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AKP > Pastest - wrong answers > Flashcards

Pastest - wrong answers Flashcards

1
Q

S/e of phenytoin

A

Balance - cerebellar like symps
Mental slowing
Nystagmus
liver dysfunction

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2
Q

How is Caeruloplasmin affected in Wilsons

A

LOW

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3
Q

Accelerated Hep B vaccination schedule in neonates

A

Birth
1 month
2 months
12 months

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4
Q

Most common cause of HFMD

A

Coxsackie A
Then enterovirus

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5
Q

Complications of VZV

A

Pneumonia
Encephalitis
Cerebellar ataxia
Sepsis

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6
Q

Congenital VZV infection

A

Limb hypoplasia
Microcephaly
Cataracts
Growth retardation
Skin scarring

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7
Q

What is purpura fulminans & causes of it

A

Thrombotic disorder with haemorrhagic skin infarction & DIC

Meningococcus
Strep
VZV
Gram -ve bacilli

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8
Q

ECG appearance in rheumatic fever

A

Prolonged PR interval ie 1st degree HB

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9
Q

Presentation rheumatic fever

A

2-4w after Group A strep infection

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10
Q

Diagnostic criteria for Rheumatic fever

A

Jone’s criteria =
Need 2x major or
1x major and 2x minor

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11
Q

Major diagnostic criteria for rheumatic fever

A

Polyarthritis
Carditis
Sydenham’s chorea
Erythema marginatum
Subcutaneous nodules

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12
Q

Minor diagnostic criteria for rheumatic fever

A

Fever
Prolonged PR interval on ECG
Raised inflammatory markers

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13
Q

Most common heart problem after rheumatic fever

A

Mitral valve problems

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14
Q

How long do joint Sx need to be present for diagnosis of JIA

A

> 6w

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15
Q

Role of diuretics in heart failure secondary to VSD

A

Help to relieve pulmoanry congestion caused by L>R shunting

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16
Q

‘Dancing eyes, dancing feet’ syndrome

A

Paraneoplastic syndrome associated with NEUROBLASTOMA

Aka opsoclonus-myoclonus > rapid involuntary horizontal and vertical eye movements

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17
Q

Prognostic sign for opsoclonus-myoclonus in neuroblastoma

A

GOOD prognostic sign

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18
Q

Appearance of toxoplasmosis on Fundoscopy

A

White-yellow Chorioretinitis lesions

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19
Q

Sources of toxoplasmosis infection

A

Contaminated or undercooked meat and dairy products, cat faeces

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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

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21
Q

What does a gallop rhythm indicate

A

Sign of acutely impaired ventricular function, resulting in pulmoanry and venous congestion

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22
Q

S/e of carbamazepine

A

Vit k deficiency

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23
Q

S/e phenytoin

A

Congenital malformations
Vit k deficiency

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24
Q

Which anti-epileptic is considered safest in pregnancy

A

Keppra

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25
Q

MOA metoclopramide

A

Dopamine antagonistw

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26
Q

Why is metoclopramide not liceneced in paeds

A

Can cause a dystonic reaction

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27
Q

GI complication of CF and how is it caused

A

Distal intestinal obstruction syndrome - increased level of dehydration and poor pancreatic enzyme compliance > sticky faeces > blocked gut

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28
Q

Asthma stepwise Rx

A
  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
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29
Q

Central vs peripheral precious puberty

A

Central will present in the same order as normal puberty but early

peripheral will present in an abnormal order

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30
Q

What can sometimes be the first presentation of T cell lymphoma

A

Upper airway obstruction ‘widened mediastinum’

