PPQ Facts Flashcards
Hx of eczema -> Painful + itchy rash on face/neck. Punched out lesions.
Eczema herpetiformis
HSV 1 or 2
Tx = Oral aciclovir
16yo girl with short stature, short ring finger, webbed neck, high-arched palate, widely spaced nipples.
NO breast development or periods.
O/E Crescendo-decrescendo ejection systolic murmur, radiates to carotids. OR peripheral pulses absent/ radio-femoral delay/ ‘click’ over aortic valve/
Turner’s syndrome 45X (Deletion of an X)
Murmur is due to Bicuspid aortic valve causing aortic stenosis
Peripheral pulses absent = Co-arctation of aorta (less common than bicuspid)
Associated with Gastroschisis/Omphalocele
Tx = oestrogen replacement, Growth hormone replacement
Causes of delayed puberty with short stature
- *Turners** - 45X
- *Prader-Willi** (Imprinting - Fat & floppy - obesity + hypotonia)
- *Noonan’s** (AD condition - Web neck, pectus excavatum, pulmonary stenosis - ESM louder on inspiration)
Causes of delayed puberty with normal height
PCOS
Androgen insensitivity
Kallman’s
Klinefelters
How do you differentiate the causes of normal-stature delayed puberty?
Klinefelter’s - 47 XXY. Lack of secondary sexual characteristics, small firm testes. HIGH LH + LOW testosterone.
Kallman’s (X-linked) = LOSS OF SMELL (anosmia). Hypogonadotrophic so LOW LH + low testosterone
Androgen Insensitivity (X-linked) = Resistance to testosterone. ‘Girl’ presents with delayed puberty and bilateral groin masses = undescended testes. HIGH LH + Normal/high testosterone.
Testosterone-secreting tumour = LOW LH + High testosterone
Rheumatic fever
Group A b-haemolytic Strep (GAS) or Scarlet Fever
5-15yo
2-6wks post-throat infection
Then you get triad of PPE:
- Polyarthritis (joint swelling or pain)
- Pericarditis (endo/myo/pericarditis)
- Erythema marginatum (map-like outlines)
Major criteria = CASES
Carditis, Arthritis, Subcutaneous nodules, Erythema marginatum, Sydenham’s chorea
Minor criteria = FRAPP
Fever, Raised ESR/CRP, Arthralgia, Prolonged PR, Previous Hx
Diagnosis = 2 major OR 1 major + 2 minor
Mx:
- 1st line = High-dose aspirin
- Amoxicillin if evidence of persistent infection
- Corticosteroids if fever/inflammation doesn’t resolve rapidly
Prophylaxis after the episode = Benzathine penicillin
Infective Endocarditis
Most common cause WITH heart abnormality = Strep viridans
Most common cause WITHOUT heart abnormality = Staph aureus
Tx = IV amoxicillin for 4-6wks (initial)
BenPen (if you know its viridans)
Fluclox (if you know its Staph aureus)
Fragile X
Long, thin face + Macrognathia (large mandible)
Associated with mitral valve prolapse
GORD Tx
- Small frequent feeds
- Thicken feeds
- Alginate trial
- PPI trial
Physiological changes in pregnancy
CVS = CO increase
Renal = GFR increases 30-60%, meaning glucose and protein losses in urine
Liver = Raised ALP, low albumin
Haem = Hb + Pt decreases (dilutional).
Cyst in midline of neck/ external angle of eye/ posterior pinna of ear with hair follicles visible in it?
Dermoid cyst
Ondansetron use in pregnancy?
Small risk of cleft palate if used in first trimester
Commonest cause of ovarian enlargement in women of reproductive age
Follicular cyst
- Commonest type of ovarian cyst
- due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
- commonly regress after several menstrual cycles
Mx of Perthes?
<6yo = Observe - good prognosis
>6yo = Surgery
Define Oligoarticular (pauciarticular) JIA
Affects up to 4 joints
Typically large joints (Knee, elbow, ankle)
Systemic JIA = FEVERS
Otitis media
Admit if:
- Severe systemic infection
- Complications: Meningitis, Mastoiditis, facial nerve palsy
- Mastoiditis = “Honeycomb” structure + discharge behind ear
Without effusion:
- Paracetamol/ibuprofen, should resolve in 1wk
- Immediate Amoxicillin if sytemically unwell or <2yo
With perforation = PO Amoxicillin 5 days, review in 6wks
With effusion “Glue ear”
- Conductive hearing loss
- Can interfere with speech development
- Otoscopy: Eardrum is dull + retracted ± fluid level visible
- Ix
- Tympanometry, Pure tone audiometry
- Mx
- Co-existing cleft palate, Down’s, hearing loss = Refer to ENT
- Otherwise:
- Active observation for 6-12wks
- 2x Pure tone audiometry tests (3 months apart)
- Persisting past 6-12wks = Refer to ENT
Developmental milestones referral points
- Doesn’t smile at 10 weeks
- Can’t sit unsupported at 12 months
- Can’t walk at 18 months
Hand preference before 12 months = ?Cerebral palsy
Which ovarian cancer increases risk of endometrial hyperplasia?
