November 2024 Flashcards

Question

Oesophageal cancer ddx

Answer 1

Dysphagia intermittent = Achalasia Hoarseness and cough = also in Pancoast tumour but Horner is present and no GI symptoms

Answer 2

▪ Iatrogenic - 56% due to an endoscopy or paraesophageal surgery ▪ Boerhaave's syndrome- 10% ▪ Spontaneous perforation include: - Caustic ingestion - Pill esophagitis -Barrett's oesophagus -Infectious ulcers in AIDS patients - oesophageal strictures dilation

Answer 3

Plummer Vinson Syndrome/Syderopenic dysphagia

Answer 4

history of atopy (genetic tendency to develop allergic diseases): - eczema - asthma - rhinitis - hay fever - cow’s milk allergy - dietary allergens or aeroallergens - chronic, immune-mediated esophageal inflammation

Answer 5

Oesophageal SCC

Answer 6

- Prophylaxis: Beta blocker (propranolol or nadolol) - Endoscopic variceal/band ligation - If failed endoscopic or medical management TIPS (trans-jugular intrahepatic portosystemic shunt) - Active bleeding: Octreotide

Answer 7

Oesophageal varices 30%-60%

Answer 8

3-3.9cm = 2 yearly US 4-4.5cm = 1 yearly US 4.6-5cm = 6m US >5cm = 3m US >5.5cm (male) = surgical intervention

Answer 9

- family history 20% - **>50 years US**

Answer 10

- **>50 years fast US** - CT angiogram (before elective surgical repair)

Answer 11

- Cardiac/arterial **embolus** (eg, AF, LV thrombus, IE) - Local thrombosis from disruption of a **preexisting atherosclerotic plaque (PAD)** - Iatrogenic/blunt trauma

Answer 12

- **Paralysis** - Paraesthesia - Rest pain

Answer 13

- Rapid growth > 1cm yearly - Males > 5.5cm - Females > 5cm - Symptomatic (abdominal/back pain, tenderness, distal embolization)

Answer 14

embolectomy

Answer 15

not enough oxygen causes muscles to die releasing potassium outside the cell but restricted to the limb. When restoriung blood flow all the potassium will get into circulation causing hyperkalaemia in the heart and px dies due to AF/VF The same thing happens with the myoglobin gets into the circulation and gets into the kidneys causing blockage leading to AKI. Px doesn't pass any urine.

Answer 16

- nonfatal myocardial infarction and stroke in the next 5 years (20%) - death due to cardiovascular causes in the next 5 years (15%—30%) - The risk rises exponentially PAD progression 1-year risk of cardiovascular mortality in patients with critical limb ischemia (25%)

Answer 17

– Metabolic acidosis – Acute renal failure – Hyperkalaemia. – Myoglobinemia. – CK elevation

Answer 18

Thrombosis - lower limbs 80%

Answer 19

Triad: 1. abdominal and/or back pain 2. pulsatile abdominal mass 3. hypotension

Answer 20

- Context of a patient with: Thrombosis (most common cause) or Embolus from AF. 1. Pain (progressive) - Calf: Common femoral art / Superficial femoral art (MC site of occlusion). - Buttock: Common iliac/external iliac Thrombosis. 2. Paralysis - Foot drop = Peroneal nerve paralysis - Most reliable sign requiring Emergency Qx intervention 3. Pulselessness 4. Paraesthesia 5. Pallor 6. Poikilothermia

Answer 21

- Measure ABI - Doppler US - CT angiogram (gold standard) for surgical intervention

Answer 22

Golden time: 4 hrs 1. IV Unfractionated Heparin: 5000 IU then 1250IU/hour. APTT guides further adjustment. 2. Surgical treatment: Embolectomy - Can cause reperfusion injury (HyperK, metabacid, myoglobinuria, increased CK). Keep pt hydrated and perfused. - Arterial bypass is helpful if it is chronic limb ischemia. - Amputation is required only if there are irreversible ischemic changes. 3. After acute, give warfarin for 3m Angioplasty/Catheter

Answer 23

If Potassium >= 5.5: - Stop all K+ supplementation - Stop medication causing hyperK+ - Cardiac monitoring If px asymptomatic + normal EKG + K >= 5.5 <= 6: - Consider if treatment necessary. - ± Salbutamol Neb - ± Polystyrene sulfonate PR or oral - ± Bicarbonate IV if metabolic acidosis Patient Asymptomatic and Normal ECG and K+ >6 <=7mmoI/L: - Salbutamol NEB - Insulin/Glucose perfusion IV - ± Resonium PR or oral - Bicarbonate IV if metabolic acidosis Patient unstable or Symptomatic or Clearly abnormal ECG or K+>7mmoI/L: - Discuss dialysis - Consider transfer to tertiary centre. ↓ - Calcium IV - Salbutamol Neb - Insulin / Glucose IV - Bicarbonate IV if metabolic acidosis - ± Resonium PR or oral

