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OPIC, cancer, paeds Flashcards

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1
Q

Delirium vs dementia

A

Delirium:
- reversed sleep wake cycle
- acute onset
- fluctuating consciousness
- no autonomic features

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2
Q

Screening tools for pressure ulcers

A

waterlow
braden
Northton

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3
Q

Grades for pressure ulcers

A
  1. non blanching erythema
  2. partial thickness loss of epidermis/dermis
  3. full thickness loss loss subcut
  4. into muscle/ bone
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4
Q

Type dementia if
Cognitive imp then >1yr Parkinsonism

A

> 1yr = Lewy body

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5
Q

Features of Lewy body dementia

A

progressive cognitive impairment but day to day fluctuations
parkinsons symptoms after a year
visual hallucinations

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6
Q

First line meds for dementia + MAO
Second line

A

1st line: acetylcholinesterase inhibitors: rivastigmine, donepezil (not if bradycardia), galantamine
2nd line: NMDA antagonist: memantine

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7
Q

Where in brain does Alzheimers affect

A

Hippocampus which is in temporal lobe responsible for memory, learning and emotion

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8
Q

Do you routinely offer abx for pressure ulcer

A

no unless infection signs

just wound dressing, analgesia, nutrition assessment

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9
Q

Differentials for dementia

A

delirium
hypothyroid
SOL
stroke
depression

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10
Q

Causes of dementia

A

trauma
infection
h/v impairment
metabolic abnormalities
normal pressure hydrocephalus

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11
Q

What is lying and standing bp

A

lie down for 5 mins then stand up and measure at 1 min and 3 mins

drop >20 sys or drops <90
or drop >10 diastolic with symptoms

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12
Q

Factors identifying increased risk of frailty

A

High CFS
Lots admissions
Reduced mobility
No. falls
Incontinence
Delirium

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13
Q

Ix for increased frailty

A

PRISMA7 questionnaire
Gait speed
Timed up and go test

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14
Q

Incontinence examination

A

review bowel/bladder diary
Abdo ex
PR ex + prostate
External genitalia
Urine dip + MSU
Post void bladder scan
Invasive urodynamic tests

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15
Q

Aspirin and clopidogrel mx in stroke

A

Start aspirin 300mg straight away (or 24 hours post thrombolysis) for 2 weeks
then stop after 2 weeks
then start clopidogrel 75mg lifelong

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16
Q

Features of stroke which make it different from a stroke mimic

A

stereotyped episodes
sudden
focal
symptoms fit into a vascular territory

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17
Q

What is capsular warning syndrome

A

M/S signs without cortical signs (aphasia/apraxia/agnosia)

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18
Q

What symptoms in a LACs Lacunar stroke + what blood vessel

A

Either pure sensory
Pure motor
Or ataxic gait

lenticulostriate (to basal ganglia which is in charge of motor control and refinement)

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19
Q

What symptoms in a POCs stroke + what blood vessel

A

Homonymous hemianopia with macula sparing
Cerebellar dysfunction
Bstem dysfunction (m/s deficit with cranial nerve deficit)
Bilateral m or s loss
Conjugate eye movement disorder

Either vertebral, basilar, cerebellar artery

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20
Q

what is webers syndrome

A

branch of posterior cerebral artery supplying midbrain

  • ipsilat cn3 palsy
  • contralat weakness
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21
Q

What is lateral medullary syndrome

A
  • ipsilat face pain + temp
  • contralat limb pain + temp
  • ataxia / nystagmus

from posterior inferior cerebellar artery

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22
Q

What is lateral pontine syndrome

A

same as lateral medullary
also ipsilat facial pain + deafness

anterior inferior cerebellar artery

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23
Q

Tumour marker for breast cancer

A

ca153

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24
Q

Mx for MSCC

A

Urgent mri spine within 24 hours
Dexameth 16mg stat or 8mg BD + ppi
Oncology assessment for radiotherapy or decompression surgery