Granulosa-theca cell
Secretes oestrogen
Rubella in pregnancy
Risk high (90%) in first 8-10wks GA
Low risk to foetus after 16wks
Congenital Rubella = CHD (PDA), Eye problems (cataracts, “salt & pepper” chorioretinitis, Deafness
Suspected cases of rubella in pregnancy should be discussed with the local Health Protection Unit
Williams syndrome
Elfin facies
Bubbly outgoing personality
Learning difficulty
Short stature
Shaken baby syndrome triad?
Retinal haemorrhages
Subdural haematoma
Encephalopathy (Seizures, LOC)
When is the booking visit and what is usually done?
- 8-12wks (ideally <10wks)
Consists of:
- General info e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
- BP, urine dipstick, check BMI
- Booking bloods/urine:
- FBC, ABO blood group, Rhesus status, red cell alloantibodies, haemoglobinopathies
- HIV, Hep B, Syphilis
- URINE CULTURE for asymptomatic bacteriuria (even if dipstick is normal)
Medical management of miscarriage?
Vaginal misoprostol ONLY
Baby born to mum with Hep B surface antigen +ve OR high risk.
What is Tx for baby?
Hep B vaccine + 0.5ml HBIG within 12hrs of birth
Hep vaccine at 1-2 + 6 months
Drugs contraindicated in breastfeeding?
- Abx: Ciprofloxacin, Tetracycline (Doxycycline), Chloramphenicol, Sulphonamides
- Psych: Lithium, BDZs, Clozapine
- ASPIRIN
- CARBIMAZOLE (hyperthyroidism)
- AMIODARONE
- Methotrexate
- Sulphonylureas
Whooping cough
- Cough for 2wks or more
- Vomiting after coughs
- Inspiratory whoop
- Apnoeic attacks in infants
-
ADMIT if:
- <6m
- Apnoea, cyanosis, severe paroxysms
- Complications: Seizures, pneumonia
Cough onset within 21 days = MACROLIDE (Azithromycin or Clari)
Return to school 48hrs after commencing Abx
Measles vs Rubella vs Roseola
- Measles
- Prodrome = Fever + Conjunctivitis (±febrile convulsions)
- Rash starts BEHIND THE EARS
- KOPLIK SPOTS (white)
- NO lymphadenopathy
- Rubella
- Prodrome = MILD fever
- PINK rash
- Suboccipital/Post-auricular Lymphadenopathy
- Forcheimer spots (Red spots on soft palate)
- Roseola
- Classically HIGH Fever (3 days) THEN RASH appears
- PINK macular rash
- FEBRILE CONVULSIONS
- Nagayama spots (uvula + soft palate
You are called to assist in the resuscitation of a neonate who has just been born at 38 +6 weeks but is showing signs of respiratory distress. On auscultation of the precordium you note the heart sounds are absent on the left hand side but can hear tinkling sounds. The infant is also cyanosed.
Left-sided congenital diaphragmatic hernia
Left sided = most common
Tinkling sounds = BOWEL sounds
Immediate Mx = INTUBATE + VENTILATE
beta hCG facts
- Hormone first produced by the embryo and later by the placental trophoblast
- Main role = to prevent the disintegration of the corpus luteum
- Doubles every 48hrs in first few wks of pregnancy
Eclampsia: when should magnesium be stopped?
24hrs after last seizure
Neonatal resus steps
- Dry baby and maintain temperature
- Assess tone, respiratory rate, heart rate
- If gasping or not breathing give 5 inflation breaths
- Reassess chest movements
- If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
Head lice
- pediculosis capitis
- Diagnosis = Fine-tooth combing of hair
- Treatment = ONLY if living lice are found
- 1st line = Malathion
- Household doesn’t need Tx unless they are also affected
Stress Incontinence
- Pelvic floor exercises
Medical = Duloxetine
Surgical = Retropubic mid-urethral tape procedures
Urge incontinence
- Bladder retraining
- Anti-muscarinics: Oxybutynin, Tolterodine, Darifenacin
IN FRAIL ELDERLY WOMEN: Mirabegron (Beta-3 agonist)
Retinoblastoma
Autosomal dominant
Sx: Absence of red reflex, strabismus, visual problems
>90% survive into adulthood
A mother brings her 5-week-old newborn baby to see you. She reports that she has noticed that his belly button is always wet and leaks out yellow fluid. On examination, you note a small, red growth of tissue in the centre of the umbilicus, covered with clear mucus. The child is otherwise well, apyrexial and developing normally.
Umbilical granuloma
Overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life.
Immunisation schedule at 12 months?
Hib/Men C + Men B + MMR + PCV
When is Men B vaccine given?
