w/c 15/04

Question 1

what surgery is done for paediatric malrotation?

Answer 1

ladds procedure

Question 2

what are 2 missed pills rules for COCP depending on the stage of the cycle?

Answer 2

week 1= emergency contraception
week 2= no action needed in 7 previous days taken correctly
week 3= back to back packs no break

Question 3

what are nasal polyps and recurrent chest infections in a child indicative of?

Answer 3

CF

Question 4

what is russells sign?

Answer 4

knuckles on the back of the hand seen in bulimia due to forced vomitting

Question 5

whats the difference between gastroschisis and omphalocele?

Answer 5

gastroschisis= lateral to umbilicus, not covered by peritoneum
omphalocele= involves the umbilicus itself, covered by peritoneum

Question 6

what is plagiocephaly?

Answer 6

skull deformity
unilateral occiput flattening
ipsilateral ear pushed forward
enourage sleep on back to reduce risk of SID

Question 7

what are rules for POP when on abx?

Answer 7

no change

Question 8

what is tardive dyskinesia and how does it usually present?

Answer 8

involuntary repetitive movements
usually regarding ear and mouth

Question 9

when is oral rotavirus given?

Answer 9

2 months and 3 months

Question 10

what does methotrexate use in pregnancy cause in the child?

Answer 10

cleft palate
anencephaly
hydrocephalus
skull defects

Question 11

what is naegeles rule?

Answer 11

add one year and 7 days to LMP minus 3 months

Question 12

what steroids are used for lichen sclerosus

Answer 12

potent topical eg dermovate

Question 13

whats is the most common cause of neonatal early vs late onset sepsis? how do you differentiate early and late?

Answer 13

early= listeria- first 72 hrs of life
late= staph aureus- after 72 hrs life

Question 14

how is acute fatty liver of pregnancy mx?

Answer 14

supportive care until delivery is possible

Question 15

when is menarche expected to start?

Answer 15

in someone that has secondary sexual characteristics= 16yrs

in someone that does not have secondary sexual characteristics= 14 yrs

Question 16

what are features of pataus syndrome

Answer 16

microcephaly
cleft lip
polydactyly
cardiac defects

Question 17

what score on mmse indicates dementia?

Answer 17

> 24/30

Question 18

what is krukenberg tumor and how is it identified?

Answer 18

gastric carcinoma that has metastasised to the ovaries

histologically signet ring cells are seen

Question 19

what is affected in MCAD?

Answer 19

fatty acid oxidation

Question 20

what is affected in porphyria?

Answer 20

haem synthesis

Question 21

what is affected in G6PD deficiency?

Answer 21

haemolysis (in stress)

Question 22

what is affected in PKU?

Answer 22

amino acid metabolism

Question 23

what is affected in lesch nyhan syndrome?

Answer 23

uric acid metabolism

Question 24

when are compressions started in an unresponsive neonate?

Answer 24

give 5 inflation breaths
check for response
give 5 more
check for response
ventilate for 30 secs
check HR
if <60bpm start compressions

Question 25

how do you remember what capgras syndrome is?

Answer 25

cap=captured= loved ones have been replaced

Question 26

what is pica?

Answer 26

urge to eat non food items eg soil

Question 27

what is pica in a child indicative of?

Answer 27

iron deficiency anaemia

Question 28

whats a common cause of iron deficiency anaemia in children?

Answer 28

excessive ingestion of cows milk- its low in iron

Question 29

what ethnicity are fibroids more common in?

Answer 29

afro caribbeans

Question 30

what are the compressive sx of fibroids

Answer 30

compression of bladder= increased urination compression of rectum= constipation compression of veins= pedal oedema

Question 31

what are rules regarding cocp and smoking?

Answer 31

if over 35 and currently smoking/ smoking in past year are UKMEC3

Question 32

what are rules regarding breast cancer in relatives and cocp?

Answer 32

not a contraindication only if the patient themself has or had breast cancer

Question 33

when is agranulocytosis on clozapine most common and how is it monitored for in this period?

Answer 33

most common in first 6-12 weeks monitor every week for the first 6 months

Question 34

how is acute heroin withdrawal managed?

Answer 34

first line symptomatic mx loperamide if diarrhoea is most concerning lofexidine for physical sx

Question 35

how is parity linked to risk of cervical cancer?

Answer 35

increased parity increases risk

Question 36

what is continuous dribbling after prolonged labour and poor obstetric care indicative of? how is it ix

Answer 36

vesicovaginal fistula urinary dye studies

Question 37

whats first line for menorrhagia?

Answer 37

mirena IUS

Question 38

whats the typical age for croup?

Answer 38

6-12 months

Question 39

what are some indications for ECT?

Answer 39

catatonia severe depression prolonged or severe mania

Question 40

what are hypertension and multiple ovarian cysts in pregnancy indicative of?

Answer 40

molar pregnancy high beta HCG causes growth of follicles

Question 41

what can cause raised ca125

Answer 41

ovarian cancer endometriosis- chocolate cysts on ovaries

Question 42

what inheritance pattern is polycystic kidney disease in neonates?

Answer 42

autosomal recessive

Question 43

what IQ levels are normal/mild/moderate/severe disability

Answer 43

70= normal range 50-70= mild disability 35-49= moderate disability 20-35= severe disability

Question 44

when is US renal tract done in paediatrics?

Answer 44

all kids with atypical UTI

Question 45

how is vesicoureteral reflux mx?

Answer 45

often improves with time so surgical intervention is not necessarily needed

Question 46

in testicular torsion do you do bilateral or unilateral orchidopexy?

Answer 46

bilateral

Question 47

where is a mass in intussecption most commonly found?