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25
Antiemetics for chemo induced N+V
Metoclopramide Ondanestron
26
Most common cancer causes of bone mets
Prostate Breast Lung
27
WHO performance status
0= normal activity 1= restrict when strenuous 2= no work activities 3= symptomatic, chair >50% 4= bed bound
28
What to give if they need pain meds but CKD
oxycodone for mild impairment fentanyl or buprenorphine if egfr <10
29
Signs that a pleural effusion is malignant
Unilateral Exudative
30
Most common causes of malignant pleural effusion
Lung cancer Breast cancer Lymphoma Ovarian Mesothelioma
31
Poor prognostic factors for MSCC
rapid onset loss sphincters radiosensitive tumours
32
Causes of seizures in malignancy
Cerebral mets - inc ICP Infection Metabolic abnormalities
33
Causative organisms of neutropenic sepsis
staph epidermidis staph aures ecoli
34
Metabolic issues in TLS and mx for each
Hyperkalaemia - gluconate, insulin, dextrose Hyperuricaemia - iv rasburicase Hyperphosphataemia - pi binders rarely used Hypocalcaemia - ca gluconate if symptomatic IV fluids, frequent observations, daily weights, bloods
35
Diagnostic ix for SVCO
CT contrast thorax
36
Symptoms and signs of hypercalcaemia
Confusion, depression Constipation, N+V, thirsty Bone pain Abdo pain, renal colic Dehydrated Hyporeflexia Tongue fasciculations Abdo distension Bony tenderness
37
Causes of malignant hypercalcaemia
squamous cell lung ca acc myeloma mets breast cancer mets
38
What to rule out in malignant patient with constipation
MSCC
39
Metabolic abnormality in pyloric stenosis
hypochloraemic metabolic alkalosis
40
Gold standard ix for pyloric stenosis
Abdominal USS
41
When to vaccinate pregnant woman for whooping cough
16-32 weeks
42
How long to stay off school if whooping cough
48 hours post abx Or 21 days post onset symptoms
43
Mx of minimal change disease in child
Admit Monitor fluid status 7 days prednisolone Penicillin 5 + pneumococcal Check VZV status
44
What is in the 6in1 vaccine
Dip tetanus pertussis polio haem influ hep b
45
Gold standard ix for duchennes
genetic testing
46
Biggest complication of duchennes
dilated cardiomyopathy
47
Red traffic light signs for febrile child <5
Chest wall recession Not wakening Reduced skin tugor Mottled skin Grunting
48
Complications of GORD in infant
Recurrent chest infections Faltering growth Sandifer syndrome (dystonic neck posturing)
49
Where is hypospadias located
On distal ventral surface of penis
50
Mx for neonatal sepsis
IV benzylpenicillin + gentamicin Check CRP 18-24 hours later If CRP + cultures neg then stop abx at 36 hours
51
When to refer to hospital for bronchiolitis
rr>60 feeding 50% clinical dehydration
52
Murmur in Turners
Ejection systolic murmur - bicuspid aortic valve
53
Complications of Turners
Ovarian degenesis Hypothyroidism Coeliac Aortic dilatation + dissection Horseshoe kidney
53
Features of fetal alcohol syndrome
microcephaly short palpebral fissures hypoplastic upper lip absent philtrum reduced IQ cardiac abnormalities
54
Contraindication to CF lung transplantation
burkholderia cepacia
55
When to treat bed wetting
5 years
56
Big risk factor for surface deficient lung disease
Diabetes
57
Mx of surfactant deficient lung disease
fluids endotracheal surfactant cpap prevention: antenatal betamethasone 24-25 weeks IM + mg during labour
58
Fragile X syndrome features
big bollocks large eared autistic man Learning difficulties Low set ears Hypotonia Autism Mitral valve prolapse
59
Causative organism for threadworms
enterobius vermicularis
60
Mx for threadworms
mebendazole single dose if >6 months
61
Neck masses in children: - thyroglossal - brachial - dermoid - lymphatic malformations - haemangioma
- thyroglossal : ant triangle - anechoic uss - brachial : ant to scm, anechoic on uss - dermoid: midline, supra hyoid, heterogenous + multiloculated - lymphatic malformations: cystic hygroma is from occlusion of lymphatic channels - hypoehoic on uss + transilluminates - haemangioma : grows rapidly
62
Features of roseola infantum
human herpes 6 fever then rose pink papule rash days later school exclusion not needed can cause convulsions, gbs, thrombocytopenia, myocarditis
63
<3 months old + fever
urgent referral to paeds!!
64
Murmur in TOF
Ejection systolic murmur left sternal edge (pulmonary stenosis)
65
What to screen for in Kawasaki disease
ECHO due to coronary artery aneurysms
66
Newborn hearing tests
Otoacoustic emission test If abnormal then auditory brainstem response test
67
Features of vesicoureteric reflux
recurrent utis raised creatinine
68
Cephalohaematoma vs caput succedaneum
Cepahlo: doesn't cross suture lines, takes months to resolve Caput: crosses suture lines, resolves in days
69
How to tell difference between androgen insensitivity and CAH
CAH diagnosed early with ambiguous genitalia Androgen insensitivity key symptom is primary amenorrhoea + undescended testes
70
Staging for HIE
sarnat staging: mild: poor feeding, hyperalert mod: lethargic, hypotonic, seizures Sev: flaccid, reduced reflexes
71
Big risk factor for pneumothorax in neonate
mechanical ventilation
72
Complication of jaundice in neonate
kernicterus
73
Gold standard ix + finding for intussusception
Abdo uss - target sign
74
Risk factors for dehydration
<1 >5 d in 24 hours or >2 vomits lbw malnutrition stopped b feeding
75
Signs of dehydration shock in kids