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31
Q

How many mutations needed for a CF diagnosis

A

2

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32
Q

Level of sweat chloride test for a diagnosis of CF

A

> 60 mmol/lmos

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33
Q

Most common location for a coarctation

A

Just distal to the left subclavian artery

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34
Q

Presentation of aortic stenosis

A

Systolic murmur with ejection click, radiates to the carotids

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35
Q

Presentation of mitral regurgitation

A

Pan systolic murmur
High-pitched
Loudest of apex
Radiation to left axilla

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36
Q

Rx for shigella

A

Ciprofloxacin

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37
Q

Rx for giardia

A

Metronidazole

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38
Q

Rx for severe campylobacter

A

Azithromycin

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39
Q

Definition latent TB

A

No clinically active TB
Asymptomatic and not infectious
State of immune response to stimulation by TB antigens

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40
Q

Samples to send to micro for TB diagnosis

A

Sputum
Gastric aspirates
BAL

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41
Q

Ix for TB

A

CXR
tuberculin skin tests
Microbiology (3x samples)

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42
Q

Limitation of interferon test for TB

A

Doesn’t distinguish between active and latent TB so is normally done with tuberculin skin tests

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43
Q

Management of neonatal contact with TB

A

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

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44
Q

Bacterial cause of toxic shock syndrome

A

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

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45
Q

Presentation toxic shock syndrome

A

Red palms & soles with desquamation
‘Sand-paper’ maculopapular rash
High fever
Vomiting diarrhoea
Mucositis
Myalgia (high high CK)

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46
Q

Adult Hb

A

Alpha and beta

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47
Q

Rx salicylate poisoning

A

Urinary alkalinisation : 1L NaBic over 2hc

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48
Q

Impetigo - school rules

A

Keep off until affected areas are crusted and healed OR 48h after starting Abx

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49
Q

Why can low Ca cause stridor

A

Laryngeal collapse due to loss of ridigity

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50
Q

What is a laryngeal web

A

The larynx contains web-like tissue that partially constricts the trachea and causes a CHRONIC stridor

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51
Q

Inheritance of epidermolysis bullosa simplex and layer of skin affected

A

AD

Within the epidermis

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52
Q

Inheritance of junctional epidermolysis bullosa

A

AP

Lamina Lucida of the basement membrane

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53
Q

Inheritance of dystrophic epidermolysis bullosa

A

AD (mild), AR (severe)

Uppermost dermis

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54
Q

Affected arches in DiGeorge

A

3rd and 4th pharyngeal arches

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55
Q

Which is more severe and how do the presentations differ between ABO incompatibility and Rh disease

A

ABO incompatibility generally milder disease than Rh

Liver and spleen not normally enlarged in ABO but are in RhD

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56
Q

Presentation of tinea rash

A

Annular erythema with central clearing

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57
Q

IX dermatomyositis

A

Muscle biopsy
MRI

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58
Q

Type of anaemia in hypothyroidism

A

Macrocytic

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59
Q

How unwell are patients with IgA deficiency

A

Recurrent infections but well in between
No faltering growth
Usually found incidentally, can have no clinical Sx

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60
Q

What is Bruton’s disease

A

Aka X-linked agammaglobulinaemia

Presents as a male with recurrent infections and faltering growthw

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61
Q

What is sprengel’s shoulder

A

Failure of the scapula to descend secondary to fibrosis

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62
Q

Renal conditions associated with Turners

A

Horseshoe kidney
Renal agenesis

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63
Q
A
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64
Q

Coagulation problem associated with Noonan’s

A

Factor XI deficiency

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65
Q

Causes of acute interstitial nephritis

A

Drugs (cipro, erythromycin, phenytoin, PPIs, NSAIDS)

Infection

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66
Q

Ix for acute interstitial nephritis

A

Urinary eosinophils raised
Red cell casts
Hyperkalaemia
Metabolic acidosis

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67
Q

AIN - type of hypersensitivity

A

Type IV

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68
Q

Presentation carbamazepine toxicity

A

Cerebellar Sx

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69
Q

Triad for HUS diagnosis

A

Microangiopathic haemolytic anaemia with red cell casts

Thrombocytopenia

AKI

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70
Q

Why are patients with sickle cell more likely to get sepsis

A

Repeated splenic infarcts causes splenic malfunction

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71
Q

Rx tinea capitis

A

SYSTEMIC griseofulvin

(Topical isn’t effective in penetrating hair follicles)

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72
Q

What is Wiskott-Aldrich syndrome

A

A primary immunodeficiency

Affects B and T cell lymphocytesWha

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73
Q

Live vaccines - allowed or not allowed in Wiskott-Aldrich syndrome

A

Contraindicated !

