AKP Flashcards
(122 cards)
1
Q
Reed Sternberg cells / large lymphocytes with bilobed nuclei / owl like cells
A
Hodgkin’s lymphoma
can get with NHL but less common
Hodgkin’s more common in teenagers, NHL more in elderly
2
Q
spirometry - restrictive lung disease pattern?
A
low FEV1/FVC ratio (<0.7)
high residual lung capacity
3
Q
side effects of sodium valproate / valproate toxicity
A
abnormal behaviour
hepatotoxicity (deranged LFTs)
thrombocytopenia
weight gain
4
Q
calculate insulin sensitivity factor?
A
100/TDD = 1 unit of rapid acting insulin with lower blood glucose by this amount
e.g 100 / 50 units TDD = 1 unit will drop BM by 2
target BM of 7 in a week T1DM
5
Q
fixed split S2 and harsh holosystolic murmur
A
AVSD
6
Q
soft systolic murmur and cyanosed
A
HLHS
absent/non functioning mitral valve, aortic valve
may or may not have soft systolic murmur
7
Q
cyanotic heart disease
A
(HLHS)
TOF
TGA
tricuspid atresia
truncus arteriorsus
total anomalous pulmonary venous return
8
Q
defects in TOF
A
large VSD
subpulmonary stenosis leading to RVOT obstruction
overriding aorta
RVH
9
Q
EEG findings in subacute sclerosis panencephalitis
A
paroxysms of irregular, sharp and slow wave complexes on top of normal EEG
10
Q
8 week imms?
A
6 in 1
Men B
rotavirus
11
Q
12 week imms
A
6 in 1
pneumococcal
rotavirus
12
Q
which imms are live attenuated
A
rotavirus
MMR
nasal flu
BCG
13
Q
which imms are whole inactivated vaccines?
A
polio - in IPV and 6 in 1
14
Q
which imms are recombinant vaccines?
A
hep B incl 6 in 1
HPV
Men B
15
Q
which imms are conjugate vaccines?
A
PCV 13 / prevenar
Hib
Men ACWY
Men C
16
Q
which imms are toxoid vaccines
A
diptheria
tetanus
pertussis
17
Q
what is in the 6 in 1
A
hep B
HiB
diptheria
tetanus
pertussis
polio
18
Q
16 week imms
A
6 in 1
Men B
19
Q
1 year imms
A
6 in 1
MMR
men B
Pneumococcal
20
Q
pre school imms
A
MMR
“4 in 1” D TaP P (diphtheria, tetanus, pertussis, polio)
21
Q
asthma FeNO cut off?
A
> 35 ppb
used in 5-16 years
22
Q
asthma spirometry
Incl reversibility
A
obstructive pattern
(FEV1/FVC <0.7)
reversibility - increase in FEV1 by >12% (OR if takes it to >10% of predicted)
23
Q
asthma diagnosis by PEFR?
A
only if can’t do FeNO or spirometry
diurnal variation of >20% over 2 week period
24
Q
TB medication side effects
A
rifampicin - orange body fluids
isoniazid - peripheral neuropathy
Pyridazinamide - hepatotoxicity
ethambutol - optic neuritis
25
side effects of danorubicin
cardiotoxicity
red urine
26
chemo side effects - red urine and cardiotoxicity
doxorubicin
27
side effects of bleomycin
pulmonary toxicity / ILD long term
short term nausea and bleomycin
28
side effects of cisplatin
significant vomiting
permanent nephrotoxicity
hearing loss - high tone
29
side effects of etoposide
can cause myelosuppression
typically nausea/vomiting, hair loss
30
side effects methotrexate
bone marrow suppression (easy bruising!), mucositis, hepatotoxicity
31
classic VSD murmur
pansystolic/holosystolic murmur lower left sternal edge
32
PDA murmur
continuous machine like murmur
may get wide pulse pressure
33
side effects of vincristine
constipation
peripheral neuropathy
34
hand foot and mouth viruses?
coxsackie 16
enterovirus 71
35
MSUD
encephalopathy
raised ketones, rest bloods OK
raised leucine, isoleucine, valine
36
OTC deficiency
urea cycle defect
massive hyperammonaemia
may present with respiratory alkalosis initially with only mild hyperammonaemia
37
organic acidaemia
metabolic acidosis with raised anion gap and ketosis
MMA, propionic academia, isovaleric acidaemia
38
how to calculate anion gap?
