PACES Flashcards
1
Q
What is associated with POI?
A
Iatrogenic - chemo/radiotherapy, gnrh analogues, surgery
Genetic - FH, choromosomal abnormalities
Auotimmune - Addison’s, T1DM, thyroid disease
Infection - TB, mumps
Idiopathic
2
Q
Fertility options for POI?
A
Normally IVF with donor eggs. Can carry pregnancy.
5-10% of women can conceive without medical assistance
3
Q
Questions to ask with amenorrhoea presentation?
A
Headaches/visual changes/galactorrhoea/changes to smell
Hot flushes/brain fog
Hirstuism/weight gain/acne
Exercise/weight/stress
Hx of autoimmune disease/chemo/radiotherapy
4
Q
Non-hormal treatments for POI?
A
Lifestyle advice, SSRIs, clonidine, CBT, antidepressants, vaginal moisturisers/lubricants
5
Q
Couple struggling to conceive - questions?
A
How long have you been trying?
How often sexual intercourse?
Any previous children?
Menstruation - oligomenorrhoea etc.
Endometriosis sx - dymenorrhoea
Visual changes/galactorrhoea
Hot flushes/brain fog
Acne/hirstuism/weight gain
Exercise/stress/diet/smoking/alcohol/occupation
Any PID/previous tubal surgery
Contraception
Vitamin supplements
6
Q
What are possible complications of assisted conception?
A
Ovarian hypersensitivity syndrome, multiple pregnancy, pelvic infection, ectopic pregnancy
7
Q
How is ovarian reserve tested?
A
Antral follicle count, AMH, FSH
8
Q
When is laproscopy and dye done?
A
History of tubal issues
9
Q
How long can you give clomifene for?
A
6 months? Monitor with USS.
10
Q
Risks of induction
A
Ovarian hyperstimulation
11
Q
Risks of prolonged pregnancy?
A
Stillbirth, increased mortality risk, meconium aspiration, prolonged labour, shoulder dystocia, IUGR, obstructed labour, perineal damage, instrumental delivery
12
Q
Why does PCOS increase risk of endometrial malignancy?
A
A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed estrogen that results from anovulation
13
Q
PCOS and endometrial cancer link?
A
A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed estrogen that results from anovulation
14
Q
Side effects of metformin
A
B12 deficiency, diarrhoea, vomitting, nausea
15
Q
Long term complications of PCOS
A
Metabolic syndrome, endometrial cancer, cardiovascular disease, diabetes, hypertension, impaired glucose tolerance.
Mechanism: Defect in insulin action - insulin resistance combined with abdominal obesity.
16
Q
DDx for chicken pox?
A
Herpes zoster, impetgo, contact dermatitis, drug eruptions, erythema multiforme
17
Q
Active third stage of labour treatment?
A
For women without risk factors for PPH delivering vaginally, oxytocin (10 iu by intramuscularinjection) is the agent of choice for prophylaxis in the third stage of labour. A higher dose of oxytocin is unlikely to be beneficial
18
Q
What can be used to manage women at risk of PPH?
A
Ergometrine–oxytocin may be used in the absence of hypertension in women at increased risk of haemorrhage as it reduces the risk of minor PPH (500–1000 ml)
19
Q
When to admit a child with febrile seizures?
A
First seizure, on antibiotics, unsure of cause, <18 months old, complex focal seizure
20
Q
What specific questionnaire can you use to assess anorexia nervosa?
A
SCOFF
21
Q
Lymphocyte invasion are indicative of what?
A
Chronic inflammation
22
Q
Erosion definition?
A
Loss of surface epithelium +/- lamina propria (muscularis intact)
23
Q
What cells are seen in Barett’s oesophagus?
A
Goblet cells (+ve goblet cells has a worst prognosis)
24
Q
Cause of oesohpagus squamous cell carcinoma?
A
Cigarette and alcohol consumption
25
Treatment of upper GI variceal bleeding
Resuscitate with blood and crystalloids
-Terlipressin
-Score
-Scope
-Infuse with PPI
26
What cells are not seen in stomach?
Goblet cells
27
Acute gastritis causes?