Answer 24

Check if patient stable if stable: Initial: ECG Best: CT angio If unstable: fast US

Answer 25

- Preceding surgery/renal impairment: UFH - Medical Mangement only: LMWH (enoxaparin)

Answer 26

Ultrasound-guided thrombin injection

Answer 27

femoral artery catheterization 7.5%

Answer 28

- Claudication (pain w/ exercise and relieved by rest) - if pain at rest: 🚩🚩🚩 - Shiny hairless legs - Muscles atrophied

Answer 29

- Poor pulses (hallmark) - Shiny, hyperpigmented skin. -Hair loss & ulceration on the legs -Thickened nails. -Muscle atrophy. -Vascular bruits.

Answer 30

– Rest Pain – Ischemic ulceration – Gangrene – Claudication symptoms limiting day to day life & work, no improvement with risk factor modifications, exercises, medical management > 6 months

Answer 31

Measure ABI: 1-1.4: Normal 0.9: Borderline. Nothing <0.9: Manage risk factors - Smoke cessation - Antiplatelets (aspirin or clopidogrel) ONLY if clinically evident CVD - Statins (even in the absence of dyslipidemia) - ACE Inhibitors or ARBs. - Supervised exercise program. beta-blockers should be avoided until and unless they are commenced for cardioprotection(sys/dia cardia insufficency). For mixed ulcers (Do not use compression bandage if ABI <0.8) <0.4: Urgent referral

Answer 32

– Endovascular angioplasty or stenting – Open surgical reconstruction by bypass or endarterectomy

Answer 33

1. Measure ABI 2. Duplex US (often the only imaging required to plan endovascular interventions)

Answer 34

CT Angiography w/contrast (Contraindicated in RF)

Answer 35

Inhaled corticosteroids ICS : Fluticasone NOTE: Sodium cromoglycate in some cases

Answer 36

Short-acting β2 agonist (salbutamol)

Answer 37

Oxygen and short-acting beta-2 agonists (salbutamol) - 6 puffs for children 0-5 and up to 12 puffs for 6 years - wait 20 mins If the attack does not subside, up to 6 puffs can be given every 20 minutes for one hour. If the attack still does not subside, ipratropium bromide - 4 puffs by MDI + mask or 250 mcg by nebuliser for children 0-5 years - 8 puffs by MDI + mask or 500 mcg by nebuliser for children > 6 years Oral prednisolone 1 mg/kg for first 3 days after the asthma attack (prophylactic)

Answer 38

- 2 and 5 years -Bilateral wheezing - viral wheezing, pre-school wheeze, episodic viral wheeze and multiple trigger wheeze

Answer 39

dust mites 90% sheepskin 2nd most common

Answer 40

- less than one episode of asthma in 6 weeks and no symptoms in between the flare-ups - inhaled short-acting beta2 agonist (SABA)

Answer 41

symptoms at night >1 canister b2 agonists every 3 months using beta 2 agonists >2days /week asthma attacks >2/month infrquent asthma attacks but severe spirometry with reversible airflow obstruction

Answer 42

Right heart failure

Answer 43

fluid accumulation in the pericardial cavity → ↑intrapericardial pressure > diastolic ventricular pressure ↓ This restricts venous return to the heart and lowers right and left ventricular filling → ↓preload ↓stroke volume ↓cardiac output.

Answer 44

Chest pain + SOB+ viral infection Kussmaul sign. S4 Gallop: Cardiac Tamponade

Answer 45

◦ Patent Ductus Arteriosus – Paeds Has a harsh, machinery-like quality (Gibson murmur) ◦ Pericardial friction rub: Pericarditis or pericardial effusion. Not a real murmur. Has scratchy, scraping quality

Answer 46

1. ECG: - ST elevation except in AVR & V1 - Reciprocal PR 2. CXR: - Pericardial fluid - Pulmonary congestion 3. Echocardiogram: Is diagnostic! Chest FAST scan should be done ASAP. 4. Cardiac CT

Answer 47

- Viral infection: Coxsackie B, CMV, influenza, EBV, COVID, HIV - After a major heart attack or heart surgery: **Dressler syndrome**. - Systemic inflammatory disorders: Lupus, rheumatoid arthritis. - Trauma

Answer 48

Echocardiogram with drainage and culture (Pericardiocentesis)

Answer 49

 Constrictive pericarditis.  Cardiac tamponade

Answer 50

Mild to moderate Pericarditis 1. AAS/Ibuprofen (7 to 10 days) 2. Colchicine x 3 months. Indication: Recurrent symptoms (Side Effects: Diarrhea, abd pain) 3. Prednisone If infection: ATBs and drainage

Answer 51

Severe Pericarditis, include admision 1. Cardiac tamponade: Pericardiocentesis 2. Severe, Recurrent or Constrictive: Pericardiectomy

Answer 52

Restrictive Cardiomyopathy Diastolic Dysfunction with impaired filling – relaxation Normal Ejection fraction + S4 gallop

Answer 53

1. Young age 2. B-negative blood type 3. Prior history of pericarditis 4. Prior treatment with prednisone

Answer 54

1st LINE: NSAIDs in high doses (aspirin, ibuprofen, naproxen) tapered over 4 to 6 weeks. 2nd LINE: Corticosteroids (prednisone) tapered over a 4-week period 3rd LINE: Colchicine.

