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3A REVISION > ILAs/MISC > Flashcards

ILAs/MISC Flashcards

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1
Q

What vaccines are given at 8 weeks old? (9)

A

Diptheria/Tetanus/Pertussis/Polio/Haemophilus influeunzae type B/Hepatitis B
Pneumococcal (PCV)
Meningococcal group B
Rotavirus gastroenteritis

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2
Q

What vaccines are given at 12 weeks old? (7)

A

Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B

Rotavirus

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3
Q

What vaccines are given at 16 weeks old? (8)

A

Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B
Pneumococcal (PCV)
Meningococcal group B

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4
Q

What vaccines are given at 1 year old? (7)

A

Hib/Meningococcal group C
Pneumococcal (PCV)
Measles, mumps, rubella (MMR)
Meningococcal type B

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5
Q

What vaccines are given at 3 years 4 months? (5)

A

Diptheria, tetanus, pertussis and polio

MMR

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6
Q

What vaccine is given to girls age 12/13?

A

Human papillomavirus (HPV)

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7
Q

What is given at 14 years? (7)

A

Tetanus, diptheria, polio

Meningococcal A C W Y

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8
Q

Other vaccines that may be given? (3)

A

Paediatric flu vaccine
Tuberculosis if high risk - at birth
Additional pneumococcal/flu/hepatitis vaccines for those with conditions such as diabetes, CKD, haemophilia, immunosuppression, sickle cell

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9
Q

What are developmental milestones? What are the 4 groups?

A 
Acquisition of important developmental skills
Gross motor
Vision and fine motor
Hearing, speech, language
Social, emotional, behavioural
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10
Q

What is the moro reflex?

A

Sudden extension of the head causes symmetrical extension then flexion of the arms

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11
Q

What is the grasp reflex?

A

Flexion of fingers when object placed in palm

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12
Q

What is the rooting reflex?

A

Head turns to the stimulus when touched near the mouth

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13
Q

What is the stepping reflex?

A

Stepping movements when held vertically and dorsum of feet touch a surface

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14
Q

What should a newborn development be?

A

Limbs flexed, symmetrical posture

Marked head lag on pulling up

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15
Q

Gross motor development? 4 with ages

A

Head control - 3 months
Sits unsupported - 6-8 months
Stands - 10 months
Walks - 12 months (worrying if not by 18)

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16
Q

Fine motor/vision development? 4 with ages

A

Fixes and follows - 6 weeks
Reaching - 4 months
Transferring - 7 months
Pincer grip - 10 months

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17
Q

Hearing/speech/language development? 3 with ages

A

Vocalises alone - 3-4 months
Mama/dada - 6-9 months
3 word sentences - 2 years

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18
Q

Social/behaviour development? 4 with ages

A

Smiles - 6 weeks
Food in mouth - 6-8 months
Feeds self - 18 months
Interactive play - 3 years

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19
Q

When should a child be able to make a tower of 3-4 bricks?

A

18 months

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20
Q

When should a child be able to make a tower of 6-8 bricks?

A

2/2.5 years

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21
Q

When should a child be able to build a brick bridge?

A

3-3.5 years

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22
Q

When should a child be able to draw a line, circle, square?

A

Line - 2-2.5
Circle - 3-3.5
Square - 4-5

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23
Q

What 6 things are included in a septic screen?

A 
Bloods  (FBC, CRP/ESR, U+E, blood gas)
Blood cultures
Urine dipstick and MC+S
Stool sample
Chest X ray 
Lumbar puncture (protein, glucose, MC+S, gram stain)
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24
Q

What is seen on lumbar puncture in bacterial infection vs viral?

A

Bacterial - elevated opening pressure, turbid CSF, high WCC, positive gram stain, high protein, low glucose
Viral - normal opening pressure, clear fluid, low WCC, negative gram stain, normal/high protein, normal/low glucose