Answer 47

right upper quadrant

Question 48

what 2 ix confirm diagnosis of hirschsprungs?

Answer 48

air enema rectal biopsy

Question 49

what part of the nervous system is affected in hirschsprungs disease?

Answer 49

parasympathetic

Question 50

how can you differentiate viral vs bacterial gastroenteritis?

Answer 50

viral= non bloody diarrhoea

Question 51

what complication of gastroenteritis do you need to consider in children?

Answer 51

HUS

Question 52

whats the triad for HUS?

Answer 52

MAHA renal failure thrombocytopenia

Question 53

what ix is done for pyloric stenosis?

Answer 53

abdominal US

Question 54

what is gauchers disease?

Answer 54

a lysosomal storage disorder where there in abnormal fat deposition in organs- especially the liver and spleen

Question 55

on auscultation how do you differentiate VSD and ASD?

Answer 55

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

Question 56

what is considered prolonged second stage of labour?

Answer 56

>1hr multip >2hrs primip add one hr if on epidural analgesia

Question 57

when is oxytocin given in labour?

Answer 57

1st stage= if supoptimal progess 2nd stage= if irregular contractions

Question 58

what is done if there is prolonged labour and the women is fully dilated?

Answer 58

instrumental delivery

Question 59

what is gold standard ix for endometrial cancer?

Answer 59

hysteroscopy and biopsy not first line is TVUS but this is gold standard

Question 60

what are rules regarding mania/hypomania in bipolar 1 vs 2

Answer 60

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

Question 61

what ecg feature is seen in refeeding syndrome and due to what electrolyte abnormality?

Answer 61

prominent u waves due to hypokalemia

Question 62

what are sx of amniotic fluid embolism?

Answer 62

shortness of breath chest pain hypotension high resp rate tachycardia hypotension hypoxia

Question 63

what will obs in amniotic fluid embolism be?

Answer 63

all obs high apart from BP which is low temp may be normal

Question 64

what scoring system is used for tonsilitis?

Answer 64

centor

Question 65

what is in the centor scoring system?

Answer 65

tonsilar exudate anterior cervical lymphadenopathy fever over 38 degrees absence of cough

Question 66

how do you immediately know how to manage an ectopic (when deciding between medical and surgical)?

Answer 66

presence of any symptoms= surgical mx this includes any abdominal pain

Question 67

what drug is VZV mx with in pregnancy?

Answer 67

>20 weeks GA= oral aciclovir <20 weeks GA= consider oral aciclovir note: VZV IG is no longer used

Question 68

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

Answer 68

IUS- 7 days COCP- 7 days IUD- immediate POP- 2 days implant- 7 days injection- 7 days

Question 69

describe mcroberts manoeuvre

Answer 69

supine, both legs full flexed and abducted

Question 70

what is the SSRI of choice in someone with unstable angina and previous MI?

Answer 70

sertraline

Question 71

what part of the sternum are chest compressions started in for children?

Answer 71

lower half of sternum

Question 72

what is conservative advice for bedwetting?

Answer 72

toileting before bed reduced liquid consumption before bed star chart for dry nights

Question 73

what are risk factors for endometrial cancer?

Answer 73

menopausal obesity nulliparity PCOS diabetes tamoxifen or unopposed estrogen

Question 74

whats first line mx for severe PMS?

Answer 74

SSRI

Question 75

what does boot shaped heart signify?

Answer 75

tet of fallot

Question 76

what mechanism is responsible for the development of tetralogy of fallot?

Answer 76

anterosuperior displacement of the infundibular septum

Question 77

what should be mx if a child comes in having self harmed?

Answer 77

admission and urgent CAHMS assessment

Question 78

how is a patient who had a LLETZ managed in terms of cervical screening?

Answer 78

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)

Question 79

what age does bronchiolitis present?

Answer 79

<18 months

Question 80

whats the incidence of baby blues?

Answer 80

50-75%

Question 81

what does loss of internal rotation in flexion of a leg in paeds MSK signify?

Answer 81

SUFE

Question 82

what are missed pill rules for COCP missing only one pill?

Answer 82

take missed pill asap and no further action needed

Question 83

how is screening for DDH for breech babies carried out?

Answer 83

all breech babies should have US pelvis at 6 weeks

Question 84

what heart defects is turners syndrome associated with?

Answer 84

aortic stenosis bicuspid aortic valve aortic coarctation

Question 85

what are blood glucose targets for someone with gestational diabetes?

Answer 85

fasting= <5.3 post prandial= <6.4

Question 86

what are high risk vs moderate risk factors for pre eclampsia

Answer 86

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

Question 87

what does abdo x ray in hirschsprungs disease show?

Answer 87

dilated loops of bowel with a fluid level

Question 88

what needs to be given to all children after they have an asthma attack?

Answer 88

steroids for 3-5 days

Question 89

in fitz hugh curtis what happens to the liver capsule and what is this called?

Answer 89

inflammation called glissons capsule

Question 90

what type of murmur are innocent murmurs in children?

Answer 90

ejection

Question 91

what are the 2 main innocent murmurs in children? describe how they sound

Answer 91

stills murmur- low pitched sound heard at lower sternal edge venous hums- continuous blowing under the clavicles

Question 92

whats medical therapy for PTSD

Answer 92

venlaflaxine or SSRI

Question 93

what GA do you treat maternal chickenpox?

Answer 93

>20 weeks GA

Question 94

what age do children start to parallel play?

Answer 94

2 years

Question 95

at what GA can you manage someone expectantly for PV bleeding?

Answer 95

<6 weeks note: they must have no pain

Question 96

when do you treat household for threadworm?

Answer 96

always

Question 97

what ix is done for NEC?

Answer 97

abdo x ray