Passmed, Quesmed, Passtest Flashcards by D J

When should children be able to smile? when to refer?

6w -> refer @10w

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ambiguous genitalia + testes in adbo + internal reproductive tracts exhibit the normal male phenotype, what is cause?

5α-reductase deficiency

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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)

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Inverted SMA and SMV relationship on USS is seen in which paeds condition?

Malrotation

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Herniation of hyperechogenic bowel loops on USS is seen in which paeds condition?

Omphalocele

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when does puberty start in males and what indicates onset of puberty?

1st sign = testicular growth (>4ml) @12y

1st sign = breast development @11.5y

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Most common type of cerebral palsy?

Spastic

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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

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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

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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

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What maternal conditions can increase risk of NTDs?

Coeliac, diabetes + Thal trait hence need 500mg folic acid

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Abnormal semen sample what to do?

Repeat in 3m

Immediate recheck if gross spermatozoa deficiency

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GDM mx in those that can’t tolerate metformin / fail to meet targets w/ metformin but refuse insulin?

Glibenclamide

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………. 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

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How long should copper IUD used as emergency contraception be kept in for as a minimum?

Until next period

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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

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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

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Which form of contraceptions should be used w caution in asthmatics?

Ulipristal

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Which emergency contraception may need an adjusted dose + in which women?

Levonelle:

5mg - normally
0mg - 26+ BMI or 70+ kg

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What conditions cause late-systolic murmurs?

Mitral valve prolapse + aortic coarction

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What conditions cause mid-late diastolic murmurs?

Mitral stenosis

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What conditions cause pansystolic murmurs?

Tricuspid regurgitation + VSD

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What conditions cause ejection systolic murmurs?

Bicuspid aortic valve

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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

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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?

1. Reflux into the ureter only, no dilatation 2. Reflux into the renal pelvis on micturition, no dilatation 3. Mild/moderate dilatation of the ureter, renal pelvis and calyces 4. Dilation of the renal pelvis and calyces with moderate ureteral tortuosity 5. 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

Passmed, Quesmed, Passtest Flashcards

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