Alcohol consumption, NSAIDs, etc. (H. Pylori), Stress Stomach is the most sensitive organ in the GI tract to ischaemia
28
Chronic gastritis causes?
A: autoimmune (pernicious anaemia)
B: bacteria (H. Pylori)
C: corrosives (bile reflux, NSAIDs)
CMV (patients on immunosuppression) and Crohn’s
29
H. Pylori Eradication Tx
One-week triple-therapy
-PPI
-Clarithromycin
-Amoxicillin or metronidazole
30
H. pylori can cause what?
MALT (b cell lymphoma)
31
Most common gastric cancer?
Adenocarcinoma
32
Types of adenocarcinoma gastric cancer?
Diffuse and intestinal
33
Describe diffuse adenocarcinoma of the stomach
Diffuse: single-cell architecture, no gland formation, contain signet ring cell
34
what type of cell lines the stomach?
Parietal cells
35
Most common cause of duodenal ulcers?
H. Pylori
36
Complication of anterior duodenal ulcers?
Peritonitis
37
Complication of posterior duodenal ulcers?
Haemorrhage
38
What is Lymphocytic duodenitis?
Distinct from coeliac disease but usually a continuum
Increased intraepithelial lymphocytes = CD8+ T Cells
(20: 100 lymphocytes: enterocytes)
Architectural villous structure normal = normal villi, normal crypts
-Many have mild coeliac disease
39
Most common colorectal cancer?
Adenocarcinoma
40
Which polyps of the large bowel have higher risk of cancer?
Higher risk of cancer:
-Larger polyps
-More polyps
-Higher villous component
-Dysplastic features
41
Which zone of the liver is most metabolically active?
Zone 3
42
Histology of acute hepatitis?
Spotty necrosis, foci of inflammation
43
Rhodanine” stain used for what?
Wilson's disease
44
Discuss Wilson's disease
Wilsons disease
Cannot excrete copper
Genes on Chromosome 13
AR
Parkinons, 'aggressive behaviour'
45
Chromosome involved in haemachromatosis?
6
Leads to cardiomyopathy
46
Piecemeal necrosis describes what?
Interface hepatitis - chronic hepatitis
47
Signs of alcoholic hepatitis?
Ballooning of cells
Mallory Denk Bodies (pink material within cells)
Apoptosis
Pericellular fibrosis
Zone 3 – acetaldehyde highest, and relatively hypoxic
48
Commonest liver cancer?
Mets
49
What do alpha cells produce?
Glucagon
50
What do beta cells produce?
Insulin
51
What do delta cells produce?
Somatostatin
52
Peri-ductal acute pancreatitis - cause?
obstructive
Acinar cells adjacent to the ducts undergo necrosis
53
Peri-lobular acute pancreatitis - cause?
Vascular cause
54
Complication of acute pancreatitis?
Haemorrhagic pancreatitis
55
Dx of acute pancreatitis?
Serum lipase
56
Pancreatic pseudo-cyst?
collection of fluid without an epithelial lining
57
Most common tumour of the pancreas?
Ductal carcinoma
58
Mutation in pancreatic ductal carcinoma?
Kras mutation
59
Most common location of ductal carcinoma?
Head of the pancreas
60
Most common location of neuroendocrine tumour?
Tail of the pancreas
61
Most common neuroendocrine tumour and association
MEN1, non-secretory
62
Most common secretory neuroendocrine tumour?
Insulinoma (beta cells)
63
Mechanism of HPV causing cervical cancer?
Inhibiting TSGs (E6 and E7 enzymes)
64
Most common cyst?
Follicular cyst
65
What is hyperplasia?
Increased number of cells
66
Differentiated VIN Risk factors?
Lichen sclerosis - can progress to SCC
67
Vulval cancer is normally what type?
SCC
68
Risk factors for clear cell vulval cancer?
Teenagers, COCP
69
Cervical cancer is normally what type?
SCC (80%)
70
E6 inactivates which gene?
P53
71
E7 inactivates which gene?
Retinoblastoma (Rb)
72
Most common endometrial cancer?
Adenocarcinoma
(80% endometroid)
73
Histology of fibroids?
Bundles of smooth muscle cells
74
Endometrial tissue within the myometrium?
Adenomyosis
75
Signs of endometriosis histology?
