w/c 15/04 Flashcards
what surgery is done for paediatric malrotation?
ladds procedure
what are 2 missed pills rules for COCP depending on the stage of the cycle?
week 1= emergency contraception
week 2= no action needed in 7 previous days taken correctly
week 3= back to back packs no break
what are nasal polyps and recurrent chest infections in a child indicative of?
CF
what is russells sign?
knuckles on the back of the hand seen in bulimia due to forced vomitting
whats the difference between gastroschisis and omphalocele?
gastroschisis= lateral to umbilicus, not covered by peritoneum
omphalocele= involves the umbilicus itself, covered by peritoneum
what is plagiocephaly?
skull deformity
unilateral occiput flattening
ipsilateral ear pushed forward
enourage sleep on back to reduce risk of SID
what are rules for POP when on abx?
no change
what is tardive dyskinesia and how does it usually present?
involuntary repetitive movements
usually regarding ear and mouth
when is oral rotavirus given?
2 months and 3 months
what does methotrexate use in pregnancy cause in the child?
cleft palate
anencephaly
hydrocephalus
skull defects
what is naegeles rule?
add one year and 7 days to LMP minus 3 months
what steroids are used for lichen sclerosus
potent topical eg dermovate
whats is the most common cause of neonatal early vs late onset sepsis? how do you differentiate early and late?
early= listeria- first 72 hrs of life
late= staph aureus- after 72 hrs life
how is acute fatty liver of pregnancy mx?
supportive care until delivery is possible
when is menarche expected to start?
in someone that has secondary sexual characteristics= 16yrs
in someone that does not have secondary sexual characteristics= 14 yrs
what are features of pataus syndrome
microcephaly
cleft lip
polydactyly
cardiac defects
what score on mmse indicates dementia?
> 24/30
what is krukenberg tumor and how is it identified?
gastric carcinoma that has metastasised to the ovaries
histologically signet ring cells are seen
what is affected in MCAD?
fatty acid oxidation
what is affected in porphyria?
haem synthesis
what is affected in G6PD deficiency?
haemolysis (in stress)
what is affected in PKU?
amino acid metabolism
what is affected in lesch nyhan syndrome?
uric acid metabolism
when are compressions started in an unresponsive neonate?
give 5 inflation breaths
check for response
give 5 more
check for response
ventilate for 30 secs
check HR
if <60bpm start compressions
how do you remember what capgras syndrome is?
cap=captured= loved ones have been replaced
what is pica?
urge to eat non food items eg soil
what is pica in a child indicative of?
iron deficiency anaemia
whats a common cause of iron deficiency anaemia in children?
excessive ingestion of cows milk- its low in iron
what ethnicity are fibroids more common in?
afro caribbeans
what are the compressive sx of fibroids
compression of bladder= increased urination
compression of rectum= constipation
compression of veins= pedal oedema
what are rules regarding cocp and smoking?
if over 35 and currently smoking/ smoking in past year are UKMEC3
what are rules regarding breast cancer in relatives and cocp?
not a contraindication
only if the patient themself has or had breast cancer
when is agranulocytosis on clozapine most common and how is it monitored for in this period?
most common in first 6-12 weeks
monitor every week for the first 6 months
how is acute heroin withdrawal managed?
first line symptomatic mx
loperamide if diarrhoea is most concerning
lofexidine for physical sx
how is parity linked to risk of cervical cancer?
increased parity increases risk
what is continuous dribbling after prolonged labour and poor obstetric care indicative of? how is it ix
vesicovaginal fistula
urinary dye studies
whats first line for menorrhagia?
mirena IUS
whats the typical age for croup?
6-12 months
what are some indications for ECT?
catatonia
severe depression
prolonged or severe mania
what are hypertension and multiple ovarian cysts in pregnancy indicative of?
molar pregnancy
high beta HCG causes growth of follicles
what can cause raised ca125
ovarian cancer
endometriosis- chocolate cysts on ovaries
what inheritance pattern is polycystic kidney disease in neonates?
autosomal recessive
what IQ levels are normal/mild/moderate/severe disability
70= normal range
50-70= mild disability
35-49= moderate disability
20-35= severe disability
when is US renal tract done in paediatrics?
all kids with atypical UTI
how is vesicoureteral reflux mx?
often improves with time so surgical intervention is not necessarily needed
in testicular torsion do you do bilateral or unilateral orchidopexy?
bilateral
where is a mass in intussecption most commonly found?
right upper quadrant
what 2 ix confirm diagnosis of hirschsprungs?
air enema
rectal biopsy
what part of the nervous system is affected in hirschsprungs disease?
parasympathetic
how can you differentiate viral vs bacterial gastroenteritis?
viral= non bloody diarrhoea
what complication of gastroenteritis do you need to consider in children?
HUS
whats the triad for HUS?
