Who Knows Flashcards
1
Q
- An 11-month-old baby boy presents with extensive bruising and painful, swollen right knee joint, meaning he is now reluctant to move it. A non-accidental injury is ruled out and he is admitted for investigations. His mother takes his temperature regularly and says it has been normal all week.
What condition dose the boy have and which would be the most useful first line investigation?
A
- Haemophilia A/B
- Clotting screen
2
Q
- A 15-year-old girl presents to the GP complaining of a 5-day history of sore throat and headache. She denies any diarrhoea or vomiting. On further questioning, she tells you that she went to a house party last weekend where a few of her friends had a bit of a cough and she wonders if it could be from that. You decide to treat her for a URTI and prescribe her some amoxicillin. The patient has no known drug allergies. 2 days later the girl comes back to the GP complaining of a widespread itchy rash. What is the most likely cause of this ?
A
Infective mononucleosis
(EBV, mono, glandular fever)
3
Q
Results you would expect to find in neuroleptic malignant syndrome:
A
Raised CK (creatine kinase) –> due to muscle rigidity
Raised white cell count
Deranged LFT’s
Acute renal failure –> abnormal U&E’sMetabolic acidosis –> low pH, low HCO3
4
Q
- Down-and-out appearance of the eye is due to palsy of what nerve ?
A
Oculomotor (CN3)
5
Q
What links RFs for breast cancer
A
Increased number of ovulations
6
Q
The correct management plan in mild PID
A
- Start antibiotics immediately, before the results of the swabs
- Prescribe doxycycline, metronidazole, and IM ceftriaxone (broad-spectrum management)
- Leave in a recently inserted coil. If there is no response within 48hrs to the antibiotics, remove the coil and prescribe any other necessary emergency contraceptives
7
Q
Best AB to treat UTI in pregnancy ?
A
Cephalosporins e.g. Ceftriaxone
8
Q
What presenting feature of PID could indicate admission ?
A
Fever > 38
9
Q
How long would endometrial pain have to last be chronic ?
A
More than 6 months
10
Q
When not to use COCP
A
COCP should be avoided in patients aged over 35 that smoke more than 15 cigarettes a day
VTE related risk factors e.g AF, stroke, vascular disease, Hx VTE
Breast Cancer
11
Q
How long should ABs be given post premature rupture of membranes ?
A
10 days
12
Q
Measured when investigating delayed development of secondary sexual characteristics
A
- Androgen levels
- FSH and LH
- Estrogen
- Thyroid function tests
13
Q
Which of the following investigation results indicate that the patient has previously been treated for syphilis?
A
VRDL negative, TPHA positive
14
Q
Complications of chlamydia infection in pregnancy?
A
- Chorioamnionitis
- Neonatal conjunctivitis
- Neonatal pneumonia
- Prelabour rupture of membranes
15
Q
Causes of superficial dyspareunia
A
Genital herpes
Lichen sclerosus
Thrush
Vaginismu
16
Q
Common causes of retrograde ejaculation?
A
- Bladder neck surgery
- Congenital abnormality
- Diabetic autonomic neuropathy
- Transurethral resection of the prostate
17
Q
If a patient suffers from foot drop and weak dorsiflexion, it may indicate there is spinal nerve root compression of which nerve?
A
L5
18
Q
What can be given to reduce the effects of the heparin?
A
Protamine
19
Q
What type of anaemia is B12 deficiency anaemia?
A
Megaloblastic
20
Q
What can be the mechanistic cause of osteoarthritis in post-menopausal women ?
A
Loss of protective estrogen
21
Q
What is seen under a microscope in pseudogout ?
A
Positively bi-fringent crystals
22
Q
MOA for aspirin and clopidogrel ?
A
COX-1 inhibition P2Y12 inhibitor
23
Q
What is the mode of inheritance of Duchenne muscular dystrophy?
A
X-linked recessive
24
Q
X- linked recessive conditions
A
Haemophilia A,B
Duchenne muscular dystrophy
G6PD deficiency
25
Autosomal recessive conditions
Cystic fibrosis
Sickle cell anaemia
Haemochromatosis
Gilbert's syndrome
26
What is the most appropriate next step in the following scenario: child aged < 5 years with asthma not controlled by a SABA + paediatric low-dose ICS + leukotriene receptor antagonist?
Stop the leukotriene receptor antagonist and refer to a specialist
27
Which one of the following is the best investigation for developmental dysplasia of the hip?
Ultrasound
28
What school exclusion advice should be given for chickenpox?
Until lesions have crusted over
29
Acyanotic conditions
Coarctation of the aorta
Aortic valve stenosis
Ventricular septal defect
Atrial septal defect
30
Cyanotic conditions
Tetralogy of Fallot
Tricuspid atresia
Transposition of the great arteries
31
At what age would the average child acquire the ability to tower of 3-4 blocks?