Chocolate cysts, powder burns
76
Mutation in endometroid endometrial cancer?
PTEN
77
Subtypes of endometroid endometrial cancer?
Endometroid, serous, mucinous
78
Subtypes of non-endometroid endometrial cancer?
papillary, clear cell, serous
79
Violin strings and pre-hepatic lesion?
Fitz-Hugh Curtis syndrome. Adhesions around the liver. Associated with PID.
80
Causes of PID?
TB, schistomiasis, staph aureus, gonorrhoea, chlamydia
81
Most common ovarian cancer?
Epithelial (90%)
82
Most common malignant ovarian cancer in young women?
Dysgerminoma
83
What is associated with Rokitansky's protuberance?
Dermoid cyst
84
Micro-calcifications on non-invasive breast screening
Ductal carcinoma situ
85
Most common breast cancer?
Invasive ductal carcinoma
86
single best prognostic indicator of breast cancer?
Lymph node
87
USS of the breast age?
<35
88
B5a = what diagnosis?
Ductal carcinoma in situ
89
B5b = what diagnosis?
Invasive ductal carcinoma
90
What does B4 mean?
suspicious
91
What does B3 mean?
Uncertain
92
Stromal and epithelial?
Fibroadenoma
Phyllodes tumour is malignant version
93
Lumpiness, transilluminable?
Fibrocystic disease
94
Stellate area
Radical scar
95
Which proliferative breast condition has highest rate of turning malignant?
In situ lobular neoplasia
96
Breast cancer grading system?
Nottingham grading system
97
What part of brain is affected first in alzheimer's
Hippocampus
98
Most common tumour in children
Pilocytic astrocytoma
99
Intraparenchymal haemorrhage site most common?
Basal ganglia
HTN
100
Hyperattenuation within the circle of willis?
SAH
101
Lemon shape bleed?
extradural haemorrhage
102
most common cell in the brain?
Astrocytes
103
Near the surface brain tumour?
Meningioma
104
Cancers that metastasise to the brain?
Lung, skin, breast
105
Most aggressive brain tumour?
Glioblastoma multiforme (grade 4)
106
Grade 2/3 tumour?
Diffuse glioma
107
Craniopharyngioma buzzwords?
Inferior bitemporal hemianopia (grow downwards)
108
Pituitary tumour
Superior bitemporal hemianopia
109
Ependyoma buzzword?
Posterior fossa, Tuberous sclerosis
110
Medulloblastoma?
In the cerebellum, squinting child
111
Meningioma?
Psomomma bodies
112
Order of dementias?
Alzheimer's > vascular > Lewy-body dementia > frontotemporal dementia
113
Alzheimer's aetiology
Beta amyloid plaques
Hyperphosphorylation of tau
114
Pathophysiology of Frontotemporal dementia?
Pick bodies
115
Staging for alzheimer's
BRAAK
116
Alpha synuclein mutation?
Parkinson's, lew-bodies
117
Most common malignant bone cancer in adults?
Osteosarcoma
118
Café au lait spots, Chinese letters, difficulty walking, shepherd's crook deformity
McCune-Albright syndrome
(also associated with precocious puberty)
119
Genetic predisposition of RA?
HLA DR4
120
First stage of TB infection?
Ghon focus
121
Rat bite erosions?
Gout
122
White lines of chrondrocalcinosis?
Pseudo-gout
123
Signs of malignant bone disease?
Acute periosteal rection, irregular bone formation, extraosseous and irregular calcification
124
When is osteosarcoma seen?
Osteosarcoma
Often at the knee
125
Signs of osteosarcoma?
Codman's triangle
Sunburst appearance
126
Signs of chondrosarcoma?
Fluffly calcifications
127
Ewing's sarcoma?
Small round cells
Onion skinning of periosteum
128
Soap bubble appearance?
Giant cell (borderline malignancy)
129
McCune Albright syndrome?
Triad of cafe au lait spots, fibrous dysplasia, precocious puberty
Chinese letters, Shepherd's crook deformity
130
Which cells drive RA?
Lymphocytes
131
Layers of the epidermis?
Corneum, granulosum, spinosum, basale
132
What mutation is associated with eczema?