tachyc/pnoea dec consciousness mottled skin inc crt weak pulse hypotensive
76
Gold standard diagnostic ix for biliary atresia
percutaneous cholangiography
77
1st line vs definitive mx for hirschprungs
1st line: colon irrigation definitive: surgical resection
78
What is kocher criteria
For septic arthritis in children WCC>12 CRP>20 / ESR >40 Temp 38.5 Can't weight bear
79
Ix for dysplasia of hip + when to screen
if <4.5 months uss if >4.5 months xray Screen 6 week uss: 1st degree fx breech after 36 weeks multiple preg
80
Xray findings for JIA
soft tissue swelling joint effusion osteopenia
81
Symptoms of HSP
Abdo pain Hematuria/proteinuria Oligoarthritis Purpuric rash lower limbs Low grade fever
82
What is not in the PEWS chart
bp temp
83
Causative organisms of epiglottitis
haem influ b strep progenies strep pneumoniae
84
Features of Edwards syndrome
trisomy 18 micrognathia rocker bottom feet
85
Mx for undescended testes
if unilat refer around 3 months (before 6 months) if bilat refer within 24 hours
86
When to return to school after scarlet fever
24 hours post abx
87
Mx if UTI + <3 months old
urgent paeds referral
88
When to refer child for USS urinary tract
<6 months 6 months ->3 years +: 1. sepsis 2. abx not working 3. non secoli 4. abdo mass 5. creatinine inc recurrent: >3 lower, 2 lower + 1 upper, 1 upper + 1 lower
89
Rash for rubella
pink maculopapular rash on face then spreads to body suboccipital + post-auricular lymphadenopathy
90
Features of congenital hypothyroidism
prolonged jaundice delayed milestones macroglossia short hypotonia
91
Features of rickets
dental problems craniotabes (soft skull) rachitic rosary bowing legs in infant + knock knees in child On xray penia/cupping/fraying/metaphyseal widening
92
Most common cause of headache in child
migraine without aura
93
Adrenaline doses in child
>12: 500 6-12: 300 <6years: 150
94
Mx of asthma in child
ICS + SABA low dose MART + Saba mod dose MART + saba Referral
95
Features that suggest bacterial vs viral LRTI
Bacterial: >2 years High temp 38.5 Pain More acute onset less wheeze/rhinorrhoea
96
When to admit for croup
mod-sev <3 months known upper airway abnormality uncertain about diagnosis
97
What is in Westley croup score
stridor recession air entry cyanosis conscious If >6 severe
98
Features of meckels diverticulum
Painless rectal bleed Intestinal obstruction technetium scan if stable, if not mesenteric angiography
99
Omaphalocoele (exophalocoele) vs gastroschisis
omaphalocoele: still in sac, associated with downs. Needs c section + staged repair gastroschisis: ant wall defect where vag delivery and then repair asap ALP rises in abdo wall defects!!
100
Features of patau
13 fingers trisomy 13 small eyes cleft lip polydactyly
101
Features of Williams syndrome
friendly little boy who eats starbursts short learning difficulties friendly starbursts in eyes aortic stenosis
102
Mx for DDOH
pavlik harness if <6 months old If thats failed or >6 months old thenspica cast in flexion + abduction
103
Diagnostic ix for whooping cough
per nasal swab
104
Triad of shaken baby syndrome
retinal haemorrhages subdural haematoma encephalopathy
105
Glomerular haematuria vs non glomerular haematuria
Glomerular: - dark red - painless - oliguria/htn - small dysplastic abcs + red cell casts with blebs + spikes Non: - fresh - painful - monomorphic rbc
106
ASD features
ejection systolic murmur fixed splitting of s2 big stroke risk
107
VSD features
pan systolic murmur louder in smaller defects
108
Murmur in TOF
pan systolic murmur left sternal edge (pulmonary stenosis)
109
Features of TOGA
rv heave loud s2 weak femoral pulses
110
Limp <3 years old
urgent specialist assessment
111
Features of benign rolandic epilepsy
seizures at night eeg centrotemporal spikes great prognosis
112
Most common complication of measles vs most common cause of death
otitis media - most common pneumonia - death
113
Ages for precocious puberty
9 males 8 females
114
live vaccines
BCG MMR oral polio yellow fever oral typhoid
115
Immediate TIA mx
if <7 days 300mg aspirin + 300mg clodiogrel + review within 24 hours then 21 days of 75mg clopidogrel + 21 days aspirin 75mg then 75mg lifelong clopidogrel
116
Complication of stroke
haemorrhagic, cerebral oedema, seizures, bowel/bladder dysfunction, aspiration pneumonia, spasticity, immobility/ulcers, cognitive impairment
117
When to refer for bowel cancer
+ FIT Occult bleeding Rectal mass
118
Artery supply of GI
Coeliac trunk t12 - splenic, common hepatic, left hepatic SMA - right colic, ileocaecal, middle colic IMA - left colic, rectosigmoid, superior rectal
119
Types of thyroid cancer
papillary - most common, lymph node spread follicular - haematogenous spread medullary - MEN2, calcitonin secreting hence hypocalcemia anaplastic
120
Mx malignant ascites
low fluid, salt low drain perito venous shunt if recurrent
121
Mx malignant bowel obstruction
stent hyoscine hydrobromide steroids
122
SVCO mx
sit up oxygen secure airway stent morphine dexamethasone
123
Symptoms of TLS
n+v diarrhoea muscle cramps AKI arrythmias
124
Symptoms MSCC
back pain (earliest symptom) lower limb weaness sensory loss umn signs incontinence
125
Palliative hiccups
chlorpromazine or haloperidol
126
Chemo man
127
Mucositis mx
Benzydamine hydrochloride mouthwash
128
continuing disability post stroke
barthel

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