74
Q

Is a cholera vaccine routine

A

No, normally only for emergency aid workers

75
Q

Duplicated ureter - how to know if the insertion of the second ureter enters the normal position

A

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
Q

What is cystinosis and inheritance

A

AR

Lysosomal storage disorder

77
Q

Blood gas in cystinosis

A

Hyperchloraemic
Hypokalaemia
Metabolic acidosis
Normal anion gap

78
Q

Surgical treatment for coarctation

A

Balloon angioplasty & stenting

79
Q

Surgical treatment for aortic stenosis

A

Balloon valvuloplasty

80
Q

Surgical treatment for TGA

A

Arterial switch

81
Q

Definition of odds ratio

A

Measure of the strength between an exposure and an outcome

82
Q

what always needs to be taken into account when calculating odds ratio

A

Confounders

Ie a factor that can influence the strength of the association, causing a false high or low

83
Q

Congenital rubella presentation

A

Cataracts
Deafness
Retinopathy
CHD
Hepatosplenomegaly

84
Q

What causes acanthosis nigricans

A

Overgrowth of epithelial cells secondary to increased insulin production

85
Q

Mutation ataxia telangiectasia

A

ATM gene on chromosome 11q26

86
Q

Presentation ataxia telangiectasia

A

Progressive neurology - tremor, chorea, athetosis, dystonia, ataxia, dysphasia

Telangiectasia

87
Q

Presentation benign Rolandic epilepsy

A

School age boys
Nocturnal partial seizures
Speech arrest
Secondary generalised seizure

88
Q

Which antiepileptic NOT to use in myoclonic seizure

A

Lamotrigine

89
Q

Tetralogy of Fallot

A

VSD
Overriding aorta
RVH
RV outflow obstruction (pulmonary stenosis)

90
Q

Effect of Mg on PTH

A

A low Mg inhibits PTH release

91
Q

Effect on Alk P when low Ca is secondary to hypoparathyroidism

92
Q

Effect on Alk P when low Ca is secondary to Vit D disorder

93
Q

What is wrong in Pseudohypoparathyroidism

A

Failure of the action of PTH (genetic problem)

94
Q

Blood abnormality in extra hepatic biliary atresis

A

Thrombocytosis

95
Q

Definition of high conjugated fraction

A

> 200 or > 20% of total

96
Q

Presentation of PCD

A

Recurrent chest, sinus and middle ear infections

Situs inversus, Kartagener syndrome

97
Q

S/E of vincristine

A

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
Q

Inheritance of SMith-Lemli-Opitz syndrome and how it presents

A

AR

Cholesterol synthesis disorder

Midline CNS problems
Syndactyly
Microcephaly
Low set ears
Ptosis
Micrognathia

99
Q

IM adrenaline dose <6m

A

100-150 mcg
(0.15mL)

100
Q

IM adrenaline dose 6m - 6y

A

150 mcg (0.15ml)

101
Q

IM adrenaline dose 6y-12y

A

300 mcg (0.3mL)

102
Q

IM adrenaline dose >12 y

A

500 mcg (0.5mL)

103
Q

Drugs causing peripheral neuropathy

A

Amiodarone
Cisplatin
Ethambutol
Isoniazid
Metronidazole
Nitrofurantoin
Phenytoin
Vincristine

104
Q

Landau-Kleffner syndrome

A

Seizure disorder and expressive or receptive aphasia

Normal hearing

105
Q

EEG in Landau-Kleffer syndrome

A

Bitemporal abnormalities

106
Q

Melanosis coli on colonoscopy - indicative of?