Fillagrin
133
Auspitz sign?
rubbing causes bleeding
134
Koebner's phenomenon
Plaques form at sites of skin injury
135
Parakeratosis is a buzzword for what?
Psoriasis
Spongiosis on histology
136
Bullous pemphigoid
IgG and C3 to hemidesmosomes
Basement membrane
137
Pemphigus vulgaris
IgG to desmoglein 1&3 (acantholysis)
Stratum spinosum
138
Pemphigus foliaceous
IgG against desmoglein in epidermis
Stratum corneum
139
Most common melanoma?
Superficial spreading
140
Marjolin's ulcer?
SCC
141
Precursor to BCC?
Nevoid basal cell carcinoma
Gorlin-Goltz syndrome
142
Most common skin cancer?
BCC (70%)
143
Signs of chronic stable liver disease?
Palmar erythrema, dupytren's contracture, spider naevi and gyaecomastia
144
Signs of portal hypertension?
Splenomegaly, ascites,
145
C1q deficiency can cause what?
SLE
146
ICD-10 criteria for PTSD
(hyper arousal, avoidance, flashbacks, emotional blunting)
147
Most common causes of ckd?
Diabetes (most common) and hypertension
148
Causes of rapidly progressive (crescentric) glomerulonephritis?
Goodpasture's, immune complexes, Pauci-immune
149
What is associated with membranous glomerulonephropathy?
Spikey immune complex deposits, diffuse basement thickening
Associated with SLE, anti-phospholipase A2 antibodies
150
FSGS hisotlogy?
Focal scarring, loss of foot processes
151
What is seen in renal diabetes disease?
Kimmelstiel Wilson antibodies
152
Red cell casts?
Nephritic syndrome
153
Commonest worldwide nephritic syndrome?
IgA nephropathy
154
IgA nephropathy
IgA deposits in mesangium
155
Raised O titre, reduced C3, IgG deposits?
Post-streptococcal glomerulonephritis
156
Goodpasture's imnnunofluorescence findings?
Linear deposition of IgG
157
Immune complex mediated rapidly progressive imnnunofluorescence findings?
Bumpy deposition of immune complexes in GBM/mesangium
158
Pauci-immune mediated
No/scanty immune complexes.
Associated with pulmonary haemorrahge and skin rash
159
Granulomatosis with polyangitis antibodies?
C-ANCA (disease also known as Wegner's
160
Microscopic polyangitis antibodies?
P-ANCA
161
Alport's syndrome inheritance pattern
X-linked recessive, problem with type 4 collagen
162
Alport's syndrome
X-linked recessive, problem with type 4 collagen
163
Brown casts is indicative of what?
Acute tubular necrosis
164
Acute interstitial nephritis?
Eosinophil infiltrate, white cell casts in urine but no infection. normally after starting a drug.
165
PKD inheritance and gene involved?
AD inheritance, mutation in PKD gene encoding polycystin
166
Lupus nephritis signs?
Wire loop capillaries
167
How. many stages of lupus nephritis?
6
168
Last stage of lupus nephritis?
>90% sclerosis
169
Micronodular cirrhosis?
Caused by alcohol
170
Signs of extrahepatic shunting?
Oesophageal varices, anorectal varices, caput medusae
171
PSC antibodies?
P-ANCA
172
PSC signs?
Fibrosis
173
Stain for Wilson's?
Rhonadine
174
Alpha-1-antitrypsin deficiency
Schiff stain
175
Most common benign liver problem?
Hemangioma
176
What is liver cell adenoma associated with?
COCP
177
Tumour marker for hepatocellular carcinoma?
AFP
178
Signs of stable liver disease?
Spider naevi, gynaecomastia, duputryen’s contracture, palmar erythema
179
Mainstay of histological staining?
Haematoxylin and eosin
180
Lynch syndrome?
AD inheritance with mutation in DNA mismatch repair gene
Also known as HNPCC
181
Familial adenomatous polyposis inheritance?
AD mutation in APC suppressor gene
10,000 polyps
182
What is Gardner's syndrome?
AD mutation with skull osteomas, epidermoid cysts, desmoid tumours, dental caries, adrenal gland tumours
183
Cells in medullary thyroid?
