (2)
Inverted SMA and SMV relationship on USS is seen in which paeds condition?
Malrotation
Herniation of hyperechogenic bowel loops on USS is seen in which paeds condition?
Omphalocele
when does puberty start in males and what indicates onset of puberty?
1st sign = testicular growth (>4ml) @12y
1st sign = breast development @11.5y
Most common type of cerebral palsy?
Spastic
What is:
Pes planus
Genu varum
Geny valgum
Pes planus - flat feet seen @ all ages
Genu varum - bow legs seen @ 1-2y
Geny valgum - knock knees seen @ 3-4y
When is precocious puberty?
‘development of secondary sexual characteristics before:
8 years in females and 9 years in males
eg. breast changes in females, genital growth in males, and pubic hair changes in both males and females
Most common complication of measles? cause of death? complications (1-2w after + 5-10y after)
Otitis media
Death = Pneumonia
Complications = Encephalitis (1-2w) + Subacute sclerosing panencephalitis (5-10y) –> dementia, myoclonus, and epilepsy, leading to coma and death
What maternal conditions can increase risk of NTDs?
Coeliac, diabetes + Thal trait hence need 500mg folic acid
Abnormal semen sample what to do?
Repeat in 3m
Immediate recheck if gross spermatozoa deficiency
GDM mx in those that can’t tolerate metformin / fail to meet targets w/ metformin but refuse insulin?
Glibenclamide
………. should be considered in women aged 45 years using hormonal contraception who present with persistent problematic bleeding or a change in bleeding pattern
Endometrial biopsy
How long should copper IUD used as emergency contraception be kept in for as a minimum?
Until next period
MoA of Ulipristal acetate /EllaOne?
MoA of Levonorgestrel
Selective progesterone receptor modulator –> primary mode of action is thought to be inhibition of ovulation
Levonelle = Acts both to stop ovulation and inhibit implantation (72h = 84% efficacy) - if vomit repeat in 3h of ingestion
How long to wait to restart hormonal contraception after ulipristal use? breastfeeding?
5d, use barrier contraception during this period
Breastfeeding - delay for 1w
NB: Levonorgestrel / Levonelle has no such restrictions
Which form of contraceptions should be used w caution in asthmatics?
Ulipristal
Which emergency contraception may need an adjusted dose + in which women?
Levonelle:
- 5mg - normally
- 0mg - 26+ BMI or 70+ kg
What conditions cause late-systolic murmurs?
Mitral valve prolapse + aortic coarction
What conditions cause mid-late diastolic murmurs?
Mitral stenosis
What conditions cause pansystolic murmurs?
Tricuspid regurgitation + VSD
What conditions cause ejection systolic murmurs?
Bicuspid aortic valve
What does this describe:
- Bodily sensations being controlled by external influence
actions/impulses/feelings
- Experiences which are imposed on the individual or influenced by others
Passivity phenomenon
Mx of phismosis?
Should resolve by 2y
If over 2y + has recurrent balanoposhitis / UTIs consider mx
What drug can be given in stress incontinence and how does it work?
Duloxetine (SNRI) -> Inceased S + N in pudendal nerve -> increased stim of muscles in the area
VUR grading?
- Reflux into the ureter only, no dilatation
- Reflux into the renal pelvis on micturition, no dilatation
- Mild/moderate dilatation of the ureter, renal pelvis and calyces
- Dilation of the renal pelvis and calyces with moderate ureteral tortuosity
- Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity
Duchennes heart leison?
Dilated cardiomyopathy
Features of atypical UTI in children?
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms.
What does this describe?
Softening of the cartilage of patella, Common in teenage girls, Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting, Usually responds to physiotherapy
Chondromalacia patellae
What does this describe?
Pain after exercise + intermittent swelling & locking
Osteochondritis dissecans
What does this describe?
Medial knee pain due to lateral subluxation of patella, knee may give wa
Patellar subluxation
What does this describe?
common in athletic teen boys, chronic anterior knee pain that worsens after running
Patellar tendonitis
What can increase the risk of necrotising faciitis following chicken pox infection?
Use of NSAIDs
Hypospadias mx?
Hooded ventral urethral meatus
Mx = referral to specialists for corrective surgery @~12m (MUST NOT BE CIRCUMCISED - if distal no mx needed)
Trochanteric tenderness may occur in ………..
trochanteric bursitis
This describes:
- short limbs (rhizomelia) with shortened fingers (brachydactyly)
- large head with frontal bossing and narrow foramen magnum
- midface hypoplasia with a flattened nasal bridge
- ‘trident’ hands
- lumbar lordosis
Achrondoplasia
Admission criteria for croup?