(sodium + potassium) - (chloride + bicarb)
should be 8-12
39
free fatty acid oxidation defects?
non ketotic hypoglycaemia
(ketones are produced as part of FFA metabolism in the liver)
may see mildly raised ammonia
40
immune deficiency presenting with recurrent abscesses and sinopulmonary infection
two differentials and tests to tell apart
hyper IgE syndrome (Job syndrome) - eosinophilia, very high IgE levels
CGD - nitrazolam blue test
41
management of SVT
shocked - 1 J/kg synchronised shock, increasing up to 2J/kg
non-shocked - ice/vagal manouvres
adenosine 100 micrograms/kg, escalating up to 300 micrograms/kg if needed
42
how to differentiate central vs peripheral causes of neonatal hypotonia
central = floppy but strong
e.g. trisomy 21, Prader-Willi, Zellweger syndrome (+seizures)
or HIE, structural anomalies
peripheral = floppy but weak
43
infant presents with central hypotonia + seizures
Zellweger syndrome
44
hypotonic infant, weak, tongue fasciculations, normal facial expressions, absent deep tendon reflexes
SMA
45
peripherally hypotonic infant - facial weakness, ptosis
congenital myasthenia gravis
46
peripherally hypotonic infant, small triangular mouth, poor swallow/polyhydramnios, generalised weakness including both face and peripheral e.g respiratory
clubbed feet
cataracts
congenital myotonic dystrophy
47
which factor is deficient in haemophilia A
VIII
48
which factor is deficient in haemophilia B
IX
49
which part of the brain does HSV encephalitis typically affect
temporal lobes!
infero-medial part
50
congenital rubella syndrome
PDA or pulmonary stenosis
SNHL
cataracts
thrombocytopenic purpura
51
ejection systolic murmur upper left sternal edge
radiating to back
pulmonary stenosis
52
sensitivity
how good is the test at finding people with disease
true positives / true positives + false negatives i.e. what % of people with the disease, tested positive
53
specificity
how good is the test at ruling out a disease
true negatives / number of people without disease (true negatives + false positives)
what % of people without the disease have a negative test result
54
positive predictive value
if you have a positive test result, what are the chances you actually have the disease?
true positives / all positive test results
55
negative predictive value
if you have a negative test result, what are the chances you actually DON'T have the disease?
true negatives / all negative test results
56
ECG axis - if lead I is positive and lead aVF is positive?
normal
57
ECG axis - if lead I is negative and aVF is positive
RAD
58
ECG axis - if lead I is positive and aVF is negative
LAD
59
GCS eye scoring
4 spontaneous
3 to speech
2 to pain
1 none
60
GCS verbal scoring
5 oriented
4 confused
3 inappropriate words
2 cries/incomprehensible noises
1 nothing
(can modify for younger children - words gets you four, vocalising noises gets you 3, crying only is 2)
61
GCS motor scoring
6 follows commands
5 localises pain
4 withdraws from pain
3 abnormal flexion to pain (decorticate posturing)
2 abnormal extension to pain (decerebrate posturing)
1 none
62
what does decorticate posturing look like? what does it score you on GCS as a pain response
arms flexed/tucked in
legs internally rotated, feet pointing to each other
3
63
what does decerebrate posturing look like? what does it score you on GCS as a pain response
extensor posturing with wrists flexed
2
64
how might Lennox Gestaut syndrome present?
drug resistant epilepsy plus early developmental impairment
classically nocturnal tonic seizures but can also see:
atypical absences
drop attacks
myoclonic jerks
focal seizures
can use ketogenic diet, VNS, epilepsy surgery
65
side effects of carbamazepine
low WCC (leucopenia)
thrombocytopenia
liver dysfunction
cutaneous drug reactions
in toxicity - hyponatraemia
66
side effects of levetiracetam
anxiety/depression
insomnia
skin reactions
67
side effects of lamotrigine
agitation
dry mouth
sleep disorders
cutaneous drug reactions
68
side effects of phenytoin
gingival hyperplasia
hepatic disorders
megaloblastic anaemia
arrhythmias when given IV
cutaneous drug reactions
69
ethosuxamide
agranulocytosis (leading to neutropenia)
low WCC (leukopenia)
SJS
70
AED used for:
neonatal acute seizures
phenobarbitone
levetiracetam
71
AED used for:
infantile spasms
pred
vigabatrin
72
AED used for:
benign focal epilepsy of childhood
levetiracetam
sodium valproate
carbamazepine
73
AED used for:
absence epilepsy
sodium valproate
ethosuximide
(juvenile absence epilepsy in girl can also use lamotrigine)
AVOID CARBAMAZEPINE
74
AED used for:
Lennox Gestaut syndrome
sodium valproate
lamotrigine
clobazam
AVOID carbamazepine, phenobarb
often drug resistant and may try ketogenic diet, VNS, surgery
75
AED used for:
structural focal epilepsy
carbamazepine
lamotrigine
levetiracetam
76
AED used for:
juvenile absence epilepsy / juvenile myoclonic epilepsy
valproate - avoid in girls!
levetiracetam
lamotrigine
AVOID CARBAMAZEPINE
77
arrest dose for adrenaline?
10 micrograms/kg IV 1:10000 0.1mL/kg
78
when would you use a paired t-test?
normally distributed data comparing two paired groups for a difference
79
when would you use an ANOVA?
normally distributed data
comparing three or more independent groups for a difference
if related groups then you do repeated ANOVAs
80
when would you use Pearson's correlation?
normally distributed data
investigated relationship between two variables - looking for difference or relationship
81
when would you use Wilcoxon signed rank
non-parametric data
comparing two paired groups for a difference
82
when would you use Kruskal Wallis
non parametric data
comparing three or more independent groups for a difference
if three or more related groups you'd use Friedman's ANOVA
83
when would you use Spearman's rank?
non-parametric data
investigating relationship between two variables
84
when would you use logistic regression?
if you want to try and predict a value from other measured variables
85
when would you use chi-squared?
test of association used for nominal data (named categories)
86
what is the normal sequence of female pubertal development?
breast buds/bipple enlargement
progressive breast development
pubic hair onset a few months later
growth spurt early in puberty - at around stage 3 breast development
menarche comes later
typical age of onset is 8-13 years
87
what is the normal sequence of male pubertal development?
testicular enlargement to 4mls
pubic hair and penile enlargement
9-14 years
88
what is the limit age for sitting without support?
9 months
89
what is the limit age for walking?
18 months
90
what is the limit age for standing independently?
12 months
91
what is the limit age for social smile?
8 weeks
92
what is the limit age for fixing and following?
3 months
typically starts at 6 weeks
93
what murmur might you hear with an ostium secundum ASD?
ESM at ULSE
fixed split S2
94
what murmur might you hear with an AVSD?
ESM at ULSE
fixed split S2
pan systolic murmur at apex
95
what ECG changes would you expect in a secundum ASD?
RBBB
may see RAD due to RVH
96
what ECG changes would you expect in an AVSD?
"superior" axis (left axis deviation; mainly negative aVF)
due to defect where the AV node is, displacing the node and changing how electricity moves through the heart
97
what murmur would you expect in aortic stenosis?
ejection systolic maximal at URSE radiating to neck
carotid thrill
small volume, slow rising pulses
may get an apical ejection click
**can be mild or can present as critical AS with collapse**
98
what murmur would you expect in pulmonary stenosis?
ejection systolic murmur ULSE, may be a thrill
might get an ejection click in same region
ECG shows RVH
99
heart valves and auscultation points
AP TM
aortic valve = L ventricle to aorta
pulmonary valve = R ventricle to pulmonary artery
mitral valve = LA to LV (mighty mitral does the powerful side of the heart!)
tricuspid = RA to RV
100
duct dependent systemic blood flow? / obstructive CHD - will present with collapse when duct closes (as opposed to just cyanosis!)
coarctation of aorta
interrupted aortic arch
HLHS
critical aortic stenosis
(TGA)
101
duct dependent pulmonary blood flow lesions - present with severe cyanosis once duct closes
severe TOF
pulmonary atresia with intact septum
(TGA)
102
side effects of cyclophosphamide?
haemorrhagic cystitis
pneumonitis/pulmonary fibrosis
103
neonate with E coli sepsis
feed intolerance
positive urine clinitest
galactosaemia
clinitest = urine reducing substances
will also have jaundice, hepatomegaly, recurrent/persistent hypoglycaemia
104
renal tubular acidosis with nephrocalcinosis/hypercalciuria/kidney stones
distal (type 1) RTA
105
lamotrigine side effects
joint pain, rash, headache, diplopia
106
impaired glucose tolerance on OGTT?
2hr OGTT result between 7.8-11
107
what is fanconi anaemia?
autosomal recessive disorder of DNA repair
presents with pancytopaenia, short stature, cafe-au-lait spots
108
ASD murmur with LAD + incomplete RBBB on ECG
primum ASD - likely AVSD and therefore you get LAD
109
ASD murmur with RAD on ECG
secundum ASD
due to right heart overload
110
what drug given IV during labour reduces vertical HIV transmission risk
zidovudine
111
fluid of choice for resuscitation in DKA
0.9% saline
avoid Hartmann's - lactate may worsen metabolic acidosis
112
calculate fluid deficit and how long to give over
e.g. 5% dehydration for a 20kg child
% x weight x 10
e.g. 5 x 20 x 20 = 1000ml
give over 24hrs
113
who qualifies for post varicella exposure prophylaxis? what do we give?
non-immune pregnant women
immunosuppressed children
neonates in first four weeks
oral acyclovir started 7 days after exposure APART from neonates if Mum has chickenpox 7 days either side of delivery, where you start immediately. they also get VZIG.
114
Parkland burns formula?
4 x % TBSA x weight
over 24hrs, first half over 8 hrs then second half over 16hrs. don't forget maintenance!
115
Gitelman vs Barter syndrome
Gitelman's has low Mg
Barter's has hypercalciuria and normal/high Mg
both have hypokalaemia, hypochloraemia metabolic alkalosis
116
what is the definition of recurrent UTI?
3 lower
1 upper and 1 lower
2 upper UTIs
117
what is the definition of atypical UTI?
seriously ill, failure to respond within 48hrs, associated AKI
non-E coli organism
118
UTI imaging:
who needs an acute USS?
<6 months with atypical or recurrent UTI
any age atypical UTI
119
UTI imaging:
<6 month old infant with standard UTI
USS within 6 weeks
(this is the only imaging needed for a typical, first UTI!)
120
UTI imaging:
who needs an USS within 6 weeks?
< 6 months old with typical, first UTI (if atypical, or recurrent - has in acute illness)
recurrent UTI 6 months or older
121
UTI imaging:
who needs a DMSA scan? when is it done?
any under 3y with atypical UTI
any age recurrent UTI
done at 4-6 months post infection
122
UTI imaging:
who needs a MCUG?
< 6 months with atypical or recurrent UTI - looking for valves/reflux
may also do if abnormal USS in < 6 months with typical UTI