Parafollicular C cells. Secrete calcitonin
184
Treatment for low libido?
Sensate focus therapy, timetabling sex
185
Hypersexuality treatment?
CBT - can also use SSRIs, GnRH therapies
186
Hypersexuality treatment?
CBT - can also use SSRIs, GnRH therapies
187
Recommeded SSRIs with breastfeeding?
Sertraline and paroxetine
188
PND treatment
CBT and SSRI (sertraline or paroxetine). Involve home treatment team and health visitor. Post natal community mental health team will be involved
189
Puerperal psychosis treatment?
Depending on the presentation, antipsychotics, antidepressants, or lithium may be needed Benzodiazepines may be needed for agitation. MAINLY ANTIPSYCHOTICS
190
Treatment for tic disorder?
Clonidine
191
Section 2 - who makes the decision?
Made by an AMHP or nearest relative (NR) on behalf of TWO doctors, one or whom should be section 12 approved (usually SpR or consultant) and one of whom should know the patient in professional capacity (e.g. GP)
192
Cognitive assessment tools?
MMSE (scored out of 30), AMTS (scored out of 10), montreal cognitive assessment (MoCA) (out of 30), Addenbrookes cognitive examination (ACE-R) (scored out of 100)
193
Tetragenic effects of phenytoin and carbamazepine?
Cleft palate
194
Tetragenic effects of phenobarbital and phenytoin?
Cardiac malformations
195
Tetragenic effects of sodium valproate?
Neural tube defects, facial cleft and hypospadias
196
Endometritis treatment?
IV Clindamycin and IV Gentamicin
197
Medications for acute mania?
Antipsychotics and short course of benzos
198
Antidote for paracetamol OD?
N-acetylcysteine
199
Normal ranges for ABG
pH: 7.35 – 7.45
pO2: 11 – 13 kPa (82.5 – 97.5 mmHg)
pCO2: 4.7 – 6.0 kPa (35.2 – 45 mmHg)
HCO3: 22 – 26 mmol/L
Base excess: (-2 to +2 mmol/L)
200
Normal ranges for calcium, phosphate, sodium and potassium?
Na+: 133–146 mmol/L
K+: 3.5–5.3 mmol/L
Ca2+(adjusted): 2.2-2.6 mmol/L
Mg2+: 0.7–1.0 mmol/L
Chloride: 98-106 mmol/L
Phosphate: 0.74 – 1.4 mmol/L
Urea: 2.5 – 7.8 mmol/L
201
LFTs normal range?
Alkaline phosphatase (ALP): 30–130 U/L
Alanine aminotransferase (ALT):
♂ <41 U/L
♀<33 U/L
Aspartate aminotransferase (AST): 1 – 45 U/l
Bilirubin: <21 μmol/L
GGT:
♂ <60 U/L
♀<40 U/L
Albumin: 35–50 g/L
202
Signs of serotonin syndrome?
mild (shivering and diarrhoea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.
diarrhoea, headache, sweating, dilated pupils, fever, insomnia
1. Autonomic disturbance - namely:
Hypertension.
Tachycardia.
Hyperthermia.
Hyperactive bowel sounds.
Mydriasis.
Excessive sweating.
2. Neuromuscular dysfunction - namely:
Tremor.
Clonus - inducible or spontaneous.
Ocular clonus.
Hypertonicity.
Hyperreflexia (this symptom can be masked if there is severe muscle rigidity).
3. Altered mental state - namely:
Anxiety.
Agitation.
Confusion.
Coma.
203
SSRI discontinuation syndrome
Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Electric shock type sensations
204
Neuroleptic malignant syndrome
Neuroleptic malignant syndrome is a rare but potentially life-threatening idiosyncratic reaction to antipsychotic drugs[1]. It causes fever, muscular rigidity, altered mental status and autonomic dysfunction. The syndrome is usually associated with potent neuroleptics such as haloperidol and fluphenazine.
205
When to do an USS after UTI?
During the acute infection in children aged under 6 months with recurrent UTI.
Within 6 weeks for children aged 6 months and over with recurrent UTI.
Within 6 weeks, for all children younger than 6 months of age with first-time UTI that responds to treatment.
206
When to do a DMSA?