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25
What does a septic screen screen for?
Severe infection and systemic inflammation
26
Dose of cefotaxime for meningococcal septicaemia?
2g IV
27
Diagnosis of Kawasaki disease?
``` Fever + 4/5 of My HEART Mucosal involvement - lips, mouth Hand/foot redness, swelling, peelin Eye conjunctivitis Adenopathy (lymph) Red rash Temperature >5 days ```
28
What is Reye's syndrome?
Can be caused by aspirin in kids | Brain and liver disease - vomiting, fits, tiredness, confusion
29
Side effects of IV immunoglobulin?
rare - anaphylaxis | headache, nausea, wheezing/chest tightness
30
Complications of Kawasaki disease?
CV disease - aneurysm, heart disease, MI
31
How to work out maintenance fluid dose?
4ml per kilo first 10kg 2ml per kilo second 10kg 1ml per kilo after that 27kg would be 40 + 20 + 7 = 67ml hourly 67 x 24 = 1608ml daily 0.9% sodium chloride
32
How to correct fluid deficit for dehydration?
Dehydrated - 50mls/kg extra Shocked - 100mls/kg extra OVER 24 HOURS
33
Fluids for a 12kg girl 5% dehydrated?
Maintenance 44ml hourly x24 = 1056ml daily Dehydrated = 50ml/kg extra over 24 hours 50 x 12 = 600 1056 + 600 = 1656ml
34
Signs of dehydration in children? (6)
``` Appears unwell Irritable Decreased urine output Sunken eyes Dry mucous membranes Reduced skin turgor Slightly prolonged cap refill time ```
35
Signs of shock? (8)
``` Decreased level of consciousness Pale/mottled skin Cold extremities Prolonged capillary refill time Hypotension Tachycardia Tachypnoea ```
36
What is usual fluid bolus given in dehydration? Exceptions?
20mls/kg 0.9% sodium chloride If trauma or diabetic ketoacidosis give 10mls/kg
37
What 9 conditions are in the newborn blood spot screening test?
``` sickle cell disease (SCD) cystic fibrosis (CF) congenital hypothyroidism (CHT) phenylketonuria (PKU) medium-chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria (pyridoxine unresponsive) (HCU) ```
38
Dose of thyroxine for congenital hypothyroidism?
10-15mcg a day per kg
39
Differentials of a sick neonate?
``` Trauma, tumour, thermal Heart disease, hypovolaemia, hypoxia Endocrine - CAH, DM, thyroid Metabolic disturbance - electrolytes Inborn errors of metabolism Seizures of CNS metabolism Formula dilution or over concentration leading to hypo/hypernatraemia Intestinal catastrophe (NEC, volvulus, intussusception) Toxins Sepsis ```
40
Can congenital adrenal hyperplasia be treated antenatally?
Give dexamethasone to reduce virilisation
41
Biochemical presentation of a salt losing crisis?Management?
LOW SODIUM HIGH POTASSIUM METABOLIC ACIDOSIS Saline, dextrose, hydrocortisone IV
42
Management of CAH?
``` Hydrocortisone lifelong (glucocorticoid), additional if illness or injury Fludrocortisone (mineralocorticoid) if salt wasting ```
43
Characteristics of respiratory acidosis on ABG?
Low pH | High CO2
44
Causes of respiratory acidosis?
Respiratory depression Asthma COPD
45
Characteristics of respiratory alkalosis ABG?
High pH | Low CO2
46
Causes of respiratory alkalosis?
Hyperventilation - pain, anxiety, hypoxia
47
Characteristics of metabolic acidosis on ABG?
Low pH Low HCO3 Low base excess
48
Causes of metabolic acidosis?
Increased acid production - diabetic ketoacidosis Decreased acid excretion - addisons disease Loss of HCO3 - diarrhoea
49
Characteristics of metabolic alkalosis on ABG?
High pH High HCO3 High base excess
50
Causes of metabolic alkalosis?
Vomiting/diarrhoes | Renal loss - diuretics, heart failure
51
How are respiratory acidosis/alkalosis compensated?
Metabolically - by increasing or decreasing the levels of bicarb to correct pH
52
How are metabolic acidosis/alkalosis compensated?
Respiratory - retaining or blowing of CO2 to correct pH
53
What would respiratory acidosis with metabolic compensation look like on ABG?
Low pH High CO2 High HCO3!
54
What would respiratory alkalosis with metabolic compensation look like on ABG?
High pH Low CO2 Low HCO3!
55
What would metabolic acidosis with respiratory compensation look like on ABG?
Low pH Low HCO3 Low CO2!
56
What would metabolic alkalosis with respiratory compensation look like on ABG?
High pH High HCO3 High CO2!
57
Murmur in ASD?
EJECTION SYSTOLIC murmur UPPER LEFT sternal edge
58
Murmur in VSD?
Harsh PANSYSTOLIC murmur LOWER left sternal edge
59
Murmur in PDA?
CONTINUOUS murmur UPPER left sternal edge
60
How is RDS managed?
Surfactant through TRACHEAL TUBE Airway + breathing - clear if needed, high flow humidified oxygen/CPAP/mechanical ventilation Incubator
61
Neonatal antibiotics for suspected infection?