Answer 55

Gold Standard: Echocardiogram UNSTABLE patient: bedside ultrasonographic (E-FAST) ECG: Same pattern as pericarditis (global ST segment elevation and T wave inversion)

Answer 56

Cardiac Tamponade

Answer 57

Acute (<6w) Chronic (>6w).

Answer 58

Paradoxical: ↑ JVP with insp and ↓ JVP with exp) Means: constrictive and/or cardiac tamponade.

Answer 59

Pericarditis in the context of major heart attack or heart surgery

Answer 60

STEMI or pericarditis pattern.

Answer 61

coronary artery bypass grafting

Answer 62

Zenker's diverticulum (pharyngeal pouch)

Answer 63

Initial: Barium swallow/Contrast oesophagography Best: Upper gastrointestinal endoscopy

Answer 64

Surgery: cricopharyngeal myotomy ± diverticulectomy Laparoscopic surgery

Answer 65

- malignancy - infection - liver disease - DIC

Answer 66

- spherocytosis - hemorrhagic telangiectasia - Von Willebrand disease

Answer 67

- Factor 5 diseases - Fanconi’s anaemia - haemochromatosis

Answer 68

Immunocompromised - suspect HIV

Answer 69

coagulation factor deficiency

Answer 70

- Sepsis - Transfusion reactions - Neoplasm (adenocarcinoma, leukemia). - Trauma. - Obstetric complications (placental abruption, preeclampsia, septic abortion, retained dead fetus).

Answer 71

Treat underlying disorder (see causes) Platelets Packed RBC FFP Cryoprecipitate Consider IV heparin for thrombotic complications.

Answer 72

Epistaxis Petechiae purpura Bleeding from venipuncture site or incisional wounds Haematemesis Tachycardia Tachypnoea Respiratory failure

Answer 73

aspirin warfarin heparin

Answer 74

platelet issue

Answer 75

X - linked recessive = only males affected (1 in 5000) Factor VIII/IX deficiency Physical symptoms: Haemarthroses + muscle bleeds + delayed bleeding. haemoarthrosis: especially knees, ankles, elbows * Mild/moderate bleeding: after major trauma or surgery. * Severe: spontanaeous bleeding

Answer 76

Recombinant factor VIII/IX concentrates infusion

Answer 77

Supportive – bed rest and analgesia. * Corticosteroids – may reduce the duration of abdominal pain, but it is uncertain if they significantly affect other features. * Refer to a specialist if renal dysfunction, hypertension or surgical complications develop

Answer 78

* Onset 2–8 years most common. * lgA—mediated small vessel vasculitis * Post URTI * Large joint migratory arthritis of variable duration and severity. * Fever and fatigue * Non-TP * Evolving crops of palpable purpura (buttocks and legs) * Abdominal pain (occasionally melaena) may precede rash. * High risk of Intussusception * Nephritis w/ oedema: dorsum of the feet and hands, acute scrotal swelling and bruising

Answer 79

* Full blood examination (NO thrombocytopenia). * Urinalysis: haematuria/proteinuria. * Renal function: urea/creatinine and urinary protein estimation.

Answer 80

- Nearly always chronic - Duration > 14 days - 50% associated with HIV, SLE, CLL - Rarely recovers without treatment - Splenectomy usually required

Answer 81

- Acute onset - Follows viral infection or drug hx - Nearly always self limiting (90%) - 10% pass onto chronic ITP

Answer 82

Exclude ALL/AML Bone marrow aspiration: increased megakariocytes

Answer 83

Conservative management: - platelet count > 20 x 109/L - no active bleeding - isolated brusiing and petechiae - without mucousal, GI or renal tract bleeding Inpatient management: - Prednisolone for 2 weeks - IV Ig - Splenectomy in chronic cases

Answer 84

drug therapy (nsaids, anticaogulants)

Answer 85

Increased aPTT only: - Haemophilia A - Haemophilia B - Von Willebrand Increased aPTT + PT: - DIC - Heparin/Warfarin - Vit K deficiency

Answer 86

intrinsic pathway deficiency Factors: VIII IX XI XII

Answer 87

- Heparin/Warfarin - DIC - Vit K deficiency - Liver disease

Answer 88

extrinsic pathway deficiency Factors: II VII IX? X

Answer 89

- ADAMTS 13 deficiency - bleeding disorders: Von Willebrand - cocaine - chronic rhinitis/sinusitis - nasal cavity ulcers/ perforation - nasal polyps

Answer 90

Blood film: - Prolonged bleeding time - schistocytes (helmet cells) - High creatinine - Normal coagulation profile FBC: - anaemia - thrombocytopenia.

Answer 91

- Platelet transfusion is **contraindicated.** - Plasma exchange transfusion - FFP (maybe)

Answer 92

Clinical symptoms: - Easy bleeding/epistaxis - Neurological symptoms: confusion, seizures, headache - Thrombosis - Renal dysfunction On examination: - Fever - Pallor - Purpura/petechiae - Jaundice - Splenomegaly

Answer 93

ADAMTS 13 deficiency ▪ Haemolytic uraemic syndrome ▪ Drugs (quinine, ticlopidine, clopidogrel,cyclosporine). ▪ SLE ▪ Infections ▪ AIDS ▪ Malignancies

Answer 94

IV Vit K Severe bleeding: FFP

Answer 95

Easy bruising. Oozing from nose or gums. Excessive bleeding from wounds, injection or surgical sites. Heavy menstrual periods. Bleeding from the gastrointestinal (GI)tract. Blood in the urine and/or stool.

Answer 96

Required for the function of factors II, VII, IX, X, protein C, protein S. Associated with malabsorption, cholestatic disease.

Answer 97

- Autosomal dominant - Most common in girls (although genders equal) - vWF defect resulting in decreased factor VIII + platelet adhesion to each other/ blood vessel wall - Impaired platelet-endothelial binding - bleeding exacerbated by NSAIDs/aspirin - PT normal -aPTT prolonged Physical symptoms: - minor surgical bleeding: **dental, incisions** - epistaxis (common) - menorrhagia - bruising - gingival bleeding

Answer 98

Ristocetin co-factor assay (best test)

Answer 99

SURGERY - A single dose of DDAVP (Desmopressin) - vWF concentrate - Menorrhagia: Tranexamic acid DENTAL EXTRACTION: - Tranexamic acid preoperatively and continue for 1-5 days. - Single dose of DDAVP or/and single dose of vWF concentrate

Answer 100

Haemophilia A Haemophilia B - Glucose-6-phosphate dehydrogenase deficiency

Answer 101

Graft-versus-host disease

Answer 102

- Autoimmune gastritis - Terminal ileum disease - Gastrectomy - Metformin therapy - Coeliac disease - H.pyelori infection - Crohn disease - Postgastrectomy

Answer 103

pernicious anaemia

Answer 104

Thrombotic thrombocytopenic purpura (TTP)

Answer 105

- replacement fluid - fresh frozen plasma

Answer 106

Multiple myeloma

Answer 107

Initial: & diagnostic: serum and urinary electrophoresis

Answer 108

Serum transferrin saturation - >60% men - 50% women

Answer 109

- measure Factor 8 level at 1st antenatal visit and at 32 weeks - majority develop normal level of factor 8 and do not require replacement

Answer 110

Fanconi’s anaemia

Answer 111

acute myeloid leukaemia (AML)

Answer 112

Acute Promyelocytic myeloid leukaemia (APML)

Answer 113

B12 deficiency

Answer 114

Diagnostic: Chromosome fragility test

Answer 115

Iron deficiency anaemia

Answer 116

Occult blood loss

Answer 117

– Polycythemia vera. – Hyposplenism due to splenectomy. – Iron deficiency anemia. – Correction of vitamin B12 and folic acid deficiency

Answer 118

Polycythaemia vera

Answer 119

- JAK2 mutation positive - Increased blood viscosity - Elevated haemoglobin - Leucocytosis & thrombocytosis - Low erythropoietin level

Answer 120

- Phlebotomy - Hydroxyurea (if ↑ risk of thrombus)

Answer 121

Glucose-6-phosphate dehydrogenase deficiency

Answer 122

Glucose-6-phosphate dehydrogenase deficiency

Answer 123

1- Spherocytosis persists after splenectomy, the cells survive longer in the circulation. 2-Decrease in reticulocytosis. 3- RBC fragility remains high resulting short life span of red blood cells 4- Fall in elevated bilirubin 5- In severely affected patients, life-threatening anaemia

Answer 124

1. Hand and arm anomalies (misshapen,missing or extra thumbs or abnormalities of the radius) 2. Skeletal anomalies of the hips, spine or ribs 3. Skin discolouration (café au lait spots, hypopigmentation) 4. Small head or eyes 5. Low birth weight and subsequent short stature 6. Missing or horseshoe kidney 7. Gastrointestinal abnormalities including abnormal development of the oesophagus

Answer 125

Hematopoietic stem cell transplant

Answer 126

spectrin ancyrin protein 4.1

Answer 127

C - hypercalcaemia 13% R - renal impairment 20–40% A - anaemia 70% B - bony lesions

Answer 128

haemochromatosis

Answer 129

intrinsic factor

Answer 130

-Trisomy 21 noted in Down syndrome. -Fanconi anaemia. -Ataxia-telangiectasia. -Myeloproliferative syndromes.

Answer 131

Immunoglobulin A deficiency

Answer 132

Myelodysplasia

Answer 133

Antecedent viral illness

Answer 134

β-Thalassemia

Answer 135

Iron deficiency

Answer 136

Folate deficiency

Answer 137

High MCV megaloblastic anemias - Vitamin B12 (cobalamin) - folate deficiency - vigorous reticulocytosis - hypothyroidism - chronic liver disease - myelodysplastic syndrome

Answer 138

Low MCV iron deficiency thalassemia, anaemia of chronic disease sideroblastic anaemia (Vitamin B6 (pyridoxine) deficiency)

Answer 139

Cause | MCV | Iron | TIBC | Ferritin | Transferrin Saturation Iron Deficiency | ↓ | ↓ | ↑ | ↓ | ↓ Thalassemia | ↓↓ | ↑ | ↓ | ↑ | ↑↑ Anaemia of |Normal/↓ | ↓ | ↓ | Normal/↑ | Normal/↓ chronic disease

Answer 140

Vitamin B6 (pyridoxine) deficiency

Answer 141

hypochromic and normochromic RBC's

Answer 142

Folate deficiency

Answer 143

Chronic lymphocytic leukaemia (CLL)

Answer 144

Chronic lymphocytic leukaemia (CLL)

Answer 145

Congestive cardiac failure

Answer 146

Low haptoglobin

Answer 147

Heinz Bodies

Answer 148

pancytopenia/aplastic anemia

Answer 149

- NSAIDs - Sulphonamides. – Gold. – Anti-epileptic drugs (carbamazepine, valproic acid, phenytoin). – Nifedipine. – Chloramphenicol.

Answer 150

- Subcutaneous deferoxamine - Splenectomy - Erythrocytopheresis

Answer 151

- Vaccination - Penicillin (until age 5) - Folic acid supplementation - Hydroxyurea (for patients with recurrent vaso-occlusive crises)

Answer 152

- Hydration - Analgesia - +/- Transfusion

Answer 153

Hydroxyurea NOTE: side-effect is myelosuppression neutropenia, anaemia, thrombocytopenia

Answer 154

1. higher levels of beta-2 microglobulin 2. lower levels of albumin

Answer 155

myelodysplasia

Answer 156

Bone marrow biopsy

Answer 157

agranulocytosis

Answer 158

1-Haemolytic Anaemia and jaundice. 2-Splenomegaly. 3- elevated mean corpuscular hemoglobin concentration (MCHC) 4-Positive family history of anaemia, jaundice, or gallstones. 5-Spherocytosis with increased reticulocytes. 6-Increased osmotic fragility. 7-Negative direct antiglobulin test (DAT).

Answer 159

1. Liver disease 2. cardiomypathy

Answer 160

Progressive hepatic cirrhosis

Answer 161

Von Willebrand disease

Answer 162

Bone infarction (can lead to avascular necrosis)

Answer 163

non-Hodgkin lymphoma

Answer 164

GI tract most common site - 3% of all malignant gastric tumors - Surgery alone can be considered adequate treatment that does not infiltrate beyond the submucosa -

Answer 165

diagnostic: hemoglobin electrophoresis

Answer 166

- typically mucocutaneous - Bleeding is usually less severe and less frequent than thrombosis - Arterial thromboses are more common than venous thrombosis - Strokes are more frequent followed by myocardial infarction and peripheral arterialocclusion

Answer 167

Activated partial thromboplastin time (aPTT)

Answer 168

heparin induced thrombocytopenia

Answer 169

Type 1 : first 2 days after exposure, platelet count normalizes with continued heparin therapy. non-immune Type 2: typically occurs 4-10 days after exposure, immune-mediated disorder - Venous limb gangrene - Bilateral adrenal hemorrhagic infarction - Skin lesions at injection sites - Acute systemic reactions following an i- ntravenous heparin bolus

Answer 170

discontinue and avoid all heparin products immediately

Answer 171

1st line: corticosteroids such as prednisolone chemotherapy if needed

Answer 172

Positive Coombs test

Answer 173

schistocytes Hemolytic anemia

Answer 174

Decreased serum haptoglobin level

Answer 175

hemolytic uremic syndrome (HUS).

Answer 176

Haemolytic uremic syndrome (HUS)

Answer 177

Transfusion-related acute lung injury (TRALI)

Answer 178

Hodgkin lymphoma (HL)

Answer 179

- Bimodal peak incidence: age 15-35 & > 60 - Association with EBV in the immunosuppressed

Answer 180

- Painless lymphadenopathy - Mediastinal mass - Fever, sweats, weight loss - Pruritus

Answer 181

Supraclavicular lyphadenopathy

Answer 182

Lymph node excision biopsy - Reed-Sternberg cells on histology

Answer 183

– Confusion of new onset. – Urea greater than 7 mmol/l. – Respiratory rate of 30 breaths per minute or higher. – Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less. – Age 65 or older CURB-65 score equal or >3, an inpatient treatment for community acquired pneumonia is necessary.

Answer 184

IV benzyl penicillin and azithromycin

Answer 185

Aspiration pneumonia

Answer 186

1st line: ampicillin-sulbactam (1.5 to 3 g IV every 6 hours)

Answer 187

oral streptococci

Answer 188

IV ticarcillin-clavulanate

Answer 189

Small cell lung carcinoma -Ectopic production of adrenal corticotropin (ACTH)

Answer 190

Ectopic production of ACTH can lead to Cushing's syndrome - hypokalaemia

Answer 191

- COPD - Emphysema

Answer 192

bronchiectasis

Answer 193

High-res CT

Answer 194

Use of accessory muscles upon inspiration

Answer 195

Postoperative atelectasis

Answer 196

1. Removal of impacted secretions by coughing, managed by physiotherapists, and involves active chest percussion and breathing exercises. 2. oxygen supplementation 3. Passive postural drainage. 4. bronchoscopy if px still hypoxic

Answer 197

Restrictive airway disease

Answer 198

Obstructive airway disease

Answer 199

chemotherapy and radiation

Answer 200

- pH always below 7.30 - Pleural/serum protein ratio greater than 0.5 - Pleural/Serum lactic dehydrogenase ratio of greater than 0.6 - Glucose concentration (30-50 mg/dL) - Bloody pleural fluid is strongly suggestive of malignancy

Answer 201

Hypoxic pulmonary vasoconstriction

Answer 202

– Cystic fibrosis. – Interstitial pulmonary fibrosis. – Lung cancer – Interstitial lung disease - bronchiectasis

Answer 203

Legionnaires disease

Answer 204

allergic bronchopulmonary aspergillosis

Answer 205

Isoniazid (5mg/kg up to a maximum 300mg daily) for 9 months

Answer 206

chest CT angiogram

Answer 207

adenocarcinoma

Answer 208

FNAC gold standard

Answer 209

squamous cell carcinoma

Answer 210

hypersensitivity pneumonitis (alveolitis)

Answer 211

Pneumocystis jiroveci pneumonia

Answer 212

Alpha-1 antitrypsin (AAT) deficiency

Answer 213

Antifibrotic therapy

Answer 214

Sarcoidosis Lofgren syndrome

Answer 215

Byssinosis doesn't cause COPD

Answer 216

75-100 mmHg

Answer 217

35-45 mmHg

Answer 218

22-26 meq/L

Answer 219

Sarcoidosis

Answer 220

Primary spontaneous pneumothorax (PSP)

Answer 221

PSP < 15%: observation PSP > 15%: needle aspiration SSP: mechanical ventilation (can't put needle into an already damaged lung) Symptomatic SSP: Catheter drainage/water sealed thorcostomy

Answer 222

Secondary spontaneous pneumothorax (SSP)

Answer 223

ICS - fluticasone - beclomethasone - budesonide Montelukast if ICS contraindicated NOTE: Montelukast is associated with nightmares in children

Answer 224

mesothlioma

Answer 225

using preventer if they use salbutamol more than 3x week

Answer 226

obstructive disease

Answer 227

restrictive disease

Answer 228

emotional changes gord allergies pregnancy occupational hazards dust mites

Answer 229

- pulmonary fibrosis - pneumothorax

Answer 230

- asthma - COPD

Answer 231

triad: dyspnoea + wheeze + cough fev1/fevc ratio < 75 PEF: improvement in fev1 more > 12% after medication (salbutamol) - prolonged expiration - resonant - expiratory wheeze respiratory acidosis

Answer 232

mild: moderate: severe:

Answer 233

1. <94% oxygen saturation 2. altered mental state 3. effort on breathing 4. struggling to talk

Answer 234

can only be used in exacerbation, not for long term prolonged use of oral steroids (prednisolone): - Cushing syndrome, - osteoporosis, - immunosuppression

Answer 235

- wheezing - respiratory rate

Answer 236

Infectious mononucleosis

Answer 237

- Trauma - Spontaneous rupture (mononucleosis) - Hypersplenism (ITP) - Neoplasia

Answer 238

**Initial:** FBC - Atypical lymphocytosis (>50%) - ESR: Differentiate between IM (elevated) & Strep pharynitis (normal) **Diagnostic:** Positive heterophile antibody (Monospot) test Transient hepatitis