Ensure that a dimercaptosuccinic acid scintigraphy (DMSA) scan to detect renal parenchymal defects is carried out within 4–6 months following the acute infection in:
All children aged under 3 years with atypical or recurrent UTI.
All children aged 3 years or over with recurrent UTI.
This investigation should be arranged by paediatric specialists when appropriate.
207
Counselling of UTI in children
Safety net!!: Advise the parents or carers to bring the child for reassessment if they do not respond to treatment within 24–48 hours.
Outline the importance of completing any course of treatment.
Advise use of paracetamol for pain relief where required.
Advise on adequate fluid intake to avoid dehydration.
Advise that children who have had a UTI should have ready access to clean toilets when required and should not be expected to delay voiding.
Ensure that they are aware of the possibility of a UTI recurring and the need to seek prompt treatment from a healthcare professional should this occur.
Patient information leaflets on UTI in children are available at NHS and Patient.Info.
208
Signs of an atypical UTI?
* During the acute infection in all children with atypical infection, indicated by:
* Poor urine flow.
* Abdominal or bladder mass.
* Raised creatinine.
* Sepsis.
* Failure to respond to treatment with suitable antibiotics within 48 hours.
* Infection with non-E. coli organisms.
* Note: infants and children with abnormal imaging results should be assessed by a paediatric specialist.
209
Jittery baby – what should your first test be?
Capillary blood glucose
210
6 year old kid with Down’s syndrome with bilious vomiting and distended abdomen, patent anus
Volvulus
211
Girl goes to Pakistan. Develops macular rash. High fever for 5 days. HR was 70bpm. Cause?
Typhoid
212
Difficult balance, cannot build block of towers, hyperreflexia (description of ataxic CP). Where is lesion?
Cerebellum
213
Cannot examine ear directly, lump behind ear causing ear to stick out
Mastoiditis
214
You are in GP, Child with mild croup comes in?
Dexamethasone + review in 48 hours
215
Child with 6 month history of loose stools. Passed one hard blood streaked stool 10 days ago. What investigation?
No investigation needed
216
Sickle cell anaemia patient with Hb of 40 and low reticulocyte count with Howell-Jolly bodies
Parvovirus B19
217
Kid with hepatomegaly and breathlessness (?heart failure)
CXR
218
Maternal T1DM increases risk of what condition in newborn?
Neural tube defects
219
Kid has a hearing test at age 3 - which one?
Pure tone audiometry
220
When is distraction testing done?
6-9 months
221
5 year old with nocturnal enuresis every single night
Enuresis alarm?
222
Kid with limp
Transient synovitis
223
Maintenance fluid to give to kid with diabetes mellitus?
In DKA: 0.9% saline, not in DKA: 0.9% saline with 5% dextrose
224
Child with mild croup symptoms comes into GP, RR of 65. What is your management?
Keep child calm and get them urgently to hospital
225
Kid with spiral fracture. What do you do?
Admit and investigate for NAI
226
Kid with petechial rashes, low RBC and raised WBC with a limp and sick?
ALL
227
4. Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give?
Repeat dexametasone
228
Foreign kid that is drooling and unvaccinated
Epiglottitis
229
Kid with delayed milestones in language, GP clicked his fingers and she turned to look, what’s the next step?
Refer to SALT?
230
6. Kid with globally delayed milestones, started to walk at 18 months, saying 2 word phrases at 3 years, 50 word vocabulary at 3 years. What would be the most useful investigation?
MRI
231
7. Kid with a strawberry tongue, what was the likely diagnosis?
Scarlet fever (caused by group A haemolytic strep)
232
8. Kid with anal itch, what do you give?
Mebendazole cream for whole household
233
10. Kid with impaired taste stuff, then awareness and then goes to sleep for like an hour and back to normal. No memory of event?
Focal seizure?
234
Another kid that would fall down and scream and stuff but was completely fine afterwards
Temper tantrum
235
13. Kid with bouts of crying and episodes where they flex their knees and hips and red stool
Intussception
236
12. Kid with yellow and grey stools and was like 4 weeks old or something. What do you test for?
Split bilirubin levels
237
14. Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it?