18 months
32
At what age would the average child acquire the ability to smiles?
6 weeks
33
At what age would the average child acquire the ability to sits without support?
7 to 8 months
34
Measles complications
- otitis media: the most common complication
- pneumonia: the most common cause of death
- encephalitis: typically occurs 1-2 weeks following the onset of the illness)
- subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
- febrile convulsions
- keratoconjunctivitis, corneal ulceration
- diarrhoea
- increased incidence of appendicitis
- myocarditis
35
At what age would the average child acquire the ability to use double syllables e.g. 'adah','erleh'?
6 months
36
A 3-year-old develops oral ulcers associated with a mild fever and vesicles on the palms and soles
Coxsackie A virus
37
A 9-month-old boy presents with vomiting and passing blood stained stools. His parents describe regular 'colicky' episodes during which he draws his knees up and appears pale. On examination there is a sausage-shaped mass in the abdomen is a stereotypical history of:
Intussusception
38
Which one of the following is/are most characteristic of patent ductus arteriosus?
Look up
39
Which condition is associated with an S4 heart murmur ?
Aortic stenosis
40
At what age would the average child acquire the ability to points with a finger?
9 months
41
What developmental milestones would you expect from a 9 month infant ?
- Ability to say Mamma and Dadda
- Crawls
- Points finger
42
Kawasaki disease management
- Aspirin
- Intravenous immunoglobulin
43
Which one of the following is the best investigation for bronchiolitis?
Immunofluorescence of nasopharyngeal secretions
44
What medication can be given prophylactically to reduce the risk of pre-eclampsia and intrauterine growth retardation ?
Low dose aspirin from 12 weeks 75-150mg daily until birth
45
What is adenomyosis ?
Presence of endometrial tissue within the myometrium
46
What are the features of adenomyosis
- Dysmenorrhea
- Menorrhagia
- Enlarged, boggy uterus
47
When is menorrhagia
Bleeding for more than 7 days
48
What is dysmenorrhea ?
Painful menstruation
49
Investigation for adenomyosis
- Transvaginal US
- MRI alternative
50
Management of adenomyosis
- Symptomatic treatment e.g. tranexamic acid to manage menorrhagia
- GnRH agonists
- Uterine artery embolization
- Hysterectomy – considered definitive treatment
51
Medication that can induce restless leg syndrome ?
- Ropinirole
- Dopamine agonist used in Parkinsons
52
What could development of hand preference before 12 months indicate ?
- Cerebral palsy
53
What should patients with Downs be screened for partially if taking part in sports ?
- Atlantoaxial instability
- Thus, increased risk of neck dislocation
54
Features of Downs ?
- Short stature
- Upslanting palpebral fissures
- Flat occiput
- Single palmer crease
55
Seizure with short jerking in part of or all of the body that often occurs in the morning upon waking ?
- Myoclonic
56
Treatment for myoclonic seizure
- Levetiracetam
57
What type of virus is the rotavirus and when is it given ?
- Oral, live attenuated virus
- 2 months and 3 months
58
What test is used to screen newborns for hearing problems ?
- Otoacoustic emission test
- If they fail they are then referred to impedance audiometry tests
59
What tool is used to measure disability or dependence in activities of daily living in stroke patients ?
- Barthel Index
60
Risk Factors for developmental dysplasia of the hip ?
- Positive family history
- Breech presentation (even if external cephalic version is used)
- Female sex
- Firstborn child
61
What type of movement is spared in motor neuron disease ?
Eye movement
62
Weakness of what nerve can cause weakness of foot dorsiflexion and foot eversion ?
- Common peroneal nerve
63
What is Weber’s syndrome ?
- A midbrain stroke involving the fascicles of the oculomotor nerve (CN3) resulting in ipsilateral CN3 palsy and contralateral hemiplegia or hemiparesis
64
What is cataplexy ?
- A sudden and transient episode of muscle weakness, typically triggered by strong emotions such as laughter, anger or surprise
- Often associated with narcolepsy
65
What would an anterior artery stroke cause ?
- Leg weakness but not facial weakness or speech impairment
66
A child presenting with learning difficulties but is extremely friendly and extroverted. They are short for their age and has supravalvular aortic stenosis
- Williams syndrome
67
Heart defect associated with Williams syndrome ?
- Supravalvular stenosis
68
Parts of the core Child Health Promotion Program as outlined in the Children’s National Service Framework ?