MAHA
renal failure
thrombocytopenia
what ix is done for pyloric stenosis?
abdominal US
what is gauchers disease?
a lysosomal storage disorder where there in abnormal fat deposition in organs- especially the liver and spleen
on auscultation how do you differentiate VSD and ASD?
VSD= lower left sternal edge, normal 1st and 2nd heart sounds
ASD= upper left sternal edge, radiate to back, fixed splitting of second heart sound
what is considered prolonged second stage of labour?
> 1hr multip
2hrs primip
add one hr if on epidural analgesia
when is oxytocin given in labour?
1st stage= if supoptimal progess
2nd stage= if irregular contractions
what is done if there is prolonged labour and the women is fully dilated?
instrumental delivery
what is gold standard ix for endometrial cancer?
hysteroscopy and biopsy
not first line is TVUS but this is gold standard
what are rules regarding mania/hypomania in bipolar 1 vs 2
1= mania needed, identify by not being able to do usual daily activities
2= hypomania and depressive episodes, identify by being able to do usual daily activities
what ecg feature is seen in refeeding syndrome and due to what electrolyte abnormality?
prominent u waves due to hypokalemia
what are sx of amniotic fluid embolism?
shortness of breath
chest pain
hypotension
high resp rate
tachycardia
hypotension
hypoxia
what will obs in amniotic fluid embolism be?
all obs high apart from BP which is low
temp may be normal
what scoring system is used for tonsilitis?
centor
what is in the centor scoring system?
tonsilar exudate
anterior cervical lymphadenopathy
fever over 38 degrees
absence of cough
how do you immediately know how to manage an ectopic (when deciding between medical and surgical)?
presence of any symptoms= surgical mx
this includes any abdominal pain
what drug is VZV mx with in pregnancy?
> 20 weeks GA= oral aciclovir
<20 weeks GA= consider oral aciclovir
note: VZV IG is no longer used
how long do these different contraceptive methods take to work if someone isnt on the first day of their cycle:
IUS
COCP
IUD
POP
implant
injection
IUS- 7 days
COCP- 7 days
IUD- immediate
POP- 2 days
implant- 7 days
injection- 7 days
describe mcroberts manoeuvre
supine, both legs full flexed and abducted
what is the SSRI of choice in someone with unstable angina and previous MI?
sertraline
what part of the sternum are chest compressions started in for children?
lower half of sternum
what is conservative advice for bedwetting?
toileting before bed
reduced liquid consumption before bed
star chart for dry nights
what are risk factors for endometrial cancer?
menopausal
obesity
nulliparity
PCOS
diabetes
tamoxifen or unopposed estrogen
whats first line mx for severe PMS?
SSRI
what does boot shaped heart signify?
tet of fallot
what mechanism is responsible for the development of tetralogy of fallot?
anterosuperior displacement of the infundibular septum
what should be mx if a child comes in having self harmed?
admission and urgent CAHMS assessment
how is a patient who had a LLETZ managed in terms of cervical screening?
test to see if HPV negative in 6 months
If positive refer back to colposcopy without further tests
if negative recall in 3 years
if negative in 3 years go back to routine screening (this could be every 3 or 5 yrs depending on age)
what age does bronchiolitis present?
<18 months
whats the incidence of baby blues?
50-75%
what does loss of internal rotation in flexion of a leg in paeds MSK signify?
SUFE
what are missed pill rules for COCP missing only one pill?
take missed pill asap and no further action needed
how is screening for DDH for breech babies carried out?
all breech babies should have US pelvis at 6 weeks
what heart defects is turners syndrome associated with?
aortic stenosis
bicuspid aortic valve
aortic coarctation
what are blood glucose targets for someone with gestational diabetes?
fasting= <5.3
post prandial= <6.4
what are high risk vs moderate risk factors for pre eclampsia
high:
CKD
previous htn disease in pregnancy
autoimmune condition
diabetes 1 or 2
moderate:
age over 40
first pregnancy
BMI >35
multiple pregnancy
fhx pre eclampsia
pregnancy interval >10 yrs
what does abdo x ray in hirschsprungs disease show?
dilated loops of bowel with a fluid level
what needs to be given to all children after they have an asthma attack?
steroids for 3-5 days
in fitz hugh curtis what happens to the liver capsule and what is this called?
inflammation
called glissons capsule
what type of murmur are innocent murmurs in children?
ejection
what are the 2 main innocent murmurs in children? describe how they sound
stills murmur- low pitched sound heard at lower sternal edge
venous hums- continuous blowing under the clavicles
whats medical therapy for PTSD
venlaflaxine or SSRI
what GA do you treat maternal chickenpox?
> 20 weeks GA
what age do children start to parallel play?
2 years
at what GA can you manage someone expectantly for PV bleeding?
<6 weeks
note: they must have no pain
when do you treat household for threadworm?
always
what ix is done for NEC?
abdo x ray