Benzylpenicillin and gentamicin
62
Why do preterm infants get hypoglycaemia and how is it managed?
Poor glycogen stores Prevention - early frequent milk feeding Dextrose IV given NG feeding
63
Risk of building up fluids too quickly in neonates?
NEC! reflux, aspiration
64
How is adequacy of nutrition monitored in paeds?
Input/output fluid chart | Weight
65
Where does IVH originate from in babies?
IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus.
66
How does IVH present?
``` Diminished/absent Moro reflex. Poor muscle tone. Sleepiness. Lethargy. Apnoea. Tense/bulging fontanelle Premature babies often show sudden deterioration on day two or three, with periods of apnoea, pallor or cyanosis, failure to suck properly, abnormal eye signs, shrill cry, twitching or convulsions, reduced muscle tone or paralysis ```
67
What abnormality seen on ABG in IVH?
Metabolic acidosis
68
Management of IVH?
Supportive - fluids, blooc, bicarb infusion Anticonvulsants Prevention - vitamin K at birth
69
Prognosis of IVH?
25-50% may die if severe 15% need permanent CSF shunt Motor and cognitive defects, neurodevelopmental delay
70
Cause for concern with neonatal jaundice >2 weeks?
dark urine, pale stools hepatomegaly poor weight gain
71
What is the direct coombs test?
The direct Coombs test is used to test for autoimmune hemolytic anemia—that is, a condition where the immune system breaks down red blood cells, leading to anemia The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells
72
What is the indirect coombs test?
The indirect Coombs test is used in prenatal testing of pregnant women and in testing prior to a blood transfusion. The test detects antibodies against foreign red blood cells
73
Pain relief for neonates?
Paracetamol, morphine
74
What does the NIPE test? When is it done?
Newborn infant physical examination, done within 72hrs and AGAIN at 6-8 weeks Eyes i.e. congenital cataracts Heart Hips i.e. developmental dysplasia of the hip Testes i.e. undescended
75
What are Barlows and Ortolanis tests?
Barlows - If the hip is dislocatable — that is, if the hip can be popped out of socket with this maneuver — the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated) by hearing a 'thunk' as it goes back in
76
Vascular causes of unilateral visual loss?
``` Amaurosis fugax Central retinal artery occlusion/retinal detachment GCA Optic neuritis Vitreous haemorrhag ```
77
What is optic neuritis?
Inflammation of optic nerve, may be first manifestation of MS. Reduced visual acuity over a few days, pain on moving eye Exacerbated by heat/exercise Afferent pupillary defect
78
What is Lhermitte's phenomenon?
Tingling 'electrical' sensation down spine, esp. when bending head forward
79
Differential diagnosis of blackouts?
Syncope Epilepsy Non epileptic attacks
80
What is syncope?
Syncope is an abrupt and transient loss of consciousness associated with loss of postural tone that follows a sudden fall in cerebral perfusion
81
Causes of syncope?
Neurogenic - vasovagal, reflex i.e. cough/micturition Cardiac - arrhythmias, valvular disease Orthostatic - prolonged standing, heat, dehydration
82
Why do focal onset seizures need imaging?
More likely to be a structural problem
83
What are you looking for in JME on interictal EEG?
Normal background | Frequent polyspike and wave discharges
84
3 vascular territories in stroke
Anterior cerebral artery Middle cerebral artery Posterior cerebral artery
85
4 clinical syndromes in stroke
Total anterior circulation infarct TACI Partial anterior circulation infarct PACI Lacunar stroke Posterior circulation infarct
86
Benefits of thrombolysis (alteplase) in stroke?
If within 4.5 hours of ISCHAEMIC strokes, improves chance of independence Risk of death the same
87
When is risk of stroke after TIA highest?
First 48 hours
88
Which personality disorders predispose to psychosis?
``` Paranoid PD Schizotypal PD (social deficit, magical beliefs etc) ```
89
What can borderline PDs progress to?
Bipolar
90
What can obsessive PDs progress to?
OCD
91
What is attachment theory?
Deep, enduring bond connecting one person to another across time and space Child seeks attachment figure when upset Early infant separation/neglect links to later maladjustment i.e. fear of abandonment, disproportionate overreactions to change in routine etc
92
What is a biopsychosocial formulation?
Predisposing Precipitating Prolonging Protective factors of biological, psychological and social aspect of the patient to form a diagnosis/management
93
What is asked about in psych history?