- Newborn clinical examination
- Newborn hearing check
- Heel-prick check at 5-9 days
- GP examination at 6-8 weeks
69
19. A man presents with a four month history of neck and arm pain. The pain is like an electric shock and is worse when he turns his head. On examination he has decreased sensation on the dorsal aspect of the thumb and index finger. What is the most likely underlying diagnosis ?
- C6 radiculopathy
70
20. Why is ibuprofen not recommended in chickenpox ?
- Can increase the risk of necrotizing fasciitis
71
MCC of croup ?
- Parainfluenza virus
72
MCC of bronchiolitis
- RSV
73
MCC of pneumonia in paeds ?
- Streptococcus pneumonia
74
MCC of epiglottis
- Haemophilus infuenza B
75
24. MCC of whooping cough ?
- Bordettla Pertussis
76
MCC of painless GI bleeding requiring transfusion in children between 1 and 2
- Meckel’s diverticulum
77
Features of patent ductus arteriosus ?
- Continuous ‘machinery’ murmur
- Heaving apex beat
- Wide pulse pressure
- Left subclavicular thrill
78
Neonatal Hypotonia causes ?
- Sepsis
- Werdnig-Hoffman disease (spinal muscular atrophy type 1)
- Hypothyroidism
- Prader-Willi
- Materna drugs e.g. benzodiazepines
- Maternal myasthenia gravis
79
Headache red flags
- Immunosuppressed (HIV or drugs)
- Age under 20 and Hx of malignancy
- Hx of malignancy known to metastasis to the brain e.g. lungs
- Vomiting without other obvious cause
- Worsening headache with fever
- Thunderclap headache (sudden onset, reaches peak within 5 mins)
- New-onset neurological deficit
- New-onset cognitive dysfunction
- Change in personality
- Impaired GCS
- Recent trauma
- Headache triggered by a cough
- Orthostatic headache (changes with posture)
- Symptoms of GCA or acute narrow-angle glaucoma
- Substantial change in the characteristics of headache
80
Investigation of choice in patients with suspected TIA
- MRI brain with diffusion-weighted imaging
81
What is lateral medullary syndrome ?
- Cerebellar signs
- Contralateral sensory loss
- Ipsilateral Horner’s
- Caused by infarct of the posterior inferior cerebellar artery
82
What results from infarction of a posterior inferior cerebellar artery ?
- Lateral medullary syndrome
- Cerebellar signs
- Contralateral sensory loss
- Ipsilateral Horner’s
83
Abs for bacterial meningitis ?
- IV amoxicillin and IV cefotaxime
84
RFs for degenerative cervical myelopathy
- Smoko
- Genetics
- Occupation
85
MCC of ocular malignancy in children ?
- Retinoblastoma
86
Pathophysiology of retinoblastoma ?
- Autosomal dominant
- Caused by a loss of function of the retinoblastoma tumour suppressor gene on chromosome 13
- Around 10% of cases are hereditary
87
Features of retinoblastoma ?
- Absence of red-reflex, replaced by a white pupil (leukocoria) – MC symptom
- Strabismus (eyes not looking in same direction)
- Visual problems
88
Management of retinoblastoma ?
- Enucleation (removal of eyeball)
- External beam radiation therapy
- Chemo
- Photocoagulation
89
AB used to treated pseudomonas aeruginosa in patients with CF ?
- Ciprofloxacin
90
40. What complications are babies born with a VSD at risk of ?
- Endocarditis
- (Stroke)
91
Heart defect associated with Williams syndrome ?
- Supravalvular aortic stenosis
92
What is likely the cause of a baby born with hearing loss, low birth weight, petechial rash, microcephaly and seizures ?
- Cytomegalovirus
93
What is the treatment for transient tachypnoea of the newborn ?
- Observation and supportive care +/- oxygen
94
44. A newborn presents with gross abdominal distension. Bilous vomiting. He is diagnosed with CF and his abdominal X-ray shows distended coils of small bowel, but no fluid levels
- Meconium ileus
95
How are chest compressions administered in children
- Over the lower half of the sternum using the heel of your hand
96
46. 1st line treatment for baby suspected of having a mild-moderate cow’s milk protein intolerance
- Extensively hydrolysed formula
97
Heart Murmur Associated with TOF ?
- Ejection systolic murmur
- Hear at the left sternal border
98
What is Budesonide ?
- A low dose ICS
99
49. Name a low dose ICS ?
- Budesonide
100
50. A child has a high grade fever which resolves. Following this there is a new onset rash that starts on the trunk before spreading to the limbs. The rash is maculopapular and not itchy
- Roseola infantum
101
What is the pathophysiology behind newborn jaundice ?
- Physiological problems in the red blood cells or a cross reaction with the maternal blood e.g. rhesus haemolytic disease
102
Triad of shaken baby syndrome ?