< 6 months of age
known upper airway abnormalities (e.g.
Laryngomalacia, Down’s syndrome)
Uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
Triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma and encephalopathy
Subdural haematoma caused by tearing of fragile bridging cerebral veins
Premature neonate + worsening neurological function w/in 1st 72 hrs
What is the most likely dx? what can be given to reduce risk of this and NEC?
Interventricular haemorrhage
Maternal steroids
Name of staging used for Perthes?
Caterhall staging
Presentations + Mx of cephalohaematoma v caput succedaneum?
Cephalohaematoma:
- Present hours after birth
- Takes months to resolve
Caput succedaneum:
- Present @ birth
- Resolves in days
What diseases in guthrie test?
-9 days and screens for 9 diseases, 5 of which are the ‘weird ones’.
The other 4, CF, PKU, Sickle cell and hypothyroid are more common
5 weird = MCADD, MSUD, GA1 and HCU
Gastroschisis v Exomphalos:
- Delivery
- Mx
- Appearance
Gastroschiss:
- vaginal possible, surgery w/in 4h as not covered by amniotic membrane + peritoneum
Exomphalos:
- c-section to reduce risk of sac rupture, staged repair as its covered by amniotic membrane + peritoneum
Mx of pertussis?
Oral macrolides (if onset of cough is in past 21d)
Where to check pulse in <1y and >1y
<1y = brachial or femoral
> 1y = carotid or femoral
What presents similar to cellulitis but w well-defined borders and is a rare complication of chickenpox?
Erysipelas
Poor prognositc factors for ALL?
age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex
Emergency croup mx?
O2 + Neb adrenaline
Inital mx of Hirschsprungs disease?
Rectal washout / bowel irrigation
Steeples signs (PA) and Thumb’s sign (Lateral) are seen in which condition?
Croup - wait 12h between doses of dex
Whne to stop mx of neonatal hypoglycaemia?
When 3x BM >2.5mmol
What substance is checked for CF in guthrie spot?
Raised IRT (Immunoreactive trypsinogen)
Mx of kawasaki w/ no response to IvIG and high dose aspirin?
Corticosteroids
Loss of consciousness lasting more than 5 minutes (witnessed)
Amnesia (antegrade or retrograde) lasting more than 5 minutes
Abnormal drowsiness
Three or more discrete episodes of vomiting
Clinical suspicion of non-accidental injury
Post-traumatic seizure but no history of epilepsy
GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department
Suspicion of open or depressed skull injury or tense fontanelle
Any sign of basal skull fracture (haemotympanum, panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
Focal neurological deficit
If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 m, high-speed injury from a projectile or an object)
What does the following criteria describe?
Indications for Immediate CT in children
What to do if child not immunised for MMR gets measles?
Offer MMR vaccine w/in 72h -> vaccine mediated immunity is quicker than natural
What is used in paediatric OCD - medication?
SSRI - Specifcally Fluvoxamine
Mx of West syndrome?
1st line - Vigabatrin (& Prednisolone)
ACTH can also be used
What else can cause acute epiglottitis (not HiB)
Strep pyogenes + Strep pneumo
Phren’s sign -ve + absent cremaster reflex =
Phren’s sign +ve + present cremaster reflex =
Phren’s sign -ve + absent cremaster reflex = testicular torsion
Phren’s sign +ve + present cremaster reflex = epididymitis
Mx of unilateral / bilateral undescended testes?
Unilateral:
- Review @3m - if still present surgical referral @6m -> surgery ~1y
Bilateral:
- Senior review in 24h +/- endo / genetic testing
Boy w/ delayed puberty + anosmia (lack of smell) + hypogonadism / cryptorchidism (lack of testes desencion) =
Kallman’s syndrome
Complications of scarlet fever?
Most common - otitis media
10d after = acute glomerulonephritis
20d after = rheumatic fever
Invasive = bacteraemia, meningitis, nec fac
Brusing in non-mobile infant?
Same day paeds assesment referral
Pathophysiology of reflex anoxic seizures?
Thought to be caused by neurally-mediated transient asystole in children with very sensitive vagal cardiac reflexes
On discharge for children w/ acute exacerbation of asthma what should be given?
Oral steroids (prednisolone) 3-5 days
What type of vaccine is rotavirus?
Oral, live attenuated
‘Risk’ associated w/ rotavirus + precaution due to this?
1st dose - can’t be given after 14+6w
2nd dose - can’t be given after 23+6w
Due to theoretical risk of intussusception