Answer 239

- Supportive treatment: rest, fluids, analgaesia - Symptoms resolve within 1-2 weeks - Avoid sports due to risk of splenic rupture

Answer 240

Serum sickness

Answer 241

- Remove/avoid offending agent - Supportive care - Steroids or plasmapheresis if severe

Answer 242

- highly specific for the diagnosis of SLE - flat, scaly, non-pruritic and characteristically spares the nasolabial fold

Answer 243

(ANA) is indicated as the best initial screening test. The dsDNA is 90% specific

Answer 244

Anti-citrullinated peptide antibody Anti-CCP

Answer 245

- **Anaemia, leukopenia, thrombocytopenia** - most common presentation of this arthritis is symmetrical polyarthritis affecting the hands, wrist and knees. - affects women in high oestrogen period - more common in females of African American, Hispanic, and Asian descent - weight loss - malar rash and oral ulcers

Answer 246

- thrombotic microangiopathy - severely reduced activity of the von Willebrand factor-cleaving protease ADAMTS13 - small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia, and sometimes organ damage

Answer 247

1- Renal insufficiency. 2-Cytopenias. 3-Abnormal liver functions. 4-Sepsis.

Answer 248

- Peak incidence: age 5-15 - Twice as common in girls - Major symptoms: JONES *Joints (migratory arthritis) * ❤️ (Carditis) * Nodules (subcutaneous) * Erythema marginatum * Sydenham chorea - Minor symptoms: FEAP * Fever * Arthralgias * Elevated ESR/CRP * Prolonged PR interval

Answer 249

Mitral regurgitation/stenosis

Answer 250

group A streptococcal infection along with 2 major or 1 major plus 2 minor (J❤️NES)

Answer 251

carditis chorea elevated ESR

Answer 252

Hand foot and mouth disease

Answer 253

myocarditis

Answer 254

late summer early autumn

Answer 255

Coxsackie (HFM)

Answer 256

AC>BC = Normal/SNHL BC>AC= CHL

Answer 257

Girls: 8 years Boys: 9 years

Answer 258

- hyponatremia - excessive amount of ADH from hypothalamus-pituitary

Answer 259

Dehydration: hypernatremia Cardiac: Pseudohyponatremia Addisons: - Low aldosterone - Hyperkalaemia - hypotension

Answer 260

- nausea and vomiting - headache - problems with balance - mental changes (confusion, memory problems) - seizures or worst case, coma

Answer 261

- type 2 DM medication: - antiepileptic - antidepressant - surgery under general anaesthesia - brain disorders, injury, infections, stroke - lung disease (pneumonia, tuberculosis, cancer, chronic infections) - cancer of lung, small intestine, brain, leukaemia

Answer 262

Normal = lateralizes equally to both ears CHL= lateralizes to abnormal ear SNHL= lateralizes to the normal ear

Answer 263

- Age (6-18 months) - Lack of breastfeeding - Day care attendance - Smoke exposure

Answer 264

- Streptococcus pneumoniae (most common) - Nontypeable (?) Haemophilus influenzae - Moraxella catarrhali

Answer 265

Acute mastoiditis

Answer 266

**sample from the ear discharge should be taken for culture** DONE BY ENT flucloxacillin + a third-generation cephalosporin

Answer 267

- Amoxicillin 1st choice (used for 1 week) - 2nd line: amoxicillin-clavulanate

Answer 268

- clindamycin - azithromycin

Answer 269

Assess if tympanic membrane intact or perforated: If intact: ciprofloxacin ear drops to treat on going infection If perforated: initial treatment ear toilet with povidone-iodine solution, followed by dry mopping with rolled toilet papers2 to 3 times a day using 20ml syringe with plastic tubing. In addition, ciprofloxacin ear drops

Answer 270

- Marginal perforation with discharge - Perforation that is surrounded by granulation tissue - Continuously discharging central perforation - Perforation associated with a cholesteatoma

Answer 271

- history of recurrent acute otitis media - chronic middle ear effusion - tympanostomy tube placement - history of cleft palate

Answer 272

Weight loss Sustained fever Night sweats Generalized lymphadenopathy Signs and symptoms of pancytopenia Mass persisting> 6 weeks Lymph node> 3 cm Thyroid mass Supraclavicular mass Hard, irregular mass Fixed mass

Answer 273

Weight: overweight/underweight

Answer 274

Weight: obese/severely underweight

Answer 275

- autosomal dominant connective tissue disorder (FBN1) - **affects height** - **does not affect weight** - aortic aneurysm dissection, aortic regurgitation (Decrescendo high-pitched diastolic murmur at the left sternal edge) - Myopia and ectopic ocular lens.

Answer 276

- Nausea - Vomiting

Answer 277

viral upper respiratory tract infection TB, Infectious mononucleosis cytomegalovirus infection Cat scratch disease haematological and nonhematological malignancies, Kawasaki disease.