2, 4, 12 months
Neonatal blood spot screening (heel prick)
At 5-9 days of life
- congenital hypothyroidism
- cystic fibrosis
- sickle cell
- phenylketonuria
- medium chain acyl-CoA dehydrogenase deficiency (MCADD)
- maple syrup urine disease (MSUD)
- isovaleric acidaemia (IVA)
- glutaric aciduria type 1 (GA1)
- homocystinuria (pyridoxine unresponsive) (HCU)
Phimosis Mx?
<2yo = NORMAL
i.e. Review at 2yrs if present
Pathological CTG findings
Late decelerations = doesn’t return to normal until 30s after end of contraction. Indicates foetal distress. Need foetal blood sampling
Variable decelerations = ?Cord compression
Early deceleration = Innocuous, indicates head compression
Bradycardia (<100) = Maternal b-blocker use, increased foetal vagal tone
Tachycardia (>160) = Maternal fever, chorioamnionitis, hypoxia, premature
Loss of baseline variability (<5) = Prematurity, hypoxia
Endometriosis diagnosis and management?
Dx = Laparoscopy
Mx:
- NSAIDS ± paracetamol (1st line)
- COCP
- GnRH analogues - ‘pseudomenopause’
Fertility is an issue -> SURGERY (e.g. laparoscopic excision)
Placental abruption RFs mnemonic
ABRUPTION
Abruption (previous)
BP (HTN, pre-eclampsia)
Ruptured membranes (premature/prolonged)
Uterine injury (Trauma)
Polyhydramnios
Twins (multiple pregnancy)
Infection (chorioamnionitis)
Old age >35
Narcotics (COCAINE, speed, smoking)
Pregnant woman with BP >160/110. No proteinuria
IMMEDIATE assessment + ADMIT
Precocious puberty + small testes in a boy is likely to be?
Adrenal cause - tumour or Adrenal hyperplasia
Precocious puberty + enlarged testes?
Bilateral = Gonadotrophin dependent (LH/FSH)
Unilateral = Gonadal tumour
Cause of precocious puberty in girls?
McCune Albright syndrome
Undescended testicle Mx?
Unilateral = Review/refer at 3m, ideally seen by surgeon before 6m. Orchidoplexy around 1yo
Bilateral = Paediatric review within 24hrs, may need urgent endo/genetic investigation
Placental abruption mx?
Fetus alive <36wks:
- Fetal distress = Immediate C-section
- No distress = steroids
Fetus alive >36wks
- Fetal distress = Immediate C-section
- No distress = Vaginal delivery
Fetus dead = Induce vaginal delivery
Important NICE paediatric red flags
- Pale, mottled, cyanotic
- Appearing unwell to paediatric healthcare professional
- High-pitched/weak cry
- Grunting
- RR >60
- Reduced skin turgor
- Age <3m with temp. ≥38
When can you do expectant Mx for ectopic?
- Unruptured embryo (no Sx of pain/bleeding)
- <35mm in size
- NO fetal heartbeat
- Asymptomatic
- B-hCG <1,000 and declining
Endometritis Mx?
Puerperal pyrexia = >38C in the first 14 days post-partum
ADMIT + IV Clindamycin + gentamicin
Causes of meconium ileus?
- Hirschprung’s
- Cystic Fibrosis
Causes of bilious vomiting in neonate?
- Very premature baby (At least <37wks or 3wks before EDD) with Fever + abdo distension = NEC
- <6hrs after birth = Duodenal atresia (Abdo XR -> “double bubble”)
- <24hrs = Jejunal/ileal atresia
- 1-2 days = Meconium ileus (think Cystic fibrosis or Hirschprung’s)
- 3-7 days = Malrotation/volvulus (Urgent Upper GI contrast + USS)
How long can urine pregnancy test be positive for after TOP?
4 weeks
>4 weeks indicates incomplete TOP or persistent trophoblast
What factor is associated with decreased incidence of hyperemesis?
Smoking
RFs for hyperemesis?
- multiple pregnancies
- trophoblastic disease
- hyperthyroidism
- nulliparity
- obesity
Hyperemesis Mx?
- Anti-histamine - Cyclizine or Promethazine PO
-
Anti-emetic - Ondansetron or Metoclopromide PO
- Ondansetron = Small risk of cleft lip/palate in 1st trim
- Metoclopramide = Risk of EPSEs. Do not use >5 days
ADMIT if:
- Continued N+V and is unable to keep down liquids or oral antiemetics
- Continued N+V with ketonuria and/or >5% weight loss despite anti-emetics
- A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
Seborrhoeic dermatitis
1st line = Regular washing w/ baby shampoo ± emulsifying ointment
2nd line = Topical imidazole cream (e.g. clotrimazole)
3rd line = Mild topical steroids (1% hydrocortisone)
Nappy rash
Irritant = spares skin folds
Candida = Satellite spots / superficial pustules
Seborrheic = cradle cap, skin folds, bilateral salmon pink patches
Management
- Asymptomatic = Zinc & Castor oil ointment barrier preparation
- Discomfort + >1m old = Hydrocortisone 1%
- Candidal = Topical imidazole
- Bacterial = oral fluclox