Correct electrolyte imbalance. Then it's Ramstedt's pyolorotomy
238
17. 7 year old kid headache and secondary nocturnal enuresis. He’s lost 1.5kg. Urine dipstick normal (i.e. no glucose, proteins, blood. Urine specific gravity 1.010 to 1.030) What is the likely diagnosis?
Diabetes insipidus
239
18. Voraciously hungry kid, hypotonia and feeding difficulties as a neonate, and almond eyes what was the diagnosis?
Prader-willi
240
19. 7 year old kid has an accident and needs to have his leg amputated below knee. He says no and wants to wait for his mum to approve first but she’s on a business trip, dad says go for it. What do you do?
Proceed with the dad’s consent
241
21. 9 months old not feeling well, temperature was 38, comes into the GP. What should you do?
Tell him to go to hospital
242
23. Another neonate with reduced leg movements and fever?
Osteomyelitis
243
25. Kid who had rashes which had crusted over and he was also scratching them and now he had a fever and cool peripheries. What is the cause for his acute presentation?
Varicella zoster viraemia?
244
26. 3 year old kid with unilateral nasal discharge with bleeding and crust, what was the most likely cause?
Foreign body insertion
245
28. Kid had been coughing for 2 months, during winter season. He coughs a lot in night. Hx of atopy and he’s been recently getting some new wheezes. He was stable, so what should you do at the GP?
Give salbutamol as a trial
246
29. Neonate with cardio problem. Systolic murmur loudest at the left sternal edge 2/6. What was it, PDA, ASD, VSD, tetralogy of Fallot
(either pulmonary stenosis or ASD or VSD depending on other factors in the question)
247
30. Kid growing along the 55th centile and is vomiting after food. He was bottle and breast-fed. What is the cause?
GORD
248
31. Kid who basically had ADHD. What is the initial management?
Parental training
249
32. 14 year old kid who thieves, got into fights (basically conduct disorder). What is 1st Mx?
Multisystemic family therapy
250
33. Baby who just started solid foods and was being weaned and has become constipated. What do you do?
Encourage more fluids
251
34. Child who has a hx of very dry skin, rash over arms, getting worse & spreading. Sister has itchy rash on ankles and wrists. (Sounds like Eczema) What would be the management?
emollients+1% hydrocortisone
252
35. Child is 12 weeks old, what would be an absolute contraindicated for vaccination?
Acute fever <38.4oC
253
36. Hip pain on exercise and climbing stairs. Prolonged history, otherwise well
Perthe's disease
254
37. 3 year old female child with intermittent limp, otherwise well
DDH?
255
38. Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do?
Start anti-TB treatment (the kid has TB with those diameters and risk factor of living with someone with TB, plus his age if he’s under 4)
256
39. Precocious puberty (5yo and has sparse axillary and pubic hair as well as breast bud development) and high centile growth parents are along some lower centile. What definitive diagnostic test do you do?
Gonadotropin stimulation test
257
40. Fussy eater who drinks a lot of cows milk and was tired. What is the cause?
Iron-deficient anaemia
258
3 year old Kid with hypochromic microcytic anaemia and low ferritin. What could be the cause?
fussy eater common in this age, they take less iron and get anaemia, which explained the hypochromic microcytic anaemia blood film)
259
42. Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected?
Pyramidal tracts
260
Kid with rough (i.e. sandpaper) rash on face & trunk, flushed face. No rash around mouth
Scarlet fever
261
Kid with 2cm mass (inframandibular) on left side, painful – blood film shows: toxic left shift with reactive neutrophilia?
Lymphadenitis
262
Girl with sickle cell, has 0 reticulocytes
Parvovirus B19
263
47. Newborn with purple spot on face, what is the best approach?
GP follow up
264
48. Young child (non obese) with issues with internal rotation of the hip?
Perthe's
265
49. Kid needs fluids, but you can’t get standard IV access. Where do you go?
Intraosseus
266
50. Kid with symptoms of nephrotic syndrome – 1st line treatment?
Steroids
267
1. A newborn appears to be in severe respiratory distress and appears blue. Despite being given high flow O2, his saturations remain at 65%. What is the next best step to take with regards to his management?
a. Chest X-Ray
b. Infusion of Prostaglandin
c. Surgery
d. Indomethacin
Infusion of Prostaglandin
268
3. 3 months old baby with signs of HF, systolic murmur that radiates over the praecordium
VSD??