- Retinal hemorrhages
- Subdural hematoma
- Encephalopathy
103
What is ebstein’s anomaly ?
- When lithium is used during pregnancy
- It occurs when the posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle
104
ABs for meningitis > 4 months old
- IV ceftriaxone
105
ABs for meningitis < 3 months
- IV ceftriaxone
- IV amoxicillin (to cover for listeria)
106
A murmur that is a continuous blowing noise heard below both clavicle
- Venous hum
- A benign murmur
107
What is a major complication of roseola infantum ?
- Febrile convulsions
- Due to high grade fever
- Occurs in 10-15% of cases
108
What is a complication at risk if an undescended testical is not treated ?
- Testicular torsion
109
Treatment of an pediatric intestinal malrotation with a volvulus
- Ladds procedure
110
Blood gas of a patient suffering from pyloric stenosis ?
- Elevated bicarbonate, hypochloremia and hypokalemia
- Alkalosis
111
Initial management of Hirschsprung’s disease ?
- Rectal washout/bowel irrigation
111
At what ratio of contractions for rescue breaths should chest compressions be done on a neonate ?
- 3:1
112
63. Child presents with delayed developmental milestones. On examination you notice they are drooling and are making lots of slow, writhing movements of the hands and feet. The parent tells you that this is common and that his son struggles to hold onto objects such as toys. What condition ?
- Dyskinetic cerebral palsy
113
Treatment given to all croup patients regardless of severity ?
- Single dose of oral dexamethasone (0.15mg/kg)
114
17 year old girl presents to her GP because she is concerned that she hasn’t yet started menstruating. Normal height and breast development. On exam you feel 2 masses in the groin. Her external genitalia appear normal
- Androgen insensitivity syndrome
115
Causative organisms in epiglottitis
- Haemophilus influenzae
116
When should a baby be able to sit without support with a straight back ?
- 7-8 months
117
When should a child be able to run ?
- 16 months – 2 years
118
69. When should a child be able to ride a tricycle without using pedals ?
- 3 years
119
If a newborn baby has an abnormal hearing test at birth what follow up test are they referred for ?
- Auditory brainstem response test
120
Child is slow to establish feeds but has been discharged home. During the past 7 hours the baby has begun vomiting which is large and bile stained. On examination the abdomen is soft but distended
- Intestinal malrotation
121
A 4 week old baby develops profuse projectile vomiting after feeds. He is losing wight and the vomit is described as being non-biliou
- Hypertrophy of the pyloric sphincter (pyloric stenosis)
122
MC cranial injuries following normal birth ?
- Intraventricular haemorrhage
123
What treatment is appropriate for pneumonia caused by mycoplasma ?
- Erythromycin
124
What additional prophylaxis should a pregnancy mother take if there is a PMHx of HTN ?
Low-dose aspirin from 12 weeks
125
When should levonorgestrel dose be doubled ?
- BMI > 26 or weight over 7-kg
- (3mg instead of 1.5mg)
126
At what ages would precocious puberty be classed in boys and girls ?
- Development of secondary sexual characteristics before 8 years in females and 9 years in males (more common in females)
127
78. What vaccine is offered to women between 16 and 32 weeks ?
- Pertussis and influenza vaccine
128
First line treatment for non-bullous impetigo
- Topical hydrogen peroxide 1% cream
129
How long should a child stay off school with non-bullous impetigo ?
- Until lesions have crusted over and healed or 48 hours after AB treatment
130
81. Where should pulses be check in an 8 month old infant during an A-E assessment ?
- Brachial and femoral
131
82. Red flag symptoms in paeds
- Really Sick Babies Get Antibiotics
- Recession (moderate or severe chest well recession)
- Skin turgor reduced
- Blue or mottled appearance
- Grunting
- Asleep (dose not wake if roused)
132
83. When would an infant be able to talk in short sentences ?
- 2.5-3 years
133
85. When would an infant respond to their own name ?
9-12 months
134
84. When would an infant have a vocabulary of 2-6 words ?
- 12-18 months
135
86. What is the investigation of choice for reflux nephropathy ?
- Micturating cystography
136
87. A girl presents with a 3 day history of fever, mild coryzal symptoms, rash and cervical lymphadenopathy. She has erythematous, maculopapular rash on her face and neck and start spreading down the body. They have not received any of their immunizations
- Rubella
137
88. How long should a child diagnosed with rubella be kept off school ?
- 5 days from onset of the rash
138
89. How long should someone with scarlet fever be kept of school ?
- 5 days from onset of the rash
139
89. How long should someone with scarlet fever be kept of school ?
- 24 hours after commencing antibiotics
140
90. How long should someone with hand, foot and mouth (coxsackie A16) be kept off school ?
- No exclusion
141