A

Senna abuse

107
Q

Inheritance of Tay-sachs and what is it

A

AR

Lipoidosis due to deficiency of the enzyme hexosaminidase

108
Q

What happens in SIADH - explain the blood tests

A

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
Q

X-ray of osteosarcoma

A

Intramedullary sclerosis
‘Sunburst’ periosteal reaction

110
Q

Definition of toxic megacolon

A

Dilated >6cm transverse colon and at least 3 of:
Fever >38
HR >120
Neutrophilia
Hb < 105

111
Q

SUFE Rx

A

Pin & screw

To preserve blood supply and prevent AVN

112
Q

Grade 1 VUR

A

Reflux of urine in to the ureter ONLY on micturition

113
Q

Grade 2 VUR

A

Reflux into the ureter, pelvis & calyces with NO DILATATION on micturition

114
Q

Grade 3 VUR

A

Reflux of urine into the pelvis & calcyces with MILD DILATATION

115
Q

Grade 4 VUR

A

MODERATE DILATATION of the ureter, pelvis and obliteration of the sharp angle of fornices on micturitionF

116
Q

Grade 5 VUR

A

GROSS DILATATION and tortuosity with no papillary impression visible in calyces

117
Q

Definition of PUV

A

Mucosal folds in the posterior urethra of infant boys

Most common UNILATERAL
L > R

118
Q

What is Fabry’s disease and how it presetns

A

X linked recessive lysosomal storage disorder

Stroke, skin lesions, renal insufficiency, heart attacks

119
Q

Presentation Homocystinuria

A

Marfanoid habitus
Strokes
Intellectual disability
Lens abnormality

120
Q

Asplenia is a contraindication to live vaccination T. Or F

121
Q

Rubella presentation

A

Fever with rash on Day 1/2

Lymphadenopathy in posterior auricular or occipital region

122
Q

Measles presentation

A

Fever with rash on Day 3/4

Koplik spots
Rash progresses from behind the ears

123
Q

1st line treatment for juvenile myoclonic epilepsy

A

Sodium valproate

Keppra

124
Q

Long QT - how to tell apart Jervell-Lange Nielsen syndrome and Romano-Ward syndrome

A

JLNS - AR, associated with congenital deafness

RW - AD, not associated with deafness

125
Q

Medications causing prolonged QT

A

Macrolides
Antimalarials
Antipsychotics

126
Q

Definition of Brugada syndrome

A

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
Q

Diagnostic criteria for infective endocarditis

A

2x major OR
1x major and 3 minor OR
5x minor

128
Q

ECG appearance of pulmoanry stenosis

A

Prominent R waves and upright T wave in V1

129
Q

Alagille syndrome is associated with what heart abnormality

A

Pulmonary stenosis

130
Q

Dose of adenosine

131
Q

What is Ebsteins anomaly

A

Inferiorly displaced tricuspid valve, so there is a smaller RV

question recognising this on MRI

132
Q

Definition of hypertension

A

Systolic and/or diastolic BP > 95th C for age & sex measured on 3 separate occasions