269
What is the most important thing to look at in follow up of HSP?
Urine protein and RBCs
270
15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis?
Chronic renal failure
271
6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation?
CT of nasal orbits
272
10. Infant with episodes of throwing arms forward with fists clenched
Infantile spasms
273
14. Child with episodes of smelling strange things, hard to communicate with during these episodes, falls asleep for an hour after and doesn’t remember anything. Diagnosis?
Focal seizure
274
17. Baby is almost a month old and jaundiced. Parents say has been jaundiced since day 2. Stools are grey or white. Diagnosis?
Biliary atresia
275
18. 4 year old girl with a high fever that was followed by a rash. What is the most likely Dx?
Roseola infantum
276
4. Kid with temp of 39, cap refill 6s, generally unwell + bulging fontanelles, no description of rash.
Meningiococcal septicaemia
277
Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have?
Scarlet fever
278
7. Woman who had bulimia. What gives it away?
Dental enema caries
279
5. 4yo kid having acute asthma attack, given iv salbutamol and hydrocortisone. Sats still low, no chest sounds on auscultation. What do you do/give next? IM adrenaline, call for senior help, start Atrovent (Ipratropium bromide)
Call for senior help
280
8. 4-month-old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine? Confirmed history of pertussis as a baby, currently ill with a fever of 38.5?, got a rash at site of last vaccination, severe cow’s milk allergy?
Currently ill with a fever of 38.5
281
12. Kid with URTI and generalised abdo tenderness
Mesenteric adenitis
282
Posterior rib fractures
NAI
283
Treatments of Rashes
1. Nappy rash flexure sparing?
Zinc and castor oil barrier cream (eczema or irritant)
284
2. Nappy rash with satellite lesions treatment
Clomitrazole (candidiasis)
285
Scabies - treatment?
Permethrin
286
Treatment for chicken pox?
None required
287
Heart sounds not heard in left chest, scaphoid abdomen - diagnosis?
Diaphragmatic hernia
288
2. Baby was born at 41 weeks via emergency C section due to foetal distress. Needed ventilation straight away. X ray showed hyper inflated lungs with areas of consolidation
Meconium aspiration
289
Prem baby, resp distress, CXR looks like ground glass
Respiratory distress syndrome (surfactant deficiency)
290
Impetigo measuring 8mm treatment?
Fusidic acid
291
Child suffers from fever. The fever disappears but she has now developed a rash. She subsequently has febrile convulsions
Roseola infantum
292
Child appears severely unwell with a non-blanching rash
Neisseria mengitidis
293
Mother with cold sores has been kissing her child who has a background of eczema?
Eczema herpeticum
294
4. Child has an URTI 2 weeks ago. Has now developed a rash over the back of the legs along with joint and abdominal pain?
HSP
295
What are some organisation in the UK that can help with abortions?
* British Pregnancy Advisory Service
* Marie Stopes UK
* National Unplanned Pregnancy Advisory Service
* Brook (<25)
296
What is the differential for small for gestational age (<10th centile)?
IUGR – infection,
placental insufficiency, undernutrition, normal constitutionally small for gestational age so just a small baby, small parents, genetic disorders, multiples like twins
297
Consequence of heroin use in pregnancy?
– placental abruption, LBW, premature, neonatal abstinence syndrome, stillbirth.
298
Neonatal treatment if HIV positive mother?
Neonatal:
All neonates should be treated with anti-retroviral therapy within 4 hours of birth until they are 4-6 weeks.
Infants should be tested for HIV DNA and RNA at 1 day, 6 weeks and 12 weeks of age. If all these tests are negative and the baby is not being breastfed, the parents can be informed that the child is not HIV-infected. A confirmatory HIV antibody test is performed at 18 months of age.
299
When is mode of delivery finalised in HIV positive women?
Based on viral load at 36 weeks. Make sure on ART by 24 weeks.
300
What would happen if placenta praevia was diagnosed at 20 weeks on the routine scan?
Repeated at 32 weeks to see if placenta has moved. Only 1 in 10 will still be low lying at term