``` Presenting complaint History of PC Collateral history Past psych history Medical history Drugs and allergies Family history Social history - substance misuse, work, housing Personal history - birth, childhood and school, relationships etc Forensic history Premorbid personality ```
94
Mental state exam components?
``` Appearance and behaviour Mood and affect Speech - tone/rate/volume, circumstantiality/perserveration etc, flight of ideas Thoughts - obsessions, delusions, dissociation Perceptions - hallucinations, illusions Cognition Insight RISK ```
95
What gene is mutated in Fragile X ?
FMR1 on X chromosome
96
How to work out alcohol units?
Units = vol in litres x ABV%
97
What is the main inhibitory and excitatory neurotransmitter?
Inhibitory - GABA | Excitatory - glutamate
98
How does alcohol affect GABA/glutamate?
Enhances GABA which is inhibitory Inhibits glutamate which is excitatory - that's why withdrawal is agitated benzodiazepines have same effect so give in withdrawal
99
3 medications to help alcohol abstinence?
Disulfiram Acamprosate Naltrexone
100
MASER features for bipolar?
``` Mood Attention Self esteem Energy Risk ```
101
Causes of hyponatraemia?
``` Renal failure Diuretics Water loss Heart failure Nephrotic syndrome ```
102
Symptoms of hyponatraemia?
``` Confusion Seizures Cardiac failure Oedema Nausea D+V ```
103
Causes of hypernatraemia?
Not enough water Diuretics Diabetes insipidus
104
Symptoms of hypernatraemia?
``` Thirst Confusion Seizures Coma Signs of dehydration ```
105
Causes of hypokalaemia?
Thiazide/loop diuretics Cushings D+V Poor intake
106
Symptoms of hypokalaemia?
Muscle weakness - rhabdomyolysis Arrhythmias Constipation Paralysis, paraesthesia late
107
Causes of hyperkalaemia?
Decreased renal excretion | Potassium sparing diuretics
108
Symptoms of hyperkalaemia?
``` First nothing Weakness Paralysis Heart arrhythmias SoB, death ```
109
Causes of hypocalcaemia?
``` Para/thyroid surgery Chronic renal failure Pancreatitis Respiratory alkalosis Osteomalacia ```
110
Symptoms of hypocalcaemia?
Tetany Depression Neuromuscular excitability - - muscle twitching
111
Causes of hypercalcaemia?
Hyperparathyroidism Cancer Lithium use
112
Symptoms of hypercalcaemia?
``` Bones - pain, fractures Stones - renal stones Groans - confused Thrones - constipation Psychic moans - depression ```
113
How often is breast screening done?
Mammograms every 3 years from age 50 to 70 (trial of 47-73)
114
What is cervical screening?
Checks for cervical intraepithelial neoplasia (CIN) - precancerous dysplasia using a brush to collect cells
115
How often is cervical screening done?
aged 25 to 49 – every 3 years aged 50 to 64 – every 5 years over 65 – only women who have recently had abnormal tests
116
What does the infectious diseases programme in pregnancy screen for?
HIV Syphilis Hepatitis B
117
What is the combined test for Downs/Edwards/Patau? When is it done?
Nuchal translucency at dating scan Serum b-HCG Pregnancy associated plasma protein A (PAPP-A) Between 11-13+6 weeks
118
What is quadruple maternal serum screening for Downs? When is it done?
hCG alpha fetoprotein uE3 inhibin A 14-20 weeks
119
How is screening for Edwards/Patau done if over 14 weeks?
Mid pregnancy anomaly scan 18-20+6 weeks
120
What condition does the mid pregnancy scan look for? (11)
``` anencephaly open spina bifida cleft lip diaphragmatic hernia gastrochisis exomphalos serious cardiac abnormalities bilateral renal agenesis lethal skeletal dysplasia Edwards' syndrome, or T18 Patau's syndrome, or T13 ```
121
How gets tested for gestational diabetes?
Any woman with 1 or more risk factors - BMI above 30, previous baby over 4.5kg, prev gestational diabetes, parent/sibling with diabetes, south asian
122
When is OGTT done?
women who've previously had gestational diabetes: oral glucose tolerance test (OGTT) should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal. women with any of the other risk factors should be offered an OGTT at 24-28 weeks
123
When is booking visit? What is done?
8-12 weeks General info about lifestyle, BMI Bloods - HIV, syphilis, hep B, haemoglobinopathies, rhesus status, anaemia, red cell antibodies urine dipstick
124
When is first dating scan?
10-13+6
125
When is anti-D given for rhesus negative women?
First - 28 weeks Second - 34 weeks Whenever sensitisation i.e. bleeding, amniocentesis
126
Describe the HPG axis
Hypothalamus produces gonadotrophin releasing hormone Anterior pituitary releases follicle stimulating and luteinising hormones Ovary releases oestrogen
127
What part of the embryo is the urogenital system from?
Intermediate mesoderm Genital system develops from gonadal ridges from primordial germ cells
128
What is the SRY gene?
SRY gene induces testes development, lack of results in ovaries
129
What is the Mullerian duct?
Develops into uterus, fallopian tubes and upper vagina Wolffian duct regresses
130
Investigations of amenorrhoea?
Hormone tests - bhcG, FSH, LH, prolactin, thyroid, testosterone Chomosome analysis US pelvis CT/MRI head
131
Treatment of amenorrhoea?
Surgery if treatable congenital anomaly Weight loss/stop exercising as much/less stress Gonadal dysgenesis/pof - HRT PCOS - treat i.e. with the pill High prolactin - dopamine agonists Cervical stenosis/Ashermans - surgery to remove adhesions
132
Causes of acute pelvic pain?
``` Menstruation/ovulation Sex PID UTI Miscarriage/ectopic Torsion/cyst rupture Premature labour/placental abruption/uterine rupture Fibroids, pelvic tumour Appendicitis, IBS ```
133
Assessment of pelvic pain?
Acute - urinalysis, MSU, high vaginal and endocervical swabs, pregnancy test, USS if suspected ectopic Chronic - STI screen, Ca125, urinalysis, transvaginal USS, laparoscopy
134
Management of pelvic pain? (3)
Pain relief COCP/GnRH agonist if cyclical Diagnostic laparoscopy
135
Favourable position for normal vaginal delivery?
Occipito-anterior
136
Normal head position at engagement?
Occipito-transverse
137
Lie with increased risk of cord prolapse?
Footling breech
138
Symptoms of primary and secondary post partum haemorrhage?
Primary - blood loss, collapse, enlarged uterus, trauma | Secondary - blood loss, enlarged uterus, tender, open internal os
139
What are the 4 T's of post partum haemorrhage?
Tone Trauma Tissue Thrombus
140
Definition of low birth weight?
2.499kg or less | Less than 10th centile
141
Define IUGR
Fetuses failing to reach their OWN growth potential (not just constitutionally small as in sfd, may not even be small) May be related to placental dysfunction
142
What is fetal macrosomia? Causes?
Baby over 4kg at birth | Caused by maternal diabetes, prolonged pregnancy, excessive weight gain
143
Risks of macrosomic babies?
``` Shoulder dystocia Obstructed labour Instrumental/c section PPH Hypoglycaemia - RDS (breastfeed) ```
144
Risks of IUGR babies?
``` Stillbirth Cerebral palsy Preterm delivery Convulsions Meconium aspiration ```
145
Why should you not give ACEi with NSAIDs?
High risk of renal failure
146
community support for heart failure?
``` GP and specialist centres community nurses, home visits Social care palliative care rehabilitation patient groups pharmacy deliveries ```
147
What is Qrisk score?
Score for predicting cardiovascular risk - risk of a person developing CVD over next 10 years for people between 35 and 74
148
At risk groups to miss vaccinations?
``` Looked after children Children with physical/learning difficulties Children of single or teenage parents Not registered with GP In hospital Travellers, asylum seekers ```
149
Signs of respiratory distress in children?
``` Nasal flaring Accessory muscles use Stridor, wheeze Tracheal tug Chest recession ```
150
Red light NICE indicators for a sick child?
``` Pale/mottled/blue No response, appears ill High pitched cry Grunting Tachypnoea >60 Chest recession Reduced skin turgor Bulging fontanelle Non blanching rash Stiff neck Seizures AGE 3 MONTHS TEMP >39 FEVER >5 days ```
151
What 3 things are needed for consent?
Voluntarily By an individual with capacity Fully informed
152
When can confidentiality be breached?
With consent If clinically relevant/needed Risk to patient or someone else Health risk to others - DVLA
153
What are the Fraser guidelines regarding contraception under 16? UPSSI
Understanding of advice Parents will not be informed despite asking Sex will continue either way Suffering mentally/physically if no treatment given In her best interest
154
Tools for dementia screening in primary care?
Mini mental state examination GP-COG 6-CIT
155
Depression screening tool?
PHQ-9
156
Risk factors for TB?
``` HIV/immunosuppression Diabetes Malnutrition Smoking Alcohol Overcrowding Low socioeconomic status ```
157
Prevention of TB?
``` BCH vaccine for high risk newborns Symptom education Medication education Contact tracing Limit overcrowding ```
158
Symptoms of TB?
``` Weight loss Fever Night sweats Fatigue Cough - phlegm/blood Breathlessness If disseminated - abdo pain, bone pain, headache ```
159
Causative agent in TB?
Mycobacterium tuberculosis
160
Treatment of TB?
Isioniazid Rifampicin Pyrazinamide Ethambutol

3A REVISION (17 decks)

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