133
Q

1st line / 2nd line Rx for HTN

A
  1. CCB - nifedipine
  2. BBs
134
Q

What condition are CCBs contraindicated in

135
Q

Radiation of murmur in mitral regurgitation

136
Q

How does adenosine work

A

Slows conduction through the AV node

137
Q

VT Rx if conscious vs unconscious

A

conscious - amiodarone

Unconscious - 1J/kg synchronised DC shock

138
Q

Complication of coarctation surgery

A

Ischaemia of the spinal cord due to prolonged cross-clamping of the aorta

139
Q

Pressure graph of the heart chambers and the PA and aorta

A

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
Q

What is the aim of a Tet spell treatment

A

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
Q

Digoxin toxicity on ECG

A

Prolonged PR, ‘reversed tick’, ST depression

142
Q

Cardiac problems seen in Williams syndrome

A

Peripheral pulmonary stenosis
Supravalvular aortic stenosis

143
Q

Indications for early surgical closure of VSD

A

Presence of HF
Faltering growth
Signs of pulmonary hypertension

144
Q

When should children with diabetes get renal screening and what is measured

A

From diagnosis annually

Protein/Creatine ratio

145
Q

What are insulin levels like in T2DM and why

A

Usually raised

Due to insulin insensitivity

146
Q

T1DM fluid regime during surgery

A

0.9% NaCl + 5% dex + 20mmol KcL + insulin

147
Q

Criteria for T1DM diagnosis

A

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
Q

Target BMs in T1DM

A

4-7 on wakening and before meals

5-9 after meals

149
Q

How to calculate total daily dose of insulin

A

Weight (kg) = 0.75 units insulin

150
Q

How to calculate insulin sensitivity

A

100 / total daily dose of insulin

151
Q

What % of insulin in T1DM is long acting and short acting

A

Long acting = 40% of TDD

Short acting (60% of TDD)

152
Q

Dose regime for calculating long-acting insulin requirement

A

100 x 0.75 x 0.4

153
Q

Dose regime for calculating short acting insulin requirement

A

100 x 0.75 x 0.6

Then divide this into 3 for meal time doses

154
Q

Rx cerebral oedema in T1DM

A

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
Q

In diabetes insipidus, what will happen to urine osmolality after water deprivation

A

It will remain inappropriately low (<300 mosmol/kg)

156
Q

Urine osmolality after desmopressin in cranial DI

A

It will increase (because you’ve replaced the ADH)

> 800mosmol/kg

157
Q

Urine osmolality after desmopressin in nephrogenic DI

A

It will stay low (because the kidney can’t action the ADH) so can’t retain urine

< 300mosmol/kg

158
Q

Causes of nephrogenic DI

A

Congenital
Hypercalcaemia
Hypokalaemia
Drugs (lithium, amphotericin B)
Kidney disease
Sickle cell
Sjogren’s

159
Q

Mid-parental height calculation

A

(Fathers + mothers height - 13) / 2

160
Q

How to know the difference between exogenous and endogenous insulin

A

Endogenous - the precursor has a c-peptide attached which is removed to make active insulin

Exogenous - only the active form, no precursor

161
Q

Tumours associated with MEN1

A

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours

162
Q

Tumours associated with MEN2A

A

Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma

163
Q

Tumours associated with MEN2B

A

Mucosal neurons
Marfanoid body habitus
Medullary thyroid cancer
Phaeochromocytoma

164
Q

Non-toxic goitre - normal or abnormal TFTs

165
Q

Normal thymus on CXR

A

‘Sail shape’

166
Q

Rx status epilepticus

A

IV access - 1. Lorazepam

Then repeat if required

Then Keppra

167
Q

Percussion of tension pneumothorax

A

Hyperresonant on same side

168
Q

1st degree burn

A

Epidermis only
No blistering

169
Q

2nd degree burn

A

Epidermis and the papillary and reticular layers of dermis

Blisters

Painful

170
Q

3rd degree burn

A

Full thickness epidermis & dermis

Not painful

171
Q

What test should all be done in fire victims

A

Carboxyhaemoglobin

172
Q

Burns fluid resus

A

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
Q

TCA OD on ECG

A

Prolonged QTc
Widened QRS

Which predisposes to VF or VT

174
Q

What to do in extravasation injury

A

Aspirate the cannula

Don’t de roof blisters

175
Q

What grade does an extravastion injury start blanching

176
Q

How to differentiate Grade 3 and 4 extravasation

A

Grade 3 - normal pulses and CRT

Grade 4 - prolonged, possible absent pulses

177
Q

Definition of sepsis

A

Hypoperfusion, hypotension, and organ dysfunction

178
Q

Predictors for severity of liver injury in paracetamol injury

A

: 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
Q

GCS

A

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
Q

management of choking ep

A

Check if cough is effective

If it is then encourage coughing and check for deterioration

181
Q

Keppra dosing in status

A

40mg/kg over 5 mins

AKP (1 decks)

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