Pastest - wrong answers Flashcards
1
Q
S/e of phenytoin
A
Balance - cerebellar like symps
Mental slowing
Nystagmus
liver dysfunction
2
Q
How is Caeruloplasmin affected in Wilsons
A
LOW
3
Q
Accelerated Hep B vaccination schedule in neonates
A
Birth
1 month
2 months
12 months
4
Q
Most common cause of HFMD
A
Coxsackie A
Then enterovirus
5
Q
Complications of VZV
A
Pneumonia
Encephalitis
Cerebellar ataxia
Sepsis
6
Q
Congenital VZV infection
A
Limb hypoplasia
Microcephaly
Cataracts
Growth retardation
Skin scarring
7
Q
What is purpura fulminans & causes of it
A
Thrombotic disorder with haemorrhagic skin infarction & DIC
Meningococcus
Strep
VZV
Gram -ve bacilli
8
Q
ECG appearance in rheumatic fever
A
Prolonged PR interval ie 1st degree HB
9
Q
Presentation rheumatic fever
A
2-4w after Group A strep infection
10
Q
Diagnostic criteria for Rheumatic fever
A
Jone’s criteria =
Need 2x major or
1x major and 2x minor
11
Q
Major diagnostic criteria for rheumatic fever
A
Polyarthritis
Carditis
Sydenham’s chorea
Erythema marginatum
Subcutaneous nodules
12
Q
Minor diagnostic criteria for rheumatic fever
A
Fever
Prolonged PR interval on ECG
Raised inflammatory markers
13
Q
Most common heart problem after rheumatic fever
A
Mitral valve problems
14
Q
How long do joint Sx need to be present for diagnosis of JIA
A
> 6w
15
Q
Role of diuretics in heart failure secondary to VSD
A
Help to relieve pulmoanry congestion caused by L>R shunting
16
Q
‘Dancing eyes, dancing feet’ syndrome
A
Paraneoplastic syndrome associated with NEUROBLASTOMA
Aka opsoclonus-myoclonus > rapid involuntary horizontal and vertical eye movements
17
Q
Prognostic sign for opsoclonus-myoclonus in neuroblastoma
A
GOOD prognostic sign
18
Q
Appearance of toxoplasmosis on Fundoscopy
A
White-yellow Chorioretinitis lesions
19
Q
Sources of toxoplasmosis infection
A
Contaminated or undercooked meat and dairy products, cat faeces
20
Q
Role of Hb electrophoresis
A
Separates subsets of Hb into bands to determine the presence of abnormal subsets e.g. HbS - used to diagnose haemoglobinopathies
21
Q
What does a gallop rhythm indicate
A
Sign of acutely impaired ventricular function, resulting in pulmoanry and venous congestion
22
Q
S/e of carbamazepine
A
Vit k deficiency
23
Q
S/e phenytoin
A
Congenital malformations
Vit k deficiency
24
Q
Which anti-epileptic is considered safest in pregnancy
A
Keppra
25
MOA metoclopramide
Dopamine antagonistw
26
Why is metoclopramide not liceneced in paeds
Can cause a dystonic reaction
27
GI complication of CF and how is it caused
Distal intestinal obstruction syndrome - increased level of dehydration and poor pancreatic enzyme compliance > sticky faeces > blocked gut
28
Asthma stepwise Rx
1. SABA prn
2. very low dose ICS or LRTA (if < 5 y)
3. Very low dose ICS
+ LABA or LRTA (5 years or up)
+ LRTA (< 5y)
4. Low dose ICS or + LABA or LRTA
29
Central vs peripheral precious puberty
Central will present in the same order as normal puberty but early
peripheral will present in an abnormal order
30
What can sometimes be the first presentation of T cell lymphoma
Upper airway obstruction ‘widened mediastinum’
31
How many mutations needed for a CF diagnosis
2
32
Level of sweat chloride test for a diagnosis of CF
> 60 mmol/lmos
33
Most common location for a coarctation
Just distal to the left subclavian artery
34
Presentation of aortic stenosis
Systolic murmur with ejection click, radiates to the carotids
35
Presentation of mitral regurgitation
Pan systolic murmur
High-pitched
Loudest of apex
Radiation to left axilla
36
Rx for shigella
Ciprofloxacin
37
Rx for giardia
Metronidazole
38
Rx for severe campylobacter
Azithromycin
39
Definition latent TB
No clinically active TB
Asymptomatic and not infectious
State of immune response to stimulation by TB antigens
40
Samples to send to micro for TB diagnosis
Sputum
Gastric aspirates
BAL
41
Ix for TB
CXR
tuberculin skin tests
Microbiology (3x samples)
42
Limitation of interferon test for TB
Doesn’t distinguish between active and latent TB so is normally done with tuberculin skin tests
43
Management of neonatal contact with TB
If no clinical signs of TB
Then give
Isoniazid prophylaxis
And do tuberculin skin test at 3 MONTHS
If TST -ve, then repeat with interferon text and if this is negative then stop Abx
44
Bacterial cause of toxic shock syndrome
Toxin producing strains of S. aureus or Group A strep (strep pyogenes)
‘Super antigens’ that can non-specifically bind to T-cell receptors and cause increased inflammatory response
45
Presentation toxic shock syndrome
Red palms & soles with desquamation
‘Sand-paper’ maculopapular rash
High fever
Vomiting diarrhoea
Mucositis
Myalgia (high high CK)
46
Adult Hb
Alpha and beta
47
Rx salicylate poisoning
Urinary alkalinisation : 1L NaBic over 2hc
48
Impetigo - school rules
Keep off until affected areas are crusted and healed OR 48h after starting Abx
49
Why can low Ca cause stridor
Laryngeal collapse due to loss of ridigity
50
What is a laryngeal web
The larynx contains web-like tissue that partially constricts the trachea and causes a CHRONIC stridor
51
Inheritance of epidermolysis bullosa simplex and layer of skin affected
AD
Within the epidermis
52
Inheritance of junctional epidermolysis bullosa
AP
Lamina Lucida of the basement membrane
53
Inheritance of dystrophic epidermolysis bullosa
AD (mild), AR (severe)
Uppermost dermis
54
Affected arches in DiGeorge
3rd and 4th pharyngeal arches
55
Which is more severe and how do the presentations differ between ABO incompatibility and Rh disease
ABO incompatibility generally milder disease than Rh
Liver and spleen not normally enlarged in ABO but are in RhD
56
Presentation of tinea rash
Annular erythema with central clearing
57
IX dermatomyositis
Muscle biopsy
MRI
58
Type of anaemia in hypothyroidism
Macrocytic
59
How unwell are patients with IgA deficiency
Recurrent infections but well in between
No faltering growth
Usually found incidentally, can have no clinical Sx
60
What is Bruton’s disease
Aka X-linked agammaglobulinaemia
Presents as a male with recurrent infections and faltering growthw
61
What is sprengel’s shoulder
Failure of the scapula to descend secondary to fibrosis
62
Renal conditions associated with Turners
Horseshoe kidney
Renal agenesis
63
64
Coagulation problem associated with Noonan’s
Factor XI deficiency
65
Causes of acute interstitial nephritis
Drugs (cipro, erythromycin, phenytoin, PPIs, NSAIDS)
Infection
66
Ix for acute interstitial nephritis
Urinary eosinophils raised
Red cell casts
Hyperkalaemia
Metabolic acidosis
67
AIN - type of hypersensitivity
Type IV
68
Presentation carbamazepine toxicity
Cerebellar Sx
69
Triad for HUS diagnosis
Microangiopathic haemolytic anaemia with red cell casts
Thrombocytopenia
AKI
70
Why are patients with sickle cell more likely to get sepsis
Repeated splenic infarcts causes splenic malfunction
71
Rx tinea capitis
SYSTEMIC griseofulvin
(Topical isn’t effective in penetrating hair follicles)
72
What is Wiskott-Aldrich syndrome
A primary immunodeficiency
Affects B and T cell lymphocytesWha
73
Live vaccines - allowed or not allowed in Wiskott-Aldrich syndrome
Contraindicated !
74
Is a cholera vaccine routine
No, normally only for emergency aid workers
75
Duplicated ureter - how to know if the insertion of the second ureter enters the normal position
Continence WONT be affected if the ureter enters in the normal position
If it enters into an abnormal position then the patient will be incontinent
76
What is cystinosis and inheritance
AR
Lysosomal storage disorder
77
Blood gas in cystinosis
Hyperchloraemic
Hypokalaemia
Metabolic acidosis
Normal anion gap
78
Surgical treatment for coarctation
Balloon angioplasty & stenting
79
Surgical treatment for aortic stenosis
Balloon valvuloplasty
80
Surgical treatment for TGA
Arterial switch
81
Definition of odds ratio
Measure of the strength between an exposure and an outcome
82
what always needs to be taken into account when calculating odds ratio
Confounders
Ie a factor that can influence the strength of the association, causing a false high or low
83
Congenital rubella presentation
Cataracts
Deafness
Retinopathy
CHD
Hepatosplenomegaly
84
What causes acanthosis nigricans
Overgrowth of epithelial cells secondary to increased insulin production
85
Mutation ataxia telangiectasia
ATM gene on chromosome 11q26
86
Presentation ataxia telangiectasia
Progressive neurology - tremor, chorea, athetosis, dystonia, ataxia, dysphasia
Telangiectasia
87
Presentation benign Rolandic epilepsy
School age boys
Nocturnal partial seizures
Speech arrest
Secondary generalised seizure
88
Which antiepileptic NOT to use in myoclonic seizure
Lamotrigine
89
Tetralogy of Fallot
VSD
Overriding aorta
RVH
RV outflow obstruction (pulmonary stenosis)
90
Effect of Mg on PTH
A low Mg inhibits PTH release
91
Effect on Alk P when low Ca is secondary to hypoparathyroidism
Normal
92
Effect on Alk P when low Ca is secondary to Vit D disorder
High
93
What is wrong in Pseudohypoparathyroidism
Failure of the action of PTH (genetic problem)
94
Blood abnormality in extra hepatic biliary atresis
Thrombocytosis
95
Definition of high conjugated fraction
> 200 or > 20% of total
96
Presentation of PCD
Recurrent chest, sinus and middle ear infections
Situs inversus, Kartagener syndrome
97
S/E of vincristine
CENTRAL neurotoxicity
- headache, malaise, dizziness, seizures, depression
PERIPHERAL neurotoxicity
- loss of DTR, wrist/foot drop i.e HIGH STEPPING gait
AUTONOMIC neurotoxicity
- hoarseness, ptosis, strabismus
98
Inheritance of SMith-Lemli-Opitz syndrome and how it presents
AR
Cholesterol synthesis disorder
Midline CNS problems
Syndactyly
Microcephaly
Low set ears
Ptosis
Micrognathia
99
IM adrenaline dose <6m
100-150 mcg
(0.15mL)
100
IM adrenaline dose 6m - 6y
150 mcg (0.15ml)
101
IM adrenaline dose 6y-12y
300 mcg (0.3mL)
102
IM adrenaline dose >12 y
500 mcg (0.5mL)
103
Drugs causing peripheral neuropathy
Amiodarone
Cisplatin
Ethambutol
Isoniazid
Metronidazole
Nitrofurantoin
Phenytoin
Vincristine
104
Landau-Kleffner syndrome
Seizure disorder and expressive or receptive aphasia
Normal hearing
105
EEG in Landau-Kleffer syndrome
Bitemporal abnormalities
106
Melanosis coli on colonoscopy - indicative of?
Senna abuse
107
Inheritance of Tay-sachs and what is it
AR
Lipoidosis due to deficiency of the enzyme hexosaminidase
108
What happens in SIADH - explain the blood tests
Water is retained inappropriately by the kidney
Therefore urine osmolality is inappropriately high in relation to plasma osmolality
Low volume but high NA containing urine
109
X-ray of osteosarcoma
Intramedullary sclerosis
‘Sunburst’ periosteal reaction
110
Definition of toxic megacolon
Dilated >6cm transverse colon and at least 3 of:
Fever >38
HR >120
Neutrophilia
Hb < 105
111
SUFE Rx
Pin & screw
To preserve blood supply and prevent AVN
112
Grade 1 VUR
Reflux of urine in to the ureter ONLY on micturition
113
Grade 2 VUR
Reflux into the ureter, pelvis & calyces with NO DILATATION on micturition
114
Grade 3 VUR
Reflux of urine into the pelvis & calcyces with MILD DILATATION
115
Grade 4 VUR
MODERATE DILATATION of the ureter, pelvis and obliteration of the sharp angle of fornices on micturitionF
116
Grade 5 VUR
GROSS DILATATION and tortuosity with no papillary impression visible in calyces
117
Definition of PUV
Mucosal folds in the posterior urethra of infant boys
Most common UNILATERAL
L > R
118
What is Fabry’s disease and how it presetns
X linked recessive lysosomal storage disorder
Stroke, skin lesions, renal insufficiency, heart attacks
119
Presentation Homocystinuria
Marfanoid habitus
Strokes
Intellectual disability
Lens abnormality
120
Asplenia is a contraindication to live vaccination T. Or F
False
121
Rubella presentation
Fever with rash on Day 1/2
Lymphadenopathy in posterior auricular or occipital region
122
Measles presentation
Fever with rash on Day 3/4
Koplik spots
Rash progresses from behind the ears
123
1st line treatment for juvenile myoclonic epilepsy
Sodium valproate
Keppra
124
Long QT - how to tell apart Jervell-Lange Nielsen syndrome and Romano-Ward syndrome
JLNS - AR, associated with congenital deafness
RW - AD, not associated with deafness
125
Medications causing prolonged QT
Macrolides
Antimalarials
Antipsychotics
126
Definition of Brugada syndrome
Specific ECG pattern : ST elevation in R precordial leads V1-V3 followed by inverted T wave
+ 1 of
: VF, polymorphic VT, FHx of sudden death
127
Diagnostic criteria for infective endocarditis
2x major OR
1x major and 3 minor OR
5x minor
128
ECG appearance of pulmoanry stenosis
Prominent R waves and upright T wave in V1
129
Alagille syndrome is associated with what heart abnormality
Pulmonary stenosis
130
Dose of adenosine
0.1mg/kg
131
What is Ebsteins anomaly
Inferiorly displaced tricuspid valve, so there is a smaller RV
*question recognising this on MRI*
132
Definition of hypertension
Systolic and/or diastolic BP > 95th C for age & sex measured on 3 separate occasions
133
1st line / 2nd line Rx for HTN
1. CCB - nifedipine
2. BBs
134
What condition are CCBs contraindicated in
Diabetes
135
Radiation of murmur in mitral regurgitation
Axilla
136
How does adenosine work
Slows conduction through the AV node
137
VT Rx if conscious vs unconscious
conscious - amiodarone
Unconscious - 1J/kg synchronised DC shock
138
Complication of coarctation surgery
Ischaemia of the spinal cord due to prolonged cross-clamping of the aorta
139
Pressure graph of the heart chambers and the PA and aorta
RA: 2-8 LA: 2-10
RV: 15-30/2-8 LV 100-140/3-12
PA: 15-30/4-12 Aorta: 100-140/60-90
140
What is the aim of a Tet spell treatment
Increase pulmonary blood flow by reducing PVR
- morphine, O2, correction of metabolic acidosis
Reduce L>R shunting by increasing SVR
- knees to chest, volume administration, vasoconstrictors
141
Digoxin toxicity on ECG
Prolonged PR, ‘reversed tick’, ST depression
142
Cardiac problems seen in Williams syndrome
Peripheral pulmonary stenosis
Supravalvular aortic stenosis
143
Indications for early surgical closure of VSD
Presence of HF
Faltering growth
Signs of pulmonary hypertension
144
When should children with diabetes get renal screening and what is measured
From diagnosis annually
Protein/Creatine ratio
145
What are insulin levels like in T2DM and why
Usually raised
Due to insulin insensitivity
146
T1DM fluid regime during surgery
0.9% NaCl + 5% dex + 20mmol KcL + insulin
147
Criteria for T1DM diagnosis
Random venous plasma glucose 11.1mmol or greater OR
Fasting glucose 7 or greater OR
2h glucose conc 11.1 or greater 2h after 75g glucose ingestion
148
Target BMs in T1DM
4-7 on wakening and before meals
5-9 after meals
149
How to calculate total daily dose of insulin
Weight (kg) = 0.75 units insulin
150
How to calculate insulin sensitivity
100 / total daily dose of insulin
151
What % of insulin in T1DM is long acting and short acting
Long acting = 40% of TDD
Short acting (60% of TDD)
152
Dose regime for calculating long-acting insulin requirement
100 x 0.75 x 0.4
153
Dose regime for calculating short acting insulin requirement
100 x 0.75 x 0.6
Then divide this into 3 for meal time doses
154
Rx cerebral oedema in T1DM
30 degrees head up
Induce an osmotic diuresis with IV 20% mannitol 0.5-1g/kg over 10 mins OR
hypertonic saline (3%) 5ml/kg over 10 mins
155
In diabetes insipidus, what will happen to urine osmolality after water deprivation
It will remain inappropriately low (<300 mosmol/kg)
156
Urine osmolality after desmopressin in cranial DI
It will increase (because you’ve replaced the ADH)
> 800mosmol/kg
157
Urine osmolality after desmopressin in nephrogenic DI
It will stay low (because the kidney can’t action the ADH) so can’t retain urine
< 300mosmol/kg
158
Causes of nephrogenic DI
Congenital
Hypercalcaemia
Hypokalaemia
Drugs (lithium, amphotericin B)
Kidney disease
Sickle cell
Sjogren’s
159
Mid-parental height calculation
(Fathers + mothers height - 13) / 2
160
How to know the difference between exogenous and endogenous insulin
Endogenous - the precursor has a c-peptide attached which is removed to make active insulin
Exogenous - only the active form, no precursor
161
Tumours associated with MEN1
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours
162
Tumours associated with MEN2A
Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma
163
Tumours associated with MEN2B
Mucosal neurons
Marfanoid body habitus
Medullary thyroid cancer
Phaeochromocytoma
164
Non-toxic goitre - normal or abnormal TFTs
Normal
165
Normal thymus on CXR
‘Sail shape’
166
Rx status epilepticus
IV access - 1. Lorazepam
Then repeat if required
Then Keppra
167
Percussion of tension pneumothorax
Hyperresonant on same side
168
1st degree burn
Epidermis only
No blistering
169
2nd degree burn
Epidermis and the papillary and reticular layers of dermis
Blisters
Painful
170
3rd degree burn
Full thickness epidermis & dermis
Not painful
171
What test should all be done in fire victims
Carboxyhaemoglobin
172
Burns fluid resus
4ml of ringers lactate / kg per % BSA
Give 1/2 in the first 8h, starting from TIME OF INJURY, then the other half over 16h
173
TCA OD on ECG
Prolonged QTc
Widened QRS
Which predisposes to VF or VT
174
What to do in extravasation injury
Aspirate the cannula
Don’t de roof blisters
175
What grade does an extravastion injury start blanching
Grade 3
176
How to differentiate Grade 3 and 4 extravasation
Grade 3 - normal pulses and CRT
Grade 4 - prolonged, possible absent pulses
177
Definition of sepsis
Hypoperfusion, hypotension, and organ dysfunction
178
Predictors for severity of liver injury in paracetamol injury
: arterial pH < 7.3 and lactate > 3.5 after fluid resus
: creatinine > 300
: INR > 6.5
: elevated PT
: grade III or grade IV hepatic encephalopathy
179
GCS
E4
: spontaneous
: to voice
: to pain
: none
V5
: orientated
: confused
: incomprehensible words
: incomprehensible sounds
: none
M6
: obeys commands
: localises pain
: normal flexion to pain
: decorticate
: decerebrate
: none
180
management of choking ep
Check if cough is effective
If it is then encourage coughing and check for deterioration
181
Keppra dosing in status
40mg/kg over 5 mins
182