Answer 278

Growing pains refers to pain in the lower extremities of growing active children. children between 2 and 12 years with the peak incidence in preschool children. mostly felt in the thighs, calves and behind the knee. intermittent and in mostly present in the afternoon and evening after activity during the day. Pain may also wake up the child at night.

Answer 279

- avascular necrosis of the femoral head. 4 -8 years of age associated with hip pain and intermitent limp.

Answer 280

- 3-8 years - URTI hx - sudden onset unilateral hip or groin pain most common sx - medial thigh or knee pain 2nd common sx Arthralgia and arthritis secondary to synovium inflammation - no fever, or only a mild fever

Answer 281

– H. influenzae **High fever**, sore throat, dysphagia, odynophagia, **drooling** due to inability to swallow the saliva because swallowing is painful and difficult. child miserable adopts a tripod position with a **hyperextended neck** to maintain the airway open. Muffled voice (hot potato voice) Lungs are clear on auscultation initiallt later **expiratory stridor** (ominous sign.)

Answer 282

more common between ages 2 and 4 years;

Answer 283

U/L wheeze

Answer 284

- 2 and 5 years -Bilateral wheezing - viral wheezing, pre-school wheeze, episodic viral wheeze and multiple trigger wheeze

Answer 285

B/L perihilar infiltrates

Answer 286

mild: no treatment moderate/severe: -**Dexamethasone 0.3 mg/kg orally (first-line);** - Prednisolone 1mg/kg orally, or - Budesonide 2mg by nebulizer most severe with significant airway obstruction/fatigue: Adrenaline 1% (1:100, 10mg/ml) solution 0.05ml/kg/dose

Answer 287

1. Congenital 2. Inflammatory/ infective 3. Neoplastic

Answer 288

**CCP** - Cystic hygroma - Cervical rib - Pancoast tumour - (Naso/oropharyngeal squamous cell carcinomas)

Answer 289

- thyroglossal duct cyst (TDC) - teratomas - sternocleidomastoid tumours of infancy - vascular or lymphatic malformations.

Answer 290

**BCC** - Branchial cyst - Carotid body tumour - Carotid aneurysm

Answer 291

**TTD ** - Thyroid nodule - Thyroglossal cyst - Dermoid cyst

Answer 292

Major criteria: - Carditis -Polyarthritis -Chorea. -Subcutaneous nodules. -Erythema marginatum - Polyarthritis or aseptic mono-arthritis or polyarthralgia Minor criteria -Fever more than 38c -Previous rheumatic fever -Arthralgia -Raised ESR/CRP more than 30 -ECG shows prolonged PR interval

Answer 293

- **Normal Caucasian boy** - 4 and 10 years, peak incidence at 5 to 7 years - 15% bilateral - widening of joint hip space Hip pain result of **necrosis of the involved bone** -pain may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh. - The quadriceps muscles and adjacent thigh soft tissues may atrophy, and the hip may develop **adduction flexion contracture** - **antalgic gait** with limited hip motion, or a Trendelenburg gate (abductor lurch). - Pain may be present with passive range of motion and limited hip movement, **especially internal rotation and abduction**

Answer 294

2 major and 2 minor criteria - **history of sore throat 3 weeks** -**migratory arthralgia/arthritis** - Erythema marginatum - well demarcated bright red/pink macules rash

Answer 295

Conservative: Splinting Surgery: osteotomy

Answer 296

2 major criteria OR one major and two minor criteria + Evidence of preceding GAS infection

Answer 297

Two major criteria OR one major and two minor criteria OR three minor criteria + Evidence of preceding GAS infection

Answer 298

Cultures for GAS are the gold standard (Throat swab)

Answer 299

vaginal foreign body

Answer 300

- Vaginal foreign body - Severe vulvovaginitis - Trauma (including straddle injury and sexual abuse) - Excoriation associated with threadworms - Onset of first menstruation - Haematuria - Urethral prolapse

Answer 301

- **Infection** -Malignancy 1% - Overgrowth and pressure of the underlying structures. - Rupture and fistula formation

Answer 302

- caused by chemical irritants such as bubble baths or by poor hygiene - stop bubble baths and use only cotton underwear

Answer 303

- Spontaneous resolution <5 years (84%) - Bed wetting alarms >5 years and conservative methods (fluid intake, toileting, reward system) failed + wetting >2 per week - nasal desmopressin alternative bed wetting alarm.

Answer 304

- Norovirus 95% aus - faecal--oral route - Contaminated food and water (cold meats) - 12 to 24/48 hour incubation period - noninflammatory, nonbloody, non-mucoid

Answer 305

Common: - Nausea - Vomiting - Diarrhoea - Abdominal cramps Not common: - Headache - Low-grade fever - Chills - Muscle aches - Malaise

Answer 306

Symptomatic

Answer 307

> 1+ protein on urine dipