w/c 12/02 Flashcards
what organism usually causes bronchiolitis?
RSV
what is bronchiolitis obliterans?
a complication of bronchiolitis popcorn lung- terminal bronchiolar dilation, areas of air trapping seen on CT
what causative organism usually causes bronchiolitis obliterans?
adenovirus
what is raised immune tripsinogen on heel prick suggestive of?
cystic fibrosis
what is raised phenylalanine on heel prick suggestive of?
phenylketonuria
when is the heel prick test done?
5-8 days old
how does congenital hypothyroidism present?
macroglossia
floppy baby/hypotonia
abdo distention/ constipation
umbilical distention
whats the inheritance pattern of duchennes muscular dystrophy?
x linked recessive
what is phrens sign?
does elevation of the testes relieve pain?
negative= no (seen in testicular torsion)
positive= yes (seen in epididymitis)
what organism commonly causes early onset sepsis?
group B strep
why is IgA done with anti TTG?
lack of IgA leads to false negative
medical management for TOP is recommended for what GA?
10-23+6 weeks
what types of drugs are mifepristone and misoprostol? how do they work
mifeprostone= progesterone receptor antagonist, degrades endometrium, ripens cervix, opens os etc
misoprostol- prostaglandin analogue, causes smooth muscle contraction to expel uterine contents
describe medical mx of TOP
give oral mifeprostone
give vaginal misoprostol 36-48 hrs after
what medications are given in antiphospholipid syndrome to prevent miscarriage? when are they started and how do they work
LMWH= start when foetal heartbeat detectable
low dose aspirin= start when pregnancy confirmed on urinalysis
they both prevent thrombosis
what tests are done in the combined screening test
nuchal translucency
PAPP-A
free bHCG
what is seen in the combined screening test in downs syndrome?
high nuchal translucency and b-HCG
low PAPP-A
what nerve block is performed using local for instrumental delivery?
pudendal
how often do people with HIV need cervical screening?
every year
what is given to babies when mum has hep B?
HBV IgG and HBV vaccination within 24 hrs of delivery
what age does perthes disease occur in?
4-8 yrs
what are some RF for paediatric sepsis?
break in skin (cut/burn)
immunosupression (diabetes/splenectomy/cancer treatment etc)
surgery in past 6 weeks
indwelling catheter
what is oesophageal atresia?
when the oesophagus ends blindly, failing to connect to the stomach
what are the 4 main domains of developmental milestones?
gross motor
fine motor
social
hearing and vision
what is rhesus status of mum and baby in haemolytic disease of the newborn?
mum= rhesus negative
baby= rhesus positive
how would you explain sepsis to someone?
a condition wherein the immune systems response to an infection leads to the compromise of many organs in the body, it is serious and can be lifethreatening
what ix are done in paediatric sepsis?
bedside: obs, urine dip, urine mc/s, lumbar puncture, swabs, BG
bloods: FBC, UEs, LFTs, culture, lactate VBG/ABG, CRP, clotting screen
imaging: CXR, AXR
how is sepsis in a child managed?
immediate hospital admission
administer broad spec IV abx
escalate to senior paediatrician for review within 1 hr, prepare for escalation to ITU/HDU
administer fluid bolus and maintenance fluids, high flow oxygen if needed
what is seen on bloods in women with turners syndrome?
high FSH
what drug is given in secondary nocturesis when conservative measures fail? at what age can it be given?
desmopressin
can be given to children above 7
what medication is given while awaiting surgery in babies with duct dependant lesions? whats the moa
prostaglandin E
it prevents the duct from closing
what medication should not be given while awaiting surgery in babies with duct dependant lesions? whats the moa
NSAIDs
COX inhibitors will cause the lesion to close
how is transient synovitis mx?
rest and analgesia
what type of abx are given in whopping cough? give examples
a macrolide
clarithromycin
azithromycin
what is seen on electron microscopy in minimal change disease?
diffuse effacement of foot processes on podocytes
what is meckels diverticulum and how does it present?
a congenital GI condition where there are remnants of the embryonic vitello-duct
can present with painless rectal bleeding, abdo pain etc and if obstructed more severe sx
what ix are done for meckels diverticulum?
CT
99mTC scan
how is meckels diverticulum managed?
NG decompression
surgical resection
how is bilirubin measured in babies with jaundice first?
transcutaneous
what are the other names for slapped cheek syndrome?
erythema infectiosum
fifth disease
what age is premature ovarian insufficiency diagnosed in?
under 40
what does a positive coombs test in a newborn baby confirm?
immune mediated haemolytic anaemia (rhesus disease)
what medication regime is adopted in pregnant women with hypothyroidism?
increase levothyroxine by 25mcg daily even if the patient is euthyroid
whats the most common type of vulval cancer?
squamous cell carcinoma
in cervical ectropion what type of cell extends to where?
ectopic columnar epithelium extends from the endocervix to the ectocervix
what HRT is recommend for perimenopausal vs most menopausal women? say how they differ
perimenopausal: monthly cyclical HRT where oestrogen is given always and progestogen last 10-14 days, induces a withdrawal bleed in final phase
postmenopausal: continuous combined HRT where oestrogen and progestogen are taken daily to mimic the effects of physiological menopause
how do you differentiate pre eclampsia from pregnancy associated htn?
pre eclampsia= proteinuria present, >140 systolic and/or >90 diastolic
list RF of ectopic pregnancy
endometriosis
PID
smoking
IVF
previous ectopic
age over 35
whats the biggest risk with IOL for a healthy women who hasnt gone into labour on time?
failure of induction and c section required
what is given in paracetamol overdose
n acetylcystine
what is significant paracetamol overdose?
> 75mg/kg
how is delirium managed
de escalation techniques
IM haloperidol
how long does section 5(2) last?
72 hrs
what are common side effects of SSRI in first 2 weeks?
GI disturbance
agitation
increased anxiety
whats the difference between schizoid vs schizotypal personality disorder?
schizoid= detachment from social relationships and emotional withdrawal
schizotypal= magical/strange beliefs
what are class a personality disorders?
paranoid
schizoid
schizotypal
what blood test is done for biliary atresia and what is seen?
serum total and conjugated bilirubin
both are high
what organism commonly causes croup?
parainfluenza
what are hyperinflated lungs and fluid level in a newborn characteristic of?
transient tachypnoea of the newborn
what conditions are those with downs syndrome at risk of developing?
ALL
Alzheimers
what differetiates oligoarticular vs polyarticular juvenile idiopathi arthritis?
oligo= four or fewer joints
poly= more than four
how is oligoarticular polyarticular juvenile idiopathic arthritis managed?
intraarticular steroids
what is seen on xray in someone with ewings sarcoma?
lamellated (onion skin) periosteal reaction
what is seen on mri in someone with ewings sarcoma?
a large mass with evidence of necrosis
what is seen on histology in someone with ewings sarcoma
small round cells with clear cytoplasm on haematoxylin and eosin staining
what are the 2 common causes of not passing meconium
cystic fibrosis
hirschsprungs disease
what rf ellicit OGGT in pregnancy?
BMI >30
previous macrosomic baby
previous gestational diabetes
1st degree relative with diabetes
ethnic origin
when is OGTT in pregnancy done?
26-28 weeks
what folic acid supplementation is recommended for pregnant women? include doses and times
400 mcg folic acid daily until 12th week
what is the high dose for folic acid supplementation in pregnant women?
5mg
what is seen in the baby when there is maternal alcohol consumption
congential heart defects (VSDs)
abnormal face: thin lips, smooth philtrum, small jaw
how uterine atony addressed in PPH?
IV oxytocin
Bimanual uterine compression
what is erbs palsy, whats it associated with and how is it managed?
palsy of the arm: flaccid upper arm, extended lower arm rotated towards body and hand in waiters tip position
associated with shoulder dystocia- damage to brachial plexus
usually resolves in 12 months
what bloods would you do in someone with alcohol withdrawal?
TFTs
FBC
ESR
CRP
B12
folate
UEs
LFTs
BG and Hba1c
what is first line treatment for acute mania?
antipsychotics
(those with mood stabilising properties are used and include olanzipine, haloperidol, risperidone, quetiapine)
what electrolyte abnormality may be seen in someone after a panic attack? why?
hypocalcaemia
hyperventilation causes alkalosis with promotes calcium binding to albumin
how does osteosarcoma in a child usually present?
localised pain for several months not associated with trauma or injury, sometimes palpable lump
whats the most common primary malignant bone tumor in kids and adolescents?
osteosarcoma
what depth are compressions done in paediatric basic life support?
1/3rd chest depth
how do you differentiate transient synovitis and septic arthritis?
joint aspirate- septic arthritis will grow bacteria and transient synovitis wont
how does tetralogy of fallot present?
tet spells- episodic syanosis
left lower sternal edge murmur
how does transposition of the great arteries present?
constant cyanosis
appears hours after birth
prominent right venticular heave
single second heart sound
where does fluid accumulate in a hydrocele?
tunica vaginalis
when is surgery for a hydrocele required?
if persistent beyond the age of 2
how long is folic acid taken for?
before conception through to 12 weeks
what are indications for high dose folic acid?
partner with NTD
previous pregnancy with NTD
coeliac disease
diabetes
thalassaemia trait
obese
what microbio tests are done at booking appt?
HIV
Hep B
spyhillis
how long should you take iron for if you are anemic?
3 months
even if levels are normal
what do you need to screen for when someone presents with suspected pre eclampsia
HELPP syndrome
how is hyperemesis gravidarum managed?
electrolyte and fluid replacement
anti histamine first line (cyclizine or prochlorperazine) then anti emetics (ondansetron/metacloperamide)
thiamine and folic acid supplementation to prevent wernickes enceph
TED stockings to reduce risk of thrombosis due to pregnancy, dehydration and immobilisation
how is primary ovarian insufficiency diagnosed?
menopausal sx
2 elevated FSH 4-6 weeks apart
when is the booking appt done?
8-10 weeks
what cancers does PCOS increase the risk of?
endometrial and ovarian
when are anti D rhesus injections given?
one injection 28-30 weeks
2 injections one at 28 weeks and one at 34 weeks
