18/4

Question 1

What is a dermatological side effect of warfarin?

Answer 1

Skin necrosis - normal INR

Question 2

HSP

Question 3

What antibiotic is given first in endocarditis before you know the cause?

How does this change if pen allergic or prosthetic valve?

Answer 3

Amoxicillin

If pen allergic - vancomycin + gent

If prosthetic valve - vanc + gent + rifampicin

Question 4

Woman has RUQ pain on a BG of STI - what is likely to be going on?

Answer 4

Fitz-Hugh-Curtis = F-H-C = Female Hepatic Capsulitis

Complication of PID

Question 5

If SAH is suspected but CT is normal what should be done to ultimately exclude?

Answer 5

Lumbar puncture

Question 6

What is N-acetylcysteine used for besides paracetamol overdose?

Answer 6

Mucolytic agent - dissolves mucus so it may be coughed up

Question 7

Explain volvulus
What is the invx

What procedure is done to correct it?

Answer 7

Complete twisting of loop of intestine around mesenteric attachment site - can lead to ischaemia and shock

USS

Ladd’s procedure

Think Ladds in a Volvo

Question 8

What condition is meconium ileus associated with?

What is used to try and get child to pass the meconium?

Answer 8

CF

PR contrast and N-acetylsine - if doesn’t work -> surgery to remove meconium plugs

Question 9

NEC is a life-threatening emergency in neonates. What causes it?

Invx - what signs are typical

How is it managed?

Answer 9

Unknown cause just more likely in neonates and those who are formula fed

AXR - rigler’s sign (air in and outside the bowel) and pneumatosis intestinalis (air in the lumen wall)

Drip and suck
Abx and parenteral feeding
refer to neonatal surgery -> sometimes need surgery if perforated and systemically v unwell

Question 10

Pyloric stenosis occurs due to hypertrophy of the pyloric sphincter.

It results in … vomiting?
What might be felt on examination?

What in the invx?
What ABG would you expect?

How is it managed?

Answer 10

Projectile
Mass in the upper abdo - from hypertrophy

abdo USS
HYPOchloric metabolic alkalosis

Laproscopic pyloromyotomy AKA Ramstedt’s operation

Ram through the pylorus

Question 11

How long can a febrile convulsion go on for before parents should contact an ambulance?

Answer 11

5 mins

Question 12

When should pts with febrile convulsions be admitted to paeds

Answer 12

1st seizure OR complex

Complex
= focal nature
OR
= repeats in <24hrs
OR
= >15 min length

Question 13

Pt develops meningococcal meningitis - what should those that have been in contact with pt in the last 7 days be started on?

Answer 13

Oral ciprofloxacin prophylaxis

Question 14

Who should get listeria cover in suspected meningitis?

Answer 14

<3mth + >50yrs

Question 15

What is an ‘unrecordable’ blood sugar indicative of - high or low?

Answer 15

High

Question 16

Biliary atresia occurs when the biliary system is either narrowed or absent.

What differentiates this from other types of jaundice in the newborn?

How is it managaed?

Answer 16

V high proportion of conjugated bilirubin (conjugating in the liver but not being able to flow out)

Surgical intervention is the only management

Question 17

How is T1DM diagnosed?

Answer 17

Fasting or random glucose

As HbA1c may not show the recent rapid rise in glucose levels

Question 18

What sign can indicate perforated ear drum in children?

Answer 18

Yellow discharge

Question 19

How can ear tugging help decide if it is otitis media or externa in children?

Answer 19

Ear tugging relieves pain in OM and exacerbates in OE

Question 20

What virus causes roseola infantum (presents v similarly to measles but w/o Koplik spots in question stem)

• maculopapular rash on trunk and spreading to limbs

Answer 20

Herpes virus 6

Question 21

Make a performance status thing to stick in on the wall

Question 22

What diet