Notes from Pad 1st two rotations 2

Question 1

Most common age for breast cancer?

Answer 1

Late 40s - early 50s

Question 2

Ages and frequencies for cervical screening

Answer 2

25-49 every 3 years = smear

50-64 = smear every 5 years

Question 3

Two presenting features of cervical cancer

Answer 3

Post-coital bleeding - from contact with cervix

Abdominal distention - spread of cancer to abdomen

Question 4

Risk factors for cervical cancer x5

Answer 4

HPV
Immunosuppression 
Long term pill use 
Multiple sexual partners 
Early age 1st intercourse
(Last 3 because increased risk of STI which increases risk of cervical cancer)

Question 5

Details of stage 1 cervical cancer

Answer 5

Cervix only affected

Question 6

Details of stage 2 cervical cancer

Answer 6

Cancer expands beyond cervix but not on lateral pelvic wall

Question 7

Details of stage 3 cervical cancer

Answer 7

Cancer extends onto pelvic side wall

Question 8

Details of stage 4 cervical cancer

Answer 8

Spread onto bladder and/or rectal mucosa (4a) or spread to distant organs (4b)

Question 9

Treatment of different stages of cervical cancer

Answer 9

Stage 1 and 2 - surgery

Stage 3 and 4 - chemotherapy

Question 10

What is Mittelschmerz

Answer 10

Lower one-sided abdominal pain on ovulation

Question 11

Eczema synonym

Answer 11

Dermatitis

Question 12

What is oppositional defiant disorder

Answer 12

Not as severe as conduct disorder, usually used for younger children - effectively difficult behaviour which affects functioning

Question 13

What is eczema commonly complicated by?

Answer 13

Staphylococcal infection

Question 14

Where does discoid eczema commonly affect?

Answer 14

Mostly lower legs but can go to arms and all over

Question 15

Hormonal level differences in conduct disorder x2

Answer 15

Have lower cortisol levels therefore less scared when doing these behaviours
Also increased testosterone levels

Question 16

Incidence of depression in young children

Answer 16

Very unlikely

Question 17

In which children is depression usually diagnosed x2

Answer 17

Either very strong family history affective disorder or childhood abuse

Question 18

Behavioural changes in depression in teenagers

Answer 18

Tend to overeat and over sleep rather than normal decrease in these activities

Question 19

When must autism symptoms be present

Answer 19

Throughout life and in all situations

Question 20

What is McCune-Albright Syndrome - 3 features

Answer 20

Genetic syndrome with at least 2 of 3 of polyostotic fibrous dysplasia (advanced bone age), cafe au lait skin pigmentation, autonomous endocrine hyperfunction (gonadotrophin independent precocious puberty)

Question 21

What is pubarche?

Answer 21

Development of pubic hair, axillary hair and body odour

Question 22

What is thelarche

Answer 22

Development of breasts - with/without bleeding

Question 23

Definition of premature sexual maturation according to pubarche

Answer 23

Before 9 years old

Question 24

Definition of PSM according to thelarche

Answer 24

Before 8 years old

Question 25

What hormones cause pubarche and thelarche?

Answer 25

Androgens cause pubarche and oestrogens cause thelarche

Question 26

Androgenic causes of PSM x3

Answer 26

Early physiological adrenarche (common) Congenital adrenal hyperplasia (rare) Tumours (v.rare)

Question 27

Oestrogenic causes of PSM/thelarche x3

Answer 27

Normal variant of oestrogen activity (common) True precocious puberty Tumour (v.rare)

Question 28

PSM according to puberty age

Answer 28

Before age 8 in girls or 9 in boys

Question 29

Ethnic variation in puberty timing

Answer 29

US Black younger than US white which is younger than UK white

Question 30

Signs of male puberty

Answer 30

Penis/testes/scrotum growth | Pubic and axillary hair and body odour

Question 31

Signs of female puberty

Answer 31

Breast development, PV bleed | Pubic and axillary hair and body odour

Question 32

Risk with precocious pathological puberty

Answer 32

Early fast growth can limit final height - not if physiological

Question 33

Investigation of PSM - urine x2

Answer 33

Urinary steroid profile done in everyone - to exclude steroid synthesis disorder 24hr USP - for tumour vs adrenarche (if seriously suspect tumour)

Question 34

Other investigations in PSM

Answer 34

Serum androgens - to characterise severity post diagnosis

Question 35

What does 21-hydroxylase deficiency cause?

Answer 35

Intersex disorder | Virilized female

Question 36

What is elevated in 21-hydroxylase deficiency

Answer 36

CAH, elevated ACTH

Question 37

TTT of 21-hydroxylase deficiency

Answer 37

Replace cortisol and mineralocorticoid

Question 38

True precocious puberty gender incidence

Answer 38

F>>M | 5-10:1

Question 39

Cause of gender incidence of precocious puberty

Answer 39

Constitutional is more common in women and pathological is more common in males

Question 40

Two types of pathological precocious puberty

Answer 40

Gonadotrophin-dependant (central eg. tumour) or gonadotrophin independent (peripheral eg. autonomous gonads)

Question 41

What does hypothalamic hamartoma cause?

Answer 41

Precocious puberty - "infant hercules"

Question 42

How long do you correct for gestational age in babies born

Answer 42

At least up until 1-2 years old

Question 43

How long do you correct for gestational age in babies born

Answer 43

At least 2 years

Question 44

Definition of short stature

Question 45

Hormones which can contribute to short stature

Answer 45

Hypothyroidism GH deficiency Cortisol - cushings