Paediatrics Flashcards

Question

what is a physical finding on the chest wall in severe chronic asthma?

Answer 1

harrison sulus - indentation in chest wall along 6th rib can be bilateral or unilateral

Answer 2

Escalating Bronchodilators - Salbutamol, ipratropium bromide, magnesium sulphate, aminophylline PLUS - Steroids - prednisone (oral) or Hydrocortisone IV ABx - if suspected

Answer 3

IHR/Neb salbutamol (10 puffs every 2 hours or repeat nebs every 20-30 mins) IHR/Neb ipratropium bromide IV magnesium sulphate IV aminophylline

Answer 4

reversibility FEV1 <80%, FEV1:FVC <0.7

Answer 5

spirometry direct bronchial challenge fractional exhaled nitric oxide peak flow variability

Answer 6

Reliever - SABA (salbutamol) Preventer 1 - ICS 2 - ICS + LTRA (leukotriene receptor antagonist - montelukast) 3 - ICS + LABA (-LTRA) 4 - MART (maintenance and reliever therapy, steroid + (S)LABA)

Answer 7

folmeterol

Answer 8

can reduced adult hight with long term use by up to 1cm . dose dependent effect

Answer 9

Respiratory syncytial virus (RSV)

Answer 10

<1 year, most common <6 months can be up to 2 years

Answer 11

coryzal symptoms - URTI signs of resp distress dyspnoea tachypnoea poor feeding mild fever apnoea wheeze and crackles

Answer 12

raised RR use of accessory muscles intercostal and subcostal recession nasal flaring head bobbing tracheal tugging cyanosis abnormal airway noise

Answer 13

coryzal symptoms chest symptoms 1-2 days later worst day 3-4 symptoms usually last 7-10 days

Answer 14

<3 months, pre-existing conditions <50-70% of normal milk intake clinical dehydration RR >70 O2 <92% resp distress apnoea parent not able to manage/access medical help at home

Answer 15

ensure adequate intake - NG, IVs saline nasal drops, nasal suctioning O2 ventilation support

Answer 16

rising pCO2 falling pH

Answer 17

Palivizumab monthly injection as prevention of bronchiolitis caused by RSV given to high risk babies. Provides passive protection

Answer 18

infants peaking at 6 months - inspiratory stridor exacerbated by lying, feeding, upset => no coinciding resp distress problem resolves as larynx matures - around 1.5 years

Answer 19

chromosome 7

Answer 20

Cystic fibrosis transmembrane conductance regulatory gene

Answer 21

chloride channels

Answer 22

meconium ileus - not passing meconium in 24 hours, abdo distention, vomiting

Answer 23

hereditary cyanotic heart disease infective endocarditis CF TB IBD Liver cirhosis

Answer 24

>60 mmol/L

Answer 25

pseudomonas aeruginosa Burkholderia cepacia

Answer 26

tobramycin nebs or oral ciprofloxacin

Answer 27

multidisciplinary chest physio exercise high calorie diet CREON tablets - for pancreatic insufficiency prophylactic flucloxacillin Tx chest infections bronchodilators DNase nebs - help clear secretions hypertonic saline nebs vaccinations

Answer 28

sore throat/pain swallowing stridor drooling tripod position high fever muffled voice scared and quiet septic and unwell

Answer 29

lateral xray of neck

Answer 30

alert senior paediatrician and anaesthetist ABx - cefriaxone steroids - dexamethasone

Answer 31

epiglottic abscess

Answer 32

typically <28 weeks gestation suffer from resp distress syndrome and require O2 or intubation and ventilation at birth. Diagnosed on CXR when infant required O2 >36 weeks gestational age

Answer 33

low O2 sats increased work of breathing poor feeding and weight gain crackles and wheeze increased susceptibility to infection

Answer 34

corticosteroids (betamethasone) in premature labour mothers <36 weeks CPAP rather than intubation Caffeine to stimulate resp effort avoid over-oxygenating

Answer 35

strep pneumoniae

Answer 36

ear pain reduced hearing symptoms of URTI

Answer 37

1 - amoxicillin 5 days erythro, clarithro

Answer 38

otitis media with effusions - middle ear become full of fluid due to a blockage in the eustacion tube causing loss of hearing

Answer 39

dull tympanic membrane with air bubbles or a visible fluid level can look normal

Answer 40

usually resolves within 3 months without treatment

Answer 41

maternal rubella or CMV genetic deafness associated syndromes - downs

Answer 42

prematurity hypoxia during or after birth

Answer 43

jaundice meningitis and encephalitis otitis media or glue ear chemo

Answer 44

all readings between 0-20 dB

Answer 45

trismus - unable to open mouth change in voice (hot potato voice) swelling and erythema surrounding tonsils

Answer 46

strep pyogenes (A) and Haemophilus influenzae

Answer 47

drainage and Abx (co-amox) ?dex

Answer 48

infection of upper and lower eyelid which causes red how skin swelling around eyelid and eye - distinguish from orbital cellulitis with CT scan usually no pain or reduction in eye movements, no change in vision or abnormal pupillary response

Answer 49

systemic Abx

Answer 50

strabismus - misalignment of the eyes causing double vision

Answer 51

idiopathic hydrocephalus cerebral palsy space occupying lesion trauma

Answer 52

cover test herschberg's test

Answer 53

occlusive patch or atropine drops in good eye

Answer 54

ductus venosus foramen ovalae ductus arteriosus

Answer 55

shunt connecting umbilical vein to inferior vena cava allowing foetal blood to bypass liver

Answer 56

shunt connecting R to L atrium which allows blood to bypass R ventricle and pulmonary circulation

Answer 57

shunt connecting pulmonary artery and aorta which allows blood to bypass the pulmonary circulation

Answer 58

no - unless R sided pressure becomes so great due to pulmonary hypertension the shunt reverses - EISENMENGER SYNDROME

Answer 59

when a shunt reverses due to pulmonary HTN causing R sided pressure > L sided pressure leading to pulmonary circulation bypass and cyanosis. develops after 1-2 years with large shunts and in adulthood with small

Answer 60

stroke - with DVT - clot bypasses lungs AF or atrial flutter Pulmonary hypertension and r sided HF Eismenger syndrome

Answer 61

Ostium secondum patent foramen ovale ostium primum - tend to causes Av valve defects also

Answer 62

mid systolic crescendo-decrescendo murmur loudest at upper left sternal border with a fixed split second heart sound

Answer 63

SOB difficulty feeding poor eight gain LRTIs complications - heart failure, stroke

Answer 64

cyanosis clubbing dyspnoea plethoric complection (due to polycythaemia)

Answer 65

Heart lung transplant Management of pulmonary HTN, polycythaemia and thrombosis

Answer 66

Downs and turners

Answer 67

ASD VSD patent duct arteriosus

Answer 68

pan-systolic more prominent at left lower sternal border in 3/4 intercostal space. May be systolic thrill

Answer 69

VSD mitral regurg tricuspid regurg

Answer 70

1-3 days to stop functioning, 2-3 weeks to fully close

Answer 71

left to right - from aorta to pulmonary vessels

Answer 72

continuous crescendo -decrescendo machinery murmur

Answer 73

aortic stenosis pulmonary stenosis hypertrophic obstructive cardiomyopathy

Answer 74

transposition of the great arteries Tetralogy of fallot Eisenmengers transformation

Answer 75

turners syndrome

Answer 76

weak femoral pulses - upper limb BP higher than lower limb Systolic murmur below left clavicle tachypnoea poor feeding grey, floppy baby

Answer 77

surgery in high risk - prostaglandin E to keep ductus arteriosus open till surgery

Answer 78

transposition of the great arteries

Answer 79

prostaglandins - maintain ductus arteriosus Balloon septostomy - insert balloon catheter into foramen ovale to create largeASD open heart surgery - arterial switch

Answer 80

Pulmonary valve stenosis Right ventricular hypertrophy Overriding Aorta VSD PROVe

Answer 81

left to right - cyanotic

Answer 82

rubella infection increased age of mother alcohol in pregnancy diabetic mother

Answer 83

echo + doppler flow studies

Answer 84

boot shaped heart due to right ventricular hypertrophy

Answer 85

cyanosis clubbing poor feeding poor weight gain ejection systolic murmur loudest in pulmonary area tet spells

Answer 86

seen in tetralogy of fallot where shunt becomes temporarily worse causing cyanotic episode - usually during waking, exertion, crying

Answer 87

squatting or pulling knees to chest - increases systemic vascular resistance O2 beta blockers - relax R ventricle IV fluids morphine - decrease resp drive sodium bicarb - buffer metabolic acidosis phenylephrine infusion - increase systemic vascular resistance

Answer 88

Prostaglandins - maintain ductus arteriosus surgery

Answer 89

R tricuspid valve lower than normal causing R ventricle to be smaller causing poor flow to pulmonary vessels - usually presents after closing of ductus arteriosus

Answer 90

tetralogy of fallot william syndrome noonan syndrome and turners syndrome congenital rubella syndrome

Answer 91

autoimmune condition triggered by antibodies to group A beta-haemolytic strep - typically strep pyogenes causing tonsilitis. The process usually occurs 2-4 weeks after initial infection

Answer 92

fever joint pain - migratory of large joints erythema marginatum rash shortness of breath chorea firm painless nodules carditis - tachy/brady, murmurs, pericardial rub, heart failure

Answer 93

throat swab and culture Anti streptococcal antibodies (ASO) titres ECHO, ECG, CXR

Answer 94

jones criteria

Answer 95

for diagnosing rheumatic fever TWO of JONES Joint arthritis Organ inflammation (carditis) Nodules Erythema marginatum rash Sydenham chorea OR One JONES and TWO FEAR Fever ECG changes (prolonged PR) Arthralgia Raised inflammatory markers

Answer 96

Abx - Benzathine benzylpenicilin or phenoxymethylpenicillin NSAIDs or salicates (joint pain) Aspirin and steroids - carditis Heartfailure - Diuretics +/- ACEi Chorea - carbamazepine

Answer 97

recurrence valvular heart disease - mitral stenosis chronic heart failure

Answer 98

chronic cough hoarse cry distress after feeding reluctance to feed pneumonia poor weight gain

Answer 99

small frequent meals burping regularly not overfeeding keep baby upright after feeding

Answer 100

effortless mainly after feeding

Answer 101

gaviscon mixed with feeds thickened milk or anti-reflux formula PPIs

Answer 102

projectile vomiting

Answer 103

first few weeks (4-6 weeks) of life baby failing to thrive with projectile vomiting

Answer 104

observation of stomach peristalsis firm round 'olive like' mass in upper abdomen hypochloric (low Cl-) metabolic alkalosis on blood gas

Answer 105

laparoscopic pyloromyotomy - Ramstedt's operation

Answer 106

rotavirus norovirus

Answer 107

E.coli 0157

Answer 108

abdo cramps, bloody diarrhoea, vomiting - can lead to haemolytic uraemic syndrome

Answer 109

campylobacter jejuni

Answer 110

raw/improperly cooked poultry untreated water unpasteurised milk

Answer 111

azithromycin or ciprofloxacin

Answer 112

bacillus cereus - diarrhoea resolving in 24 hours

Answer 113

metronidazole

Answer 114

lactose intolerance IBS reactive arthritis GBS

Answer 115

chronic watery diarrhoea in well <5 year olds which can often be helped by changes in diet

Answer 116

fat - shouldnt have low fat diet Fluid - not sugary drinks, not too much water Fruit + fruit juice - gut cannot absorb fructose or sorbitol easily Fibre - 12-18g per day

Answer 117

foecal incontinence

Answer 118

spina bifida hirschprungs disease cerebral palsy overflow incontenence - stress, abuse Constipation with overflow

Answer 119

habitual not opening bowels low fibre diet poor fluid intake sedentary lifestyle psychosocial problems

Answer 120

hirschprungs disease CF Hypothyroid Spinal cord lesions sexual abuse Intestinal obstruction anal stenosis cow milk intolerance

Answer 121

10-20 years

Answer 122

one third of the way from the anterior superior iliac spine and the umbilicus

Answer 123

for apendicitis when palpation in LIF causes pain in RIF

Answer 124

loss of appetite nausea and vomiting rovsing's sign guarding rebound tenderness percussion tenderness

Answer 125

ectopic pregnancy ovarian cysts meckel's diverticulum mesenteric adenitis appendix mass

Answer 126

malformation of distal ileum present in 2% of population that can bleed, become inflamed, rupture or cause volvutus, intussusception or obstruction

Answer 127

bleeding, infection, pain, scars damage to bowel or bladder removal of normal appendix anaesthetic risks VTE

Answer 128

NESTS No blood or mucus (less than UC) Entire GI tract Skip lesions Terminal ileum most affected + Trans mural Smoking risk factor weight loss, strictures, fistulae

Answer 129

CLOSEUP Continuous inflammation Limited to colon and rectum Only superficial mucosa Smoking protective Excrete blood and mucus Use aminosalicylates Primary sclerosing cholangitis

Answer 130

finger clubbing erythema nodosum pyoderma gangrenosum episcleritis and iritis inflammatory arthritis primary sclerosing cholangitis (UC)

Answer 131

faecal calprotectin

Answer 132

1 - steroids (oral pred or IV hydrocortisone) + immunosuppression under specialist - azathioprine, mercaptopurine, methotrexate, infliximab

Answer 133

1 - azithioprine or mercaptopurine

Answer 134

1 - aminosalcylates - mesalazine 2 - corticosteroids

Answer 135

1 - IV corticosteroids (hydrocortisone) 2 - IV ciclosporin

Answer 136

aminosalicylate - mesalazine or azathioprine or meraptopurine

Answer 137

panproctocolectomy

Answer 138

meckel's diverticulum

Answer 139

anti-tissue transglutaminase (anti-TTG) anti-endomysial (anti-EMA)

Answer 140

dermatitis herpetiformis - itchy blistering skin rash usually on abdomen

Answer 141

peripheral neuropathy cerebellar ataxia epilepsy

Answer 142

crypt hypertrophy villous atrophy

Answer 143

T1DM thyroid disease autoimmune hepatitis primary billiary cirrhosis primary sclerosing cholangitis downs syndrome

Answer 144

vitamin deficiency anaemia osteoporosis ulcerative jenunitits enteropathy associated t-cell lymphoma non-hodgekin lymphoma small bowl adenocarcinoma

Answer 145

fall in weight across: 1+ centiles if birth weight below 9th 2+ centiles if birth weight between 9th-91st 3+ centiles if birth weight 91+ centiles

Answer 146

inadequate nutritional intake difficulty feeding malabsorption increased energy requirements inability to process nutrition

Answer 147

maternal malabsorption if breastfeeding IDA family or parental problems neglect availability of food

Answer 148

poor suck (cerebral palsy) cleft lip/palate genetic conditions w/ abnormal face structure pyloric stenosis

Answer 149

CF coeliac disease cows milk intolerance chronic diarrhoea IBD

Answer 150

Hyperthroidism chronic disease - CF, CHD malignancy chronic infections - HIV, immunodeficiency

Answer 151

inborn errors of metabolism T2DM

Answer 152

average of parents height

Answer 153

in nutritional assessment - includes weight, height mid-upper arm circumference and skinfold thickness

Answer 154

severe malnutrition due to inadequate energy intake in all forms. More common <1 year olds and causes muscle wasting and loss of subcutaneous fat but no oedema

Answer 155

Severe malnutrition due to protein deficiency but with adequate energy intake. Leads to oedema, ascites and enlarged liver with fatty infiltrates

Answer 156

congenital condition where nerve cells of the myenteric (auerbach's) plexus are absent causing a lack of peristalsis of the large bowel

Answer 157

absence of parasympathetic ganglion cells in the colon

Answer 158

downs neurofibromatosis waardenburg syndrome multiple endocrine neoplasia type II

Answer 159

delay in passing meconium chronic constipation since birth abdo pain and distention vomiting poor weight gain and failure to thrive

Answer 160

inflammation and obstruction of the intestines in 20% of neonates with hirschprungs presenting usually between 2-4 weeks with fever, abdo distension, diarrhoea (w/ blood usually) and features of sepsis

Answer 161

Abx fluid resuscitation decompression of obstruction

Answer 162

rectal biopsy + histology for absence of ganglionic cells

Answer 163

surgical resection of aganglionic bowel

Answer 164

6 months - 2 years more common in boys

Answer 165

when the bowel invaginates into itself causing bowel obstruction

Answer 166

concurrant viral illness henoch-schonlein purpura CF intestinal polyps meckel diverticulum

Answer 167

sever colicky abdo pain pale, lethargic unwell child redcurrant jelly stool sausage shaped RUQ mass vomiting intestinal obstruction

Answer 168

1 - therapeutic enema - contrast, water or air 2- surgery

Answer 169

obstruction gangrenous bowel perforation death

Answer 170

meconium ileus hirschprungs oesophageal atresia duodenal atresia intussusception imperforate anus malrotation of the intestines + volvulus strangulated hernia

Answer 171

proximal dilated bowel loops distal collapsed bowel loops absence of air in rectum

Answer 172

shortly after birth

Answer 173

conjugated bilirubin

Answer 174

conjugated and unconjugated bilirubin

Answer 175

>14 days term babies >21 days premies

Answer 176

surgery - kasai portoenterostomy often require full liver transplant

Answer 177

autoimmune condition usually triggered by URTI which causes inflammation of capilaries leading to purpuric rash typically on lower legs, joint pain and GI symptoms. Can also cause kidney damage

Answer 178

purpuric rash on legs joint pain GI symptoms

Answer 179

severe central abdo pain >1 hour with normal examination may also have nausea, vom, anorexia, pallor, headache, photophobia, aura

Answer 180

paracetamol ibuprofen sumatriptan

Answer 181

1 - pizotifen - serotonin agonist propanolol cyproheptadine - antihistamine flunarazine - Ca channel blocker

Answer 182

a birth defect causing abdominal organs to be located outside abdomen due to defect in abdominal wall

Answer 183

apex beat displaced to r side of chest poor air entry in L chest

Answer 184

NG tube suction to prevent intrathoracic bowel distention and surgical repair - high mortality due to underdeveloped lungs in utero

Answer 185

children of african descent

Answer 186

GI symptoms - bloating, wind, abdo pain, diarrhoea , vomiting Allergic symptoms - hives, angio-oedema, cough/wheeze, sneezing, watery eyes, eczema, anaphylaxis

Answer 187

hydrolysed formulas or in severe cases elemental amino acid formulas

Answer 188

intolerance has GI symptoms but no allergic symptoms unlike allergy

Answer 189

congenital cyst dilations of the billary tree more commonly affecting females which have a small risk of malignancy

Answer 190

abdo pain jaundice abdo mass

Answer 191

idiopathic prolonged neonatal jaundice and hepatic inflammation which may cause low birth weight and faltering growth

Answer 192

sudden inconsolable crying/screaming accompanied by drawing knees to chest and passign excessive gas

Answer 193

temp >38 degrees loin pain/tenderness

Answer 194

immediate IV Abx - cefotaxime+ amoxicillin + full septic screen

Answer 195

bloods - FBC, CRP, cultures, lactate urine dip CXR LP ? cap gas

Answer 196

if first UTI <6 months recurrent UTIs atypical utis

Answer 197

DMSA scan (dimercaptosuccinic acid) - injection of radioactive material using gamma camera done 4-6 months after infection

Answer 198

micturating cystourethrogram (MCUG) - catheterise child and inject contrast then take x rays

Answer 199

where there is a developmental abnormality of the vesicouteric junction where the ureters are displaced laterally and enter the bladder directly allowing urine to reflux back up ureters and to the kidney causing dilatation and increased risk of infection and scaring

Answer 200

oral trimethoprim 7 days or IV co-amox 2-4 days

Answer 201

oral ABx - trimeth or nitro 3 days

Answer 202

involuntary urination

Answer 203

overactive bladder - frequent small volume urination prevents development of bladder capacity fluid intake prior to bed failure to wake psychological distress secondary causes - chronic constipation, UTI, learning disability, cerebral palsy

Answer 204

wetting the bed having never stopped

Answer 205

wetting the bed having previously stopped for >6 months

Answer 206

UTI constipation T1DM psychosocial problems abuse

Answer 207

day time wetting self

Answer 208

Eneurisis alarm - 1st line desmopressin (taken at bedtime) oxybutinin - anticholinergic imipramine - tricyclic antidepressant

Answer 209

low serum albumin high urine protein (3+ or >3 grams) oedema

Answer 210

low serum albumin high urine protein oedema deranged lipid profile high BP hyper-coagulability

Answer 211

minimal change disease

Answer 212

intrinsic kidney disease - focal segmental glomerulosclerosis, mebranoproliferative glomerulonephitis Henoch schonlein purpura diabetes infection - HIV, hepatitis, malaria

Answer 213

small molecular weight proteins and hyaline casts

Answer 214

high dose corticosteroids - prednisolone

Answer 215

ACEi immunosupressants - cyclosporine, tacrolimus, rituximab

Answer 216

high dose steroids - pred low salt diet diuretics albumin infusion antibiotic prophylaxis

Answer 217

hypovolaemia and low BP thrombosis infection - kidneys leak immunoglobulins acute or chronic renal failure relapse

Answer 218

the basement membrane of the glomerulus becomes highly permeable to proteins allowing them to leak from the blood into the urine

Answer 219

inflammation of the nephrons

Answer 220

reduction in kidney function haematuria proteinuria (less than nephrotic)

Answer 221

post-streptococcal glomerulonephritis IgA nephropathy

Answer 222

1-3 weeks after b-haemolytic strep (strep pyogenes) infection e.g tonsilitis immune complexes get stuck in the glomeruli and cause inflammation leading to AKI

Answer 223

positive throat swab anti-streptolysin antibody titres

Answer 224

supportive mainly manage complications - IgA may need immunosupression

Answer 225

Henoch-schonlein purpura (IgA vasculitis)

Answer 226

IgA deposits in nephrons cause inflammation

Answer 227

IgA deposits Glomerular mesangial proliferation

Answer 228

teens and young adults

Answer 229

shinga toxin (from e.coli 0157 or shingella)

Answer 230

haemolytic anaemia AKI thrombocytopenia

Answer 231

use of antibiotics and loperamide to treat gastroenteritis caused by e.coli0157 or shingella

Answer 232

reduced urine output haematuria or dark brown urine abdo pain lethargy and irritablility confusion oedema HTN bruising

Answer 233

supportive - renal dialysis, antihypertensives, maintain fluid balance, blood transfusion

Answer 234

condition where uretheral meatus is displaced to underside of penis

Answer 235

condition where the urethral meatus is displaced to the top side of the penis

Answer 236

where head of penis is bent downwards

Answer 237

difficulty directing urination cosmetic and psychological concerns sexual dysfunction

Answer 238

pathological non-retration of foreskin

Answer 239

balantitis xerotica obliterans

Answer 240

<0.5 ml/Kg/hour over 6 hours

Answer 241

haemolytic uraemic syndrome acute tubular necrosis

Answer 242

eGFR >90 ml/min per 1.73 m2

Answer 243

eGFR 60-89

Answer 244

eGFR 30-59

Answer 245

eGFR 15-29

Answer 246

eGGR <15 ml/min per 1.73m2

Answer 247

anorexia and lethargy polydipsia and polyuria faltering growth bony deformities from renal rickets hypertension acute on chronic renal failure proteinuria normochomic normocytic anaemia

Answer 248

igE stimulates mast cells to rapidly release histamine in mast cell degranulation

Answer 249

anaphylaxis causes compromise of airway, breathing or circulation

Answer 250

urticaria itching angio-oedema abdominal pain

Answer 251

ABCDE IM adrenaline Antihistamines - chlorphenamine or certirizine steroids - hydrocortisone

Answer 252

biphasic reaction - second anaphylactic reaction after treatment

Answer 253

serum mast cell tryptase - within 6 hours of event

Answer 254

asthma requiring ICS poor access to medical tx adolescents - higher risk nut/sting allergies significant co-morbidities

Answer 255

there is a break in the infants skin that allows allergens from the environment to react with the immune system but there is no contact with the allergen through the GI tract

Answer 256

cooms and gell

Answer 257

IgE antibodies trigger mast cells and basophils to degranulate causing an immediate reaction - food allergy reactions

Answer 258

IgG and IgM mediated activating the complement system leading to direct damage of local cells - haemolytic disease of newborn, transfusion reactions

Answer 259

immune complexes accumulate and cause damage to local tissues - autoimmune conditions

Answer 260

cell mediated caused by T lymphocytes which are inappropriately activated causing inflammation and damage to local tissues - organ transplant rejection, contact dermatitis

Answer 261

skin prick test RAST testing - measure of allergen specific IgE food challenge - gold standard

Answer 262

type 1 IgE

Answer 263

runny, bocked, itchy nose sneezing itchy, red, swollen eyes

Answer 264

certirizine loratadine fexofenadine

Answer 265

chlorpenamine promethazine

Answer 266

nasal corticosteroids - fluticasone, mometasone

Answer 267

BCG MMR nasal flu vaccine

Answer 268

flexor surfaces

Answer 269

50;50 ointment hydromol

Answer 270

mild - hydrocortisone 0.5,1,2.5% moderate - eumovate 0.05% potent - betamethasone 0.1% very potent - clobetasol propionate 0.05%

Answer 271

flucloxacillin

Answer 272

viral skin infection caused by HSV-1 or varicella zoster

Answer 273

eczema sufferer developed widespread painful vesicular rash with fever, lethargy, irritability, reduced oral intake and swollen lymph nodes

Answer 274

a disproportionate immune response causing epidermal necrosis resulting in blistering and shedding of top layer of skin - SJS <10% of body, TEN >10% of body

Answer 275

anti-epileptics(lamotrigine, phenotoin) antibiotics allopurinol NSAIDs Penicillin

Answer 276

herpes HIV Mumps FLu EBV mycoplasma pneumonia CMV

Answer 277

starts with fever, cough, sore throat, mouth, eyes and skin then develop purple/red rash which blisters the after a few days skin sheds leaving raw tissue underneath can also affect internal organs

Answer 278

admit to derm/burns unit steroids immunoglobulins immunosuppression

Answer 279

secondary infection permanent skin damage and scarring visual complications with eye involvement

Answer 280

allergies contact with chemicals, latex or nettles medications viral infection insect bites rubbing skin

Answer 281

chronic idiopathic urticaria chronic inducible urticaria autoimmune urticaria

Answer 282

sunlight temperature change exercise strong emotions hot/cold weather pressure

Answer 283

Antihistamines - fexofenadine if problematic - anti-leukotrienes (montelukast), omalizumab, cyclosporin

Answer 284

neurofibromatosis type 1 (if have 6+)

Answer 285

sturge-weber syndrome klippel trenaunay syndrome macrocephaly-capillary malformation

Answer 286

blue/black macular discolouration at base of spine and on buttocks or thighs - fade over first few years of life

Answer 287

genetic condition also known as brittle bone disease caused by mutation in formation of collagen

Answer 288

hypermobility blue/grey sclera triangular face short stature deafness from early adulthood dental problems bone deformities joint and bone pain

Answer 289

deficiency in vitamin D/calcium which results in defective bone mineralisation

Answer 290

hereditary hypophasphataemic rickets

Answer 291

lethargy bone pain swollen wrists bone deformuty poor growth dental problems muscle weakness pathological or abnormal fractures

Answer 292

bowing of legs knock knees rachitic rosary - expanded ribs causing lumps on chest craniotabes - soft skull, delayed closing delayed teeth

Answer 293

serum 25-hydroxyvitamin D - <25nmol/L = deficiency

Answer 294

serum 25-hydroxyvitamin D serum calcium serum phosphate serum alkaline phosphatase parathyroid hormone

Answer 295

transient synovitis

Answer 296

preceeding viral upper resp tract infection

Answer 297

staph aureus

Answer 298

gram staining crystal microscopy culture antibiotic sensitivities

Answer 299

open fracture orthopaedic surgery immunocompromised sickle cell HIV TB

Answer 300

disruption of blood flow to femoral head causing avascular necrosis of the epiphysis of the femur

Answer 301

5-8 years - mostly in boys

Answer 302

when head of femur displaces along growth plate

Answer 303

boys aged 8-15 obese children

Answer 304

in external rotation and have limited movement of hip

Answer 305

surgery to correct femoral head position

Answer 306

inflammation of the tibial tuberosity where patella ligament inserts causing anterior knee pain in adolescents - usually unilateral but can be bilateral. causes hard lump at front of knee

Answer 307

visible or palpabl hard tender lump at tibial tuberosity pain in anterior knee pain exacerbated by activity, kneeling or extension of knee

Answer 308

avulsion fracture - tibial tuberosity separated from tibia

Answer 309

reduction in physical activity ice NSAIDs

Answer 310

structural abnormality n developmental of foetal bones leading to instability of te hips and tendency for sublaxation or dislocation

Answer 311

FHx 1st degree relative breech presentation 36 weeks multiple pregnancy female oligohydramnios prematurity macrosomnia

Answer 312

different leg lengths restricted hip abduction on one side significant bilateral restriction in hip abduction difference in knee level with flexed hips clunking of hips

Answer 313

ortolani test barlow test

Answer 314

for developmental dysplasia of the hip hips and knees flexed, hips gently abducted and pushed from the back to see if they will dislocate anteriorly

Answer 315

for developmental dysplasia of the hip hips and knees flexed and gentle pressure put on knees through femur to see if hips will dislocate posteriorly

Answer 316

Pavlik harness (<6 months) for 6-8 weeks surgery if harness fails or >6 months

Answer 317

systemic JIA polyarticular JIA Oligoarticular JIa enthesitis related arthritis juvenile psoriatic arthritis

Answer 318

Still's disease

Answer 319

subtle salmon pink rash high swinging fevers enlarged lymph nodes weight loss joint inflammation and pain splenomegally muscle pain pleuritis and pericarditis

Answer 320

macrophage activation syndrome - severe inflammatory responce causing DIC, anaemia, thrombocytopenia, bleeding, non-blanching rash chronic anterior uveitis

Answer 321

kawasaki disease still disease (systemic JIA) rheumatic fever leukaemia

Answer 322

idiopathic inflammatory arthritis in 5+ joints - equivalent of RhA in adults though most children are seronegative

Answer 323

monoarthritis affecting <4 joints, classically associated with anterior uveitis. most common in gils under 6

Answer 324

paediatric seronegative spondyloarthropathies. inflammatory arthritis + enthesitis (inflammation of tendon insertion points) usually HLA-B27 +ve

Answer 325

places of psoriasis nail piitting onycholysis (seperation of nail bed) dactylitis enthesitis

Answer 326

NSAIDs steroids DMARDs Biologics - TNF inhibitors, infliximab etc

Answer 327

coronary artery aneurysm

Answer 328

systemic medium sized vessel vasculitis?

Answer 329

high (>39) fever >5 days widespread erythematous maculopapular rash on trunk Oedema of hands and feed preceeding desquamation Strawberry tongue and cracked lips cervical lymphadenopathy bilateral conjunctivitis arthritis

Answer 330

FBC - anaemia, leukocytosis, thrombocytosis LFTS - hypoalbuminaemia, elevated enzymes raised inflammatory markers (particularly esr) Urinaralysis - wt cells without infection ECHO

Answer 331

most unwell for 1-2 weeks Fever, rash, lymphadenopathy

Answer 332

weeks 2-4 acute symptoms settle desquamation, strawberry tongue and arthralgia occur - there is risk of coronary artery aneurysms forming

Answer 333

week 2-4 remaining symptoms settle

Answer 334

high dose aspirin - reduce risk of throbosis IV Ig to reduce risk of coronary artery aneurysm

Answer 335

a preceeding viral infection usually treated with ASPIRIN followed by acute encephalopathy and hepatic dysfunction in children and young people

Answer 336

ECG and ECHO

Answer 337

type II pneumocytes

Answer 338

between 24-34 weeks gestation

Answer 339

prostaglandins

Answer 340

hypoxic-ischaemic encephalopathy => cerebral palsy

Answer 341

large SA to weight ratio - cold born wet and loose heat rapidly meconium aspiration

Answer 342

warm baby calculate APGAR score stimulate breathing inflation breaths chest compressions

Answer 343

therapeutic hypothermia

Answer 344

1, 5 and 10 minutes during resus

Answer 345

dry vigorously with towel place baby head in neutral check for airway obstruction and consider aspiration if gasping or unable to breathe

Answer 346

2 cycles of 5 inflation breaths if no response 30s of ventilation breaths can be used then chest compressions coordinated with ventilation breaths

Answer 347

preterm - air and O2 term - just air

Answer 348

if HR <60 bpm despite resus and inflation breaths

Answer 349

for neonatal resus Appearance (skin colour) Pulse Grimmace (to stimulation) Activity (tone) respiration

Answer 350

blue/pale centrally = 0 blue extremities = 1 pink = 2

Answer 351

Absent = 0 <100 = 1 >100 = 2

Answer 352

no response = 0 little response = 1 good response = 2

Answer 353

floppy = 0 flexed arms and legs =1 active = 2

Answer 354

absent =0 slow/irregular = 1 strong/crying = 2

Answer 355

< 32 weeks

Answer 356

ground glass appearance

Answer 357

intubation and ventilation endotracheal surfactant CPAP supplementary oxygen

Answer 358

penumothorax infection apnoea intraventricular haemorrhage pulmonary haemorrhage necrotising enterocolitis

Answer 359

chronic lung disease of prematurity retinopathy of prematurity neurological, hearing or visual impairment

Answer 360

maternal sock intrapartum haemorrhage prolapsed cord nucal cord

Answer 361

sarnat staging

Answer 362

poor feeding, generally irritable, hyper-alert resolves within 24 hours normal prognosis

Answer 363

poor feeding, lethargy, hypotonic, seizures can take weeks to resolve 40% develop cerebral palsy

Answer 364

reduced consciousness, apnoea, flaccid, reduced or absent reflexes 50% mortality 90% develop cerebral palsy

Answer 365

33-34 degrees for 72 hours

Answer 366

from 2-10 days of age

Answer 367

haemolytic disease of newborn ABO incompatibility Haemorrhage intraventricular haemorrhage cephalo-haemorrhage polycythaemia sepsis and DIC G6PD deficiency

Answer 368

prematurity breast milk jaundice neonatal cholestasis extrahepatic biliary atresia endocrine disorders gilbert syndrome

Answer 369

in first 24 hours of life can be sign of sepsis

Answer 370

brain damage due to high unconjugated bilirubin

Answer 371

rhesus incompatability

Answer 372

14+ days in full term babies 21+ days in premature babies

Answer 373

direct coombs test

Answer 374

treatment threshold charts

Answer 375

phototherapy with blue light (450nm)

Answer 376

cerebral palsy learning disability deafness

Answer 377

adenosine - after valsalva manoeuvres

Answer 378

disorder affecting premature neonates where part of bowel becomes necrotic and can lead to perforation

Answer 379

very low birth weight or v premature formula feeds resp distress and assisted ventilation sepsis patent ductus arteriosus and congenital heart disease

Answer 380

intolerance to feeds vomiting green bile distended tender abdomen blood in stool absent bowel sounds generally unwell

Answer 381

abdo Xray - supine and lateral

Answer 382

dilated bowel loops bowel wall oedema pneumatosis intestinalis - gas in bowel wall pneumoperitoneum - free gas in peritoneum gas in portal veins

Answer 383

nil by mouth iv fluids total parenteral nutrition antibiotics NG tube - to drain fluid and gas SURGERY

Answer 384

perforation and peritonitis sepsis death strictures abcess formation recurrence long term stoma short bowel syndrome

Answer 385

Toxoplasmosis rubella cytomegalavirus herpes simplex HIV

Answer 386

< 3 months

Answer 387

Classic triad of - deafness, blindness (congenital cataracts) and congenital heart disease also learning disability

Answer 388

foetal growth restriction microcephaly hearing loss vision loss learning disability seizures

Answer 389

intracranial calcification hydrocephalus chorioretinitis (type of posterior uveitis)

Answer 390

external herpes lesions liver involvement encephalitis sezures, tremmors, lethargy, irritability

Answer 391

foetal varicellar zoster syndrome pneumonitis hepatitis encephalitis severe neonatal infection

Answer 392

foetal growth restriction microcephaly hydrocephalus, learnign disability scars and skin changes limb hypoplasia cataracts and chorioretinitis

Answer 393

vitamin K IM injection

Answer 394

sickle cell CF congenital hypothyroidism phenylketonuria medium chain acy-COA dehydrogenase deficiency maple syrup urine disease isovaleric acidaemia glutaric aciduria type 1 homocystin

Answer 395

5 days old

Answer 396

<72 hours of birth

Answer 397

6-8 weeks by GP

Answer 398

<2% pre-ductal - R hand post ductal - feet

Answer 399

caput succedaneum

Answer 400

cephalohaematoma

Answer 401

damage to C5/6 brachial plexus ileading to lweakness in shoulder abduction and external rotation, arm flexion and finger extension may have a 'waiters tip appearance'

Answer 402

vaginal GBS colonisation GBS sepsis in previous baby Maternal sepsis, chorioamniotitis or fever prematurity premature ROM prolonged rupture of membranes

Answer 403

confirmed/suspected sepsis in mother signs of sock seizures term baby needing mechanical ventilation resp distress starting 4+ hours after burth presumed sepsis in other multiple

Answer 404

fever reduced tone and activity poor feeding resp distress or apnoea vomiting tachy or brady hypoxia jaundice <24 hours seizures hypoglycaemia

Answer 405

monitor if 1 risk factor/clinical feature start antibiotics within one hour if 2 risk factors/clinical features or 1 red flag

Answer 406

benzylpenicillin or gentamycin cefotaxime if lower risk

Answer 407

check CRP at 24 hours and blood cultures at 36 hours consider stopping Abx if blood cultures negative and CRP <10 at day 2

Answer 408

28-32 weeks

Answer 409

32-37 weeks

Answer 410

respiratory distress syndrome hypothermia hypoglycaemia poor feeding apnoea and bradycardia neonatal jaundice intraventricular haemorrhage retinopathy of prematurity necrotising enterocolitis immature immune system and infection

Answer 411

chronic lung disease of prematurity learnign an dbehvioural difficulties susceptibility to infections - particularly resp hearing and visual impairement cerebral palsy

Answer 412

stopping breathing >20 seconds or shorter periods with oxygen desaturation or bradycardia

Answer 413

due to immaturity of the autonomic nervous system

Answer 414

tactile stimulation IV caffeine

Answer 415

retinal blood vessel formation is stimulated by hypoxia which is the normal condition of the retina during pregnancy so with early exposure to oxygen in prematurity this can stop retinal blood vessel development and cause retinal detachment

Answer 416

<32 weeks gestation <1.5kg

Answer 417

transpupillary laser photocoagulation cyotherapy injections of intravitreal VEGF inhibitors Surgery if retinal detachment

Answer 418

gestational age >42 weeks foetal distress APGAR score <7

Answer 419

consumption of dairy products, raw vegetables, meats and refrigerated foods passed from mother to baby placentally

Answer 420

abortion prematurity still birth neonatal sepsis

Answer 421

culture or PCR of blood, cervix or amniotic fluid of mother prenatally culture/PCR of blood, CSF, gastric aspirate, meconium of neonate

Answer 422

Ampicillin +/- gentamicin

Answer 423

foetal tachycardia small for gestational age prematurity still birth congenital malformations

Answer 424

lower IQ and impaired psychomotor development

Answer 425

IUGR preterm born to mothers with diabetes hypothermic polycythaemic ill for any reason

Answer 426

jitters irritability apnoea lethargy drowsiness seizures

Answer 427

<2.6 mmol/L

Answer 428

lip - failure of fusion of the frontonasal and maxillary processes Palate - failure of fusion of palatine processes and nasal septum

Answer 429

lip - 3 months palate - 6 months - 1 year

Answer 430

polyhydramnios no stomach bubble

Answer 431

persistant salivation and drooling

Answer 432

VACTERL association Vertebral anorectal cardiac tracheo-oesophageal renal limb anomalies

Answer 433

continuous suction of secretions to avoid aspiration until surgery is available

Answer 434

where abdominal contents protrude through umbilical ring covered by transparent sac

Answer 435

downs syndrome

Answer 436

'double bubble' of of distention of stomach and duodenal cap with absence of air distally

Answer 437

polyhydramnios preeclampsia early and late foetal loss

Answer 438

congenital malformations IUGR macrosomia

Answer 439

neonatal hypoglycaemia respiratory distress syndrome hypertrophic cardiomyopathy polycythaemia

Answer 440

lateral curvature of frontal plane of spine. In severe cases can lead to cardiorespiratory failure from curvature of chest

Answer 441

Head twisting to the side also called wry neck. The most common cause in infants is a sternomastoid tumour.

Answer 442

14-25 days

Answer 443

prodromal fever, muscle aches, lethargy, reduced appetite, headache and dry mouth for a few days followed by parotid swelling usually self limiting after around a week

Answer 444

pancreatitis orchitis meningitis sensorineural hearing loss

Answer 445

salivary PCR salivary or blood antibodies

Answer 446

supportive - self limiting infection

Answer 447

widespread erythematous raised vesicular blistering lesions - starts as macules then papules then vesicles Starts on trunk or face and spreads outwards over 2-5 days the crusts after 5 days

Answer 448

bacterial superinfection (necrotising faciitis) dehydration conjunctival lesions pneumonia encephalitis (presents with ataxia)

Answer 449

10 days - 3 weeks

Answer 450

fever, coryza and conjunctivitis followed 2 days later by greyish white spots on the buccal mucosa - KOPLIK SPOTS followed by rash 3-5 days post fever, classically starting behind ears self limiting after 7-10 days

Answer 451

Koplik spots - grey/white spots on buccal mucosa that appear 2 days after fever

Answer 452

starts on face (classically behind ears) 3-5 days after fever and then spreads to rest of body erythematous macular rash with flat lesions

Answer 453

10-12 days

Answer 454

pneumonia diarrhoea dehydration encephalitis meningitis hearing loss vision loss death

Answer 455

exotoxins from group a strep (strep pyogenes)

Answer 456

red-pink blotchy macular rash with rough SANDPAPER skin Starts on trunk and spreads outwards may also have flushed cheeks

Answer 457

sandpaper rash fever lethargy flushed face sore throat Strawberry tongue cervical lymphadenopathy

Answer 458

phenoxymethylpenicillin (penicillin V) for 10 days

Answer 459

post-streptococcal glomerulonephritis acute rheumatic fever tonsillitis - strep throat

Answer 460

Erythematous macular rash (milder than measles) starts on face and spreads to body lasts 3 days

Answer 461

thrombocytopenia encephalitis

Answer 462

erythematous macular rash mild fever joint pain sore throat lymphadenopathy

Answer 463

Parvovirus b19

Answer 464

fever, coryza and non-specific viral symptoms followed 2-5 days later by diffuse bright red rash on both cheeks (as though slapped) a few days later a reticular mildly erythematous affecting trunk and limbs - may be raised and itchy

Answer 465

aplastic anaemia encephalitis or meningitis pregnancy complications - foetal death rare - hepatitis, myocarditis, nephritis

Answer 466

presents 1-2 weeks after high fever for 3-5 days which the settles and is followed by a rash

Answer 467

mild erythematous macular rash on arms, legs, trunk and face that isn't itchy

Answer 468

bordetella pertussis - gram neg

Answer 469

mild coryzal symptoms and low grade fever, dry cough followed by more severe coughing fits after 1 week so much so people may vomit, fait or have a pneumothorax

Answer 470

nasopharangeal PCR or culture anti-pertussis toxin IgG if cough present >2 weeks

Answer 471

1 - macrolides - azithromycin, erythromycin, clarithromycin within first 21 days 2 - Co-trimoxazole

Answer 472

bronchiectasis

Answer 473

prophylactic antibiotics

Answer 474

staph aureus - most common strep pyogenes

Answer 475

golden crusted rash/skin infection

Answer 476

bullous - 1-2cm fluid filled vesicles which grow and burst to form golden crusts. may be itchy non-bullous - golden crusts

Answer 477

staph aureus

Answer 478

1st line - hydrogen peroxide cream 1% 2nd - If unsuitable - topical fusidic acid 3rd - oral flucloxacillin - when more widespread/unwell

Answer 479

staphylococcus scalded skin syndrome

Answer 480

abx - usually flucloxacillin

Answer 481

cellulitis sepsis scarring post-streptococcal glomerulonephritis staphylococcus scalded skin syndrome scarlet fever

Answer 482

corynebacterium diphtheriae

Answer 483

sore throat + difficulty swallowing fever lymphadenopathy SOB pseudomembrane on tonsils and mucosa of pharynx larynx and nose

Answer 484

1 - diphtheria antitoxin Abx - azithromycin, erythromycin, clarithromycin,

Answer 485

staph aureus epidermolytic toxins

Answer 486

Nikolysky sign - gentle rubbing of skin causes it to peel away

Answer 487

acute flaccid paralysis

Answer 488

post-poliomyelitis syndrome - weakness and fatigue of muscle groups affected in acute illness

Answer 489

HSV-2 - genital herpes

Answer 490

HSV-1 - from cold sores

Answer 491

ganciclovir

Answer 492

change in personality, memory or cognition leaning disability headache movement disorders

Answer 493

group A strep toxins or s.aureus toxins

Answer 494

severe diffuse of localised pain in an extremity fever localised swelling or erythema hypotension diffuse, scarlatina-like red rash muscle weakness

Answer 495

clindamycin + penzylpenicillin or vancomycin

Answer 496

clindamycin + oxacillin or vancomycin

Answer 497

bacteraemia acute resp distress DIC renal failure

Answer 498

miconazole gel nystatin suspension fluconazole tablets

Answer 499

sore and itchy pustular or papular erythematous rash with an irregular edge and SATELLITE lesions often in flexural areas

Answer 500

1 - topical hydrocortisone 1% if inflamed topical imidazoles (clotrimazole), oral antibiotics if severely inflammed

Answer 501

coxsackie a virus

Answer 502

resp illness + fever 1-2 days later - mouth ulcers then red painful possibly itchy blistering spots across body

Answer 503

supportive - will resolve in 7-10 days without treatment

Answer 504

dehydration bacterial superinfection encephalitis

Answer 505

gram negative diplococci

Answer 506

group B strep

Answer 507

hypotonia poor feeding lethargy hypothermia bulging fontanelle

Answer 508

for meningitis lie patient on back and flex one hip an dknee 90 degrees then straighten knee with hip still flexed - +ve if spinal pain and resistance to movement

Answer 509

for meningitis lie patient on back and use hand to lift head and neck to flex chin to chest +ve if causes patient to flex hips and knees

Answer 510

benzylpenicillin

Answer 511

cefotaxime + amoxicilin (for listeria)

Answer 512

ceftriaxone + dexomethasone QDS for 4 days

Answer 513

single dose ciprofloxacin

Answer 514

HSV enterovirus VZV

Answer 515

cloudy high protein Low glucose high neutrophils culture +ve

Answer 516

clear mild raise/normal protein normal glucose high lymphocytes -ve culture

Answer 517

hearing loss seizures cognitive impairment memory loss cerebral palsy

Answer 518

antenatal - maternal infection, trauma in preggo perinatal - birth asphyxia, pre-term birth postnatal - meningitis, severe neonatal jaundice, head injury

Answer 519

spastic dyskinetic ataxic mixed

Answer 520

hypertonia and reduced function due to UMN damage

Answer 521

problems controlling muscle tone with hyper and hypotonia casing athetoid (slow writing) movements and oro-motor problems due to basal ganglia damage

Answer 522

problems with coordinated movement due to cerebellar damage

Answer 523

failure to meet milestones increased/decreased tone hand preference <18 months problems with coordination, speech or walking feeding or swallowing problems learning difficulties

Answer 524

learning difficulty epilepsy kyphoscoliosis muscle contractures hearing/visual impairement GORD

Answer 525

multidisciplinary physio OT speech and language dietician orthopaedics Meds - muscle relaxants - baclofen, antiepileptics, glycopyrronium bromide - drooling

Answer 526

ages 6 months - 5 years

Answer 527

one generalised tonic clonic <15 minutes

Answer 528

downs fragile X foetal alcohol syndrome rett syndrome Metabolic disorders

Answer 529

cerebral palsy ataxia myopathy spina bifida visual impairement

Answer 530

dyspraxia cerebral palsy muscular dystrophy visual impairment congenital ataxia

Answer 531

social circumstance hearing impairement learning disability neglect autism cerebral palsy

Answer 532

emotional and social neglect parenting issues autism

Answer 533

gross motor fine motor and vision language and hearing personal and social

Answer 534

start supporting head and keep in line with body

Answer 535

Maintain sitting position usually supported as unbalanced

Answer 536

walk unaided

Answer 537

sit unsupported start crawling maintain standing and bouncing position wile supported

Answer 538

standing and cruising

Answer 539

squat and pick things up

Answer 540

run and kick ball

Answer 541

climb stairs one foot at time stand on one leg ride tricycle

Answer 542

hop climb stairs normally

Answer 543

lost development unable to hold object 5 months not sitting unsupported at 12 months not standing independently 18 months not walking 2 years not running 2.5 years no words 18 months no interest in others 18 months

Answer 544

communicates pleasure

Answer 545

curious and engages with people

Answer 546

apprehensive around strangers

Answer 547

engages with others pointing and handing objects waves bye claps

Answer 548

interest in others beyond parents parallel play

Answer 549

play with others bowel control

Answer 550

has best friend dry at night dresses self imaginative play

Answer 551

say 1 word in context follows simple instructions

Answer 552

5-10 words

Answer 553

combines 2 words

Answer 554

basic 3 word sentences

Answer 555

tells stories

Answer 556

fixes and attempts to follow recognises faces

Answer 557

palmar grasp

Answer 558

scissor grasp between thumb and forefinger

Answer 559

pincer grasp with tip of thumb and forefinger scribbles randomly

Answer 560

clumsily use cutlery tower of 2-4 blocks

Answer 561

1 - sodim valporate 2 - lamotrigine or carbamezapine

Answer 562

1 - carbamexapine or lamotragine 2 - sodium valporate or levetiracetam (keppra)

Answer 563

temporal lobes

Answer 564

ethosuximide

Answer 565

drop attacks with breif lapses of muscle tone usually lasting <3 mins may be indicative of lennox-gastaut syndrome

Answer 566

1 - sodium valporate 2 - lamotrigine

Answer 567

1 - sodium valporate others - lamotrigine, levetiracetam or topiramate

Answer 568

around 6 months

Answer 569

1/3rd die by 25 1/3rd keep seizures 1/3rd seizure free

Answer 570

pred vigabitrin

Answer 571

teratogenic liver damage and hepatitis hair loss tremor

Answer 572

agranulocytosis aplastic anaemia P450 drug interactions

Answer 573

folate and vitamin d deficiency megaloblastic anaemia osteomalacia

Answer 574

night terrors rashes

Answer 575

stevens-johnson syndrome leukopenia

Answer 576

seizure lasting >5 mins 2 or more seizures without regaining consciousness

Answer 577

IV lorazepam buccal midazolam rectal diazepam IV phenytoin can be used if seizure persists

Answer 578

chromosome 11

Answer 579

anaemia increased risk of infection chronic kidney disease sickle cell crisis acute chest syndrome stroke avascular necrosis pulmonary hypertension gallstones priaprism (painful persistent erections)

Answer 580

dehydration infection stress cold weather

Answer 581

low threshold for admission treat infections keep warm good hydration analgesia

Answer 582

sickle shaped RBCs clog capillaries causing distal ischaemia presents with pain and swelling in hands, feet, chest or back can cause priapism in men

Answer 583

blood flow to spleen blocked by sickle cells causing acutely enlarged painful spleen which can lead to severe anaemia and hypovolaemic shock management - supportive, blood transfusion, fluid resus

Answer 584

complication of sickle cell temporary absence of creation of RBCs usually triggered by parvovirus B19

Answer 585

vaso-oclussive crisis due to sickle cells of the blood vessels of the lungs causing fever, SOB, chest pain, cough and hypoxia

Answer 586

analgesia good hydration Abx blood transfusion for anaemia incentive spirometry resp support

Answer 587

avoid triggers vaccines Abx prophylaxis (penicillin V) hydroxycarbamine crizanluzumab blood transfusion bone marrow transplant

Answer 588

hydroxycarbamide

Answer 589

microcytic anaemia splenomegally pronounced forehead and malar eminences jaundice gallstones poor growth and development fatigue pallor

Answer 590

haemoglobin electrophoresis

Answer 591

alpha or beta

Answer 592

carriers with one faulty gene causes mild microcytic anaemia usually only requires monitoring

Answer 593

either two defective geners or one and one deletion causes more significant microcytic anaemia patients require monitoring and blood transfusions which may require iron chelation

Answer 594

homozygous for the deletion genes severe anaemia and failure to thrive in early childhood severe microcytic anaemia splenomegaly bone deformities regular transfusions, iron chelation, splenectomy

Answer 595

when a male has a additional X chromosomes making them 47XXY

Answer 596

normal development as male till puberty then taller height wider hips and gynaecomasitia weaker muscles small testes reduced libido shyness infertility subtle learning difficulties

Answer 597

testosterone injections advanced IVF techniques breast reduction

Answer 598

breast cancer (more than other men) osteoporosis diabetes anxiety and depression

Answer 599

females with single X chromosome on chromosome 45 -> 45XO

Answer 600

short stature webbed nack high arching palate downward sloping eyes with ptosis broadchest and with wide spaced nipples cubitus valgus underdeveloped ovaries late/incomplete puberty infertile

Answer 601

recurrent otitis media recurrent UTI Cardiac - coarctation of aorta, pulmonary stenosis hypothyroid hypertension obesity diabetes osteoporosis learning difficulties

Answer 602

growth hormone therapy for height oestrogen and progesterone for female secondary sex characteristics fertility treatment

Answer 603

hypotonia brachycephaly (small head with flat back) short neck short stature flattened face and nose prominent epicanthic folds upward sloping palpebral fissures single palmar crease

Answer 604

recurrent otitis media and deafness (eustachion tube abnormalities) visual problems hypothyroidism cardiac defects - ASD, VSD, PDA, tetralogy atlantoaxial instability leukaemia - AML (most common) and ALL Alzheimers Hirschprungs disease and duodenal atresia

Answer 605

ASD VSD PDA Tetralogy of fallot

Answer 606

11-14 weeks USS for neucal transleucency bloods - B-HCG, PAPPA

Answer 607

between 14-20 weeks maternal bloods - B-HCG, alpha-fetoprotein, serum oestrodiol

Answer 608

14-20 weeks HCG, AFP, Total Oestrodiol + inhibin-A

Answer 609

chorionic villus sampling amniocentesis

Answer 610

regular thyroid checks - 2 yearly echo regular audiometry regular eye checks

Answer 611

trisomy 13

Answer 612

trisomy 18

Answer 613

Rocker(rounded)-bottom feet low birth weight prominent occiput small mouth and chin short sternum flexed overlapping fingers cardiac and renal malformations

Answer 614

structural defects of brain scalp defects small eyes and eye defects cleft lip and palate polydactyly cardiac and renal malformations

Answer 615

fragile X mental retardation 1 gene on X chromosome males are always affected but females vary

Answer 616

intellectual disability long narrow face large ears large testes after puberty hypermobile joints ADHD ASD Seizures

Answer 617

UBE3A gene on chromosome 15

Answer 618

fascination with water happy demeanour wide spaced mouth and teeth learning and developmental delay Fair skin, light hair, blue eyes epilepsy

Answer 619

loss of functional genes on proximal arm of chromosome 15 inhertied from father

Answer 620

constant insatiable hunger hypotonia mild/moderate learnign disability hypogonadism dysmorphic - narrow forehead, almond eyes, thin upper lip, downturned mouth mental health problems

Answer 621

growth hormone - for improving muscle development an body composition dieticians, education support, psych, physio, OT

Answer 622

short stature broad forehead downward sloping eyes with ptosis hypertelorism (widespaced eyes) prominent nasolabial folds low set ears webbed neck widely spaced nipples

Answer 623

congenital heart disease Undescended testes learning disability lymphoedema increased risk of leukaemia and neuroblastoma

Answer 624

deletion on chromosome 7 - usually random rather than inherited

Answer 625

broad forehead starburst iris flattened nasal bridge long philtrum wide mouth and spaced teeth small chin sociable and trusting personality mild learning disability

Answer 626

supravalvular aortic tenosis hypercalcaemia ADHD hypertension

Answer 627

echo and BP monitoring low calcium diet

Answer 628

children with proximal weakness get onto their hands and knees then go into downward dog and push themselves up using their hands MUSCULAR DYSTROPHY

Answer 629

Gower's sig

Answer 630

duchennes muscular dystrophy beckers muscular dystrophy faciosapulohumeral muscular dystrophy oculopharyngeal muscular dystrophy limb-girdle muscular dystrophy emery-dreifuss muscular dystrophy

Answer 631

X-linked recessive

Answer 632

25-35 years

Answer 633

oral steroids - slow progress of muscle weakness creatine supplements improve muscle strength

Answer 634

8-12 years

Answer 635

progressive muscle weakness prolonged muscle contractions cataracts cardiac arrhythmia

Answer 636

weakness around face progressing to shoulders and arms sleeping with eyes slightly open weak pursing lips unable to blow out cheeks without air leaking from mouth

Answer 637

bilateral ptosis restricted eye movements swallowing problems usually presents in alate adulthood

Answer 638

presents in teenage years with progressive weakness around limb girdles - hips and shoulders

Answer 639

presents in childhood with contractures which restricts range of movement also progressive weakness and wasting of muscles starting with upper arms and lower legs

Answer 640

chromosome 7 cystic fibrosis transmembrane conductance regulatory gene

Answer 641

Chloride channels

Answer 642

thick pancreatic and biliary secretions causing blockages low vllume thick airway secretions congenital bilateral absence of vas deferens

Answer 643

autosomal recessive

Answer 644

hereditary clubbing cyanotic heart disease infective endocarditis CF TB IBD Liver cirrhosis

Answer 645

newborn blood spot test sweat test - GOLD genetic testing

Answer 646

pseudomonas aeruginosa

Answer 647

long termtobramycin nebs or oral ciprofloxacin

Answer 648

multidisciplinary chest physio exercise high calory diet creon tablets prophylactic flucloxacillin tx infections bronchodilators DNase Nebs hypertonic saline nebs vaccination

Answer 649

mycobacterium tuberculosis

Answer 650

Zeihl-neelson stain acid-fast bacilli that turn red against blue background on Z-N

Answer 651

cough haemoptysis lethargy fever/night sweats wt loss lymphadenopathy erythema nodosum spinal pain

Answer 652

mantoux test interferon gamma release assay

Answer 653

for TB inject tuberculin proteins into intradermal space and measure size of injection site at 72 hours - >5mm = positive

Answer 654

millet seeds uniformally distributed

Answer 655

RIPE Rifampicin - 6 months Isoniazid - 6 months Pyrazinamide - 2 months Ethanbutol - 2 months

Answer 656

isoniazid and rifampicin 3 months or isoniazid for 6 months

Answer 657

red/orange piss and tears reduced CYP450 drug effectiveness - COCP hepatotoxic

Answer 658

pyridoxine (vit B6)

Answer 659

peripheral neuropathy hepatotoxic

Answer 660

hyperuricaemia => gout and kidney stones hepatotoxic

Answer 661

colour blindness reduced visual acuity

Answer 662

testicular torsion infertility testicular cancer

Answer 663

FHx low birth weight small for gestational age prematurity maternal smoking

Answer 664

watch and wait for 3 months then refer orchidopexy between 6-12 months

Answer 665

teenage boy unilateral testicular pain abdo pain and vomiting often triggered by sport

Answer 666

firm swollen testicle elevated esticle absent cremasteric reflex abnormal testicular lie rotation so epididymis is not posterior

Answer 667

bell-clapper deformity - testicle hangs in more horizontal position

Answer 668

nil by mouth analgesia urgent senior urology assessment surgical exploration of scrotum orchiopexy orchidectomy if needed

Answer 669

whirlpool sign - spiral appearance of spermatic cord and blood vessels

Answer 670

usually picked up on blood spot prolonged neonatal jaundice poor feeding constipation increased sleeping reduced activity slow growth and development

Answer 671

antithyroid peroxidase antibodies and antithroglobulin antibodies

Answer 672

congenital deficiency in 21-hydroxylase enzyme causing underproduction of cortisol and aldosterone and overproduction of androgens (testosterone) Causes increased sodium and potassium excretion

Answer 673

autosomal recessive

Answer 674

enlarged clitoris in females hyponatraemia hyperkalaemia hypoglycaemia poor feeding vomiting dehydration arrhythmias SKIN HYPERPIGMENTATION

Answer 675

female - tall for age - facial hair - absent periods - deep voice - early puberty Males - tall or age - deep voice - large penis - small testicles - early puberty

Answer 676

cortisol replacement - hydrocortisone aldosterone replacement - fludrocortisone virilised genitals corrective surgery

Answer 677

X-linked recessive due to mutation on androgen receptor gene on X-chromosome in XY males

Answer 678

cells are unresponsive to androgen hormones due to a lack of androgen receptors leading to excess androgens which are converted to oestrogen resulting in female secondary sexual characteristics and external female phenotypes from birth. Internally there are testes in the abdo/inguinal canal but no internal female organs due to the testes releasing anti-Mullerian hormone

Answer 679

inguinal hernias primary amenorrhoea

Answer 680

Raised LH normal/raised FSH Normal/raised testosterone for a man Raised oestrogen for a man

Answer 681

bilateral orchidectomy - testicular tumours oestrogen therapy vaginal dilators and surgery

Answer 682

abdo pain haematuria lethargy fever HTN Weight loss Abdo mass

Answer 683

surgical excision +/- nephrectomy +/- adjuvant chemo/radio

Answer 684

up to 90% cure in early stages

Answer 685

1st - ALL 2nd - AML

Answer 686

Down syndrome kleinfelter syndrome Noonan syndrome faconi's anaemia

Answer 687

80% cure rate

Answer 688

failure of treatment stunted growth and development immunodeficiency and infection neurotoxicity infertility secondary malignancy cardiotoxicity

Answer 689

type 2 hypersensitivity reaction that casues antibodies to target and destroy platelets either spontaneously or triggered due to viral infection

Answer 690

prednisolone IVIG blood transfusion if required platelet transfusion may work temporarily

Answer 691

chronic ITP anaemia intracrania and subrachnoid haemorrhage GI bleeds

Answer 692

physiological anaemia anaemia of prematurity blood loss haemolysis twin-twin transfusion syndrome

Answer 693

normal dip in haemoglobin at 6-9 weeks due to high O2 at birth

Answer 694

less time in utero getting iron from mum RBC production cant keep up with growth reduced EPO blood tests

Answer 695

albendazole or mebendazole

Answer 696

acid from stomach is required to comvert iron into ferrous (Fe2+) form so PPIs can interfere with absorption also coeliac or chrons

Answer 697

direct coombs test

Answer 698

factor VIII

Answer 699

X-linked recessive

Answer 700

intracranial haemorrhage haemarthrosis compartment syndrome

Answer 701

a glycoprotein important in platelet adhesion and aggregation (formation of platelet plug)

Answer 702

1 - partial deficiency 2 - reduced function 3 - complete deficiency

Answer 703

desmopressin (stimulated release of vWF from endothelial cells) Tranexamic acid vWF infusion +/- factor VIII

Answer 704

tranexamic acid mefanamic acid mirena coil COCP norethisterone

Answer 705

rare inherited disorder of gradual bone marrow failure and birth defects eventually leading to aplastic anaemia

Answer 706

an X linked disorder Causes hypogonadotrophic hypogonadism due to failure of GnRH release Delayed puberty Low sex hormones, LH and FSH differentiating feature of INABILITY TO SMELL

Answer 707

deficits in social interaction communication and behaviour

Answer 708

lack of eye contact delay in smiling avoids physical contact unable to read non-verbal cues difficulty establishing friendships no desire to share attention (play with others)

Answer 709

delay, absence or regression in language lack of appropriate non-erbal communication difficulty with imaginative or imitative behaviours repetitive use of words or phrases

Answer 710

greater interest in things than people sterotypical repetitive movements intensive deep interests repetitive behaviours and fixed routines anxiety and distress with deviation from routine extremely restricted food preferences

Answer 711

very short attention span quick moving from one activity to another quick loss of interest in task or inability to persist with challenging task constantly moving or fidgeting impulsive behaviour disruptive or rule breaking

Answer 712

methyphenidate - ritalin dexamfetamine atomoxetine

Answer 713

excessive wt loss amenorrhoea lanugo hair hypokalaemia hypotension hypothermia changes in mood cardiac complications

Answer 714

arrythmias cardiac atrophy sudden cardiac death

Answer 715

alkalosis on Blood gas hypokalaemia erosion of teeth swollen salivary glands mouth ulcers GORD calluses on knuckles (russels sign)

Answer 716

hypomagnesaemia hypokalaemia hypophosphataemia

Answer 717

slowly refeed magnesium, potassium, posphate and glucose monitoring fluid balance monitoring ECG monitoring supplementations with electrolytes, B vitamins and thyamine

Answer 718

Fluoxetine 10-20mg

Answer 719

appear unwell altered consciousness sunken eyes tachycardia tachypnoea reduced skin turgor dry mucous membranes decreased urine outpt

Answer 720

0.9% NaCl + 5% glucose

Answer 721

if well 10% dextrose if unwell seek advice

Answer 722

100 mk/kg/day 1st 10kg 50ml/kg/day 2nd 10kg 20 ml/kg/day >20kg

Answer 723

day 1 - 50-60 ml/kg/day 2 - 70-80 ml/kg/day 3 - 80-100 ,l/kg/day 4 - 100-120 ml/kg/day 5-28 - 120-150 ml/kg/day

Answer 724

(well weight - current weight)/well weight X100

Answer 725

% dehydration X weight (kG) X 10

Answer 726

maintenance fluid + fluid deficit

Answer 727

0.9% NaCl 10 ml/Kg <10 mins

Answer 728

males - 9 years females - 8 years development before this age is precocious puberty

Answer 729

Slipped upper femoral epiphysis (SUFE) idiopathic intracranial hypertension hypoventilation syndrome fatty liver disease T2DM PCOS HTN abnormal blood lipids

Answer 730

idiopathic/familial CNS abnormalities - congenital, tumours (neurfibromatosis, craniopharyngioma) Hypothyroism

Answer 731

adrenal tumour congenital adrenal hyperplasia ovarian/testicular tumour (granulosa/leydig cell) Exogenous sex steroids

Answer 732

6 months - 2 years fluctuating development of breast buds which is self limiting and does not require treatment

Answer 733

when pubic hair develops precociously with no other signs of sexual development most commonly caused by accentuation of normal maturation androgen. More common in non-white population. Leads to increased risk of PCOS in adult life.

Answer 734

>14 years in females >15 years in males

Answer 735

congenital/familial - most common hypogonadotrophic hypogonadism Hypergonadotrophic hypogonadism

Answer 736

systemic disease - CF, asthma, crohns Hypothalamo-pituitary disorders - tumours, kallman syndrome, pituitary dysfunction acquired hypothyroidism

Answer 737

chromosomal abnormalities - klinefelter syndrome, turner syndrome steroid hormone enzyme deficiencies acquired gonadal damage

Answer 738

brain tumour

Answer 739

astrocytomas - raneg from benign to the highly malignant glioblastoma multiforme

Answer 740

persistant/recurrent vomiting problems with balance, coordination or walking behaviour change abnormal eye movement seizures abnormal head positioning headache blurred/double vision lethargy deteriorating school work/developmental delay increasing head size in infants

Answer 741

2nd most common childhood brain tumour arises in midline of posteriod fossa and may spread through CSF to spinal mets

Answer 742

brain tumour that behaves much like medulloblastoma but arises in posterior fossa

Answer 743

malignant brain tumour with very poor prognosis

Answer 744

developmental tumour arising from squamous remnant of rathke pouch - non-malignant but locally invasive

Answer 745

neural crest tissue in adrenal medulla and sympathetic nervous system

Answer 746

mostly abdo mass but primary tumour may be anywhere along sympathetic chain from neck to pelvis pallor, wt loss, abdo mass, hepatomegally, bone pain, limp

Answer 747

urinary catecholamine metabolite levels (VMA/HVA) BIOPSY

Answer 748

autosomal dominant - incomplete penetrance chromosome 13

Answer 749

red reflex turns white squint

Answer 750

hepatoblastoma usually presents with bloating and abdo mass

Answer 751

2-6 months

Answer 752

around 32 weeks gestation - not fully developed until 36 weeks

Answer 753

around 2 months

Answer 754

around 2 months

Answer 755

around 4 months

Answer 756

10-20 year olds

Answer 757

femur tibia and humorous also common

Answer 758

persistent bone pain pain worse at night - disturb or wake from sleep bone swelling palpable mass restricted joint movement

Answer 759

periosteal reaction causing 'sun-burst' appearance of bone

Answer 760

raised ALP

Answer 761

pathological fractures metastasis

Answer 762

urgent (in 48 hours) x-ray and specialist assesment

Answer 763

osteosarcoma

Answer 764

ewing sarcoma

Answer 765

necrotising fasciitis - increase risk of bacterial infection

Answer 766

from 4 days pre-rash to around 5 days after rash appears when all crusted over

Answer 767

2 months, 4 months, 12 months

Answer 768

enterobius vermicularis

Answer 769

Mebendazole single dose for whole household only for >6 months

Answer 770

Hypochloraemia Hypokalaemia elevated bicarb

Answer 771

downs syndrome prader-willi syndrome growth hormone deficiency hypothyroid cushings syndrome

Answer 772

Ortho - SUFE, MSK Pains, Blounts disease Psycho - bullying, low self esteem sleep apnoea benign intracranial hypertension long term - T2DM, hypertension, IHD

Answer 773

sodium valporate

Answer 774

lamotrigine or levetiracitam

Answer 775

temporal lobes affect hearing, speech, memory and emotion may cause people to do things on autopilot

Answer 776

1 - lamotrigine or levitiracitam 2 - carbamazepine, oxcarbazepine, zonisamide. 3 - lacosamide

Answer 777

1 - ethosuximide 2 - sodium valporate/lamotrigine/levetiracitam

Answer 778

Lennox-Gastaut syndrome

Answer 779

1 - sodium valporate 2 - lamotrigine

Answer 780

sodium valporate/levetiracitam (girls)

Answer 781

lamotrigine, levetiracetam or topiramat

Answer 782

Prednisolone Vigabatrin

Answer 783

teratogenic liver damage/hepatitis Hair loss tremmor

Answer 784

increases activitiy of GABA

Answer 785

Agranulocytosis Aplastic anaemia Induces the P450 system so there are many drug interactions

Answer 786

Folate and vitamin D deficiency Megaloblastic anaemia (folate deficiency) Osteomalacia (vitamin D deficiency)

Answer 787

Night terrors Rashes

Answer 788

Stevens-Johnson syndrome or DRESS syndrome. These are life threatening skin rashes. Leukopenia

Answer 789

IV lorazepam x2 IV phenytoin/phenobarbital ITU

Answer 790

Buccal midazolam Rectal diazepam

Answer 791

autosomal dominant

Answer 792

mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene

Answer 793

short limbs (rhizomelia) with shortened fingers (brachydactyly) large head with frontal bossing and narrow foramen magnum midface hypoplasia with a flattened nasal bridge 'trident' hands - gap between middle and ring finger lumbar lordosis

Answer 794

SABA + ICS for 8 weeks + leukotriene receptor antagonist (LTRA) refer to secondary care

Answer 795

<200 micrograms

Answer 796

>400 micrograms

Answer 797

cryptorchidism inguinal hernia

Answer 798

Lumacaftor/Ivacaftor (Orkambi)

Answer 799

innocent murmur heard just below clavicles of blood returning to heart

Answer 800

innocent murmur of Low-pitched sound heard at the lower left sternal edge

Answer 801

soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area may vary with posture localised with no radiation no diastolic component no thrill no added sounds (e.g. clicks) asymptomatic child no other abnormality

Answer 802

encourage feeding + monitor

Answer 803

SCBU IV 10% dextrose

Answer 804

unilateral - only bilateral 10% of time

Answer 805

6 in 1 (DTaP, IPV, Hib, Hep B), Men B Rotavirus

Answer 806

6 in 1 (DTaP, IPV, Hib, Hep B) Pneumococcal Rotavirus

Answer 807

6in1(DTaP,IPV,Hib,HepB) MenB.

Answer 808

Hib/Men C Pneumococcal booster MMR Men B booster.

Answer 809

DTap/IPV - Diptheria, Tetenus, Petussus, Polio MMR.

Answer 810

Tetanus, diphtheria, polio Men ACWY.

Answer 811

Diphtheria Tetanus Pertussis Hib Hepatitis B Inactivated Polio Vaccine

Answer 812

8, 12 and 16 weeks

Answer 813

12 months and 3 years

Answer 814

8 and 12 weeks

Answer 815

8 and 16 weeks booster at 1 year

Answer 816

CNS Testes most likely to have secondary malignancies

Answer 817

0.1 units/kg/h

Answer 818

Acidotic Hyperglycaemia Ketonaemia Low Bicarb raised creatinine raised potassium

Answer 819

Cerebral oedema

Answer 820

slowing IV fluids IV mannitol IV hypertonic saline

Answer 821

pH 7.2- 7.29 or bicarbonate < 15 mmol/L. Assume 5% dehydrationwh

Answer 822

pH 7.1-7.19 or bicarbonate < 10 mmol/L. Assume 7% dehydration

Answer 823

pH less than 7.1 or serum bicarbonate < 5 mmol/L. Assume 10% dehydration

Answer 824

20 ml/kg bolus of 0.9% Sodium Chloride over 15 minutes

Answer 825

10 ml/kg 0.9% sodium chloride

Answer 826

when not in shock

Answer 827

0.9% sodium chloride with 20 mmol potassium chloride in each 500ml bag until glucose <14mmol/L

Answer 828

22q11.2 deletion congenital heart disease (e.g. tetralogy of Fallot), learning difficulties, hypocalcaemia, recurrent viral/fungal diseases, cleft palate

Answer 829

kassmaul breathing - seen in DKA

Answer 830

twitching numbness or tingling episodes usually at night or when tired

Answer 831

if symptomatic or BM <1 mmol/L

Answer 832

2.5 mg/Kg 10% dextrose

Answer 833

1 - macrogol laxative (movicol) 2 - senna if doesnt work after 1 week use lactulose if macrogol isn't tolerate

Answer 834

Swensen's procedure

Answer 835

hypermetropia (long sightedness)

Paediatrics Flashcards

(913 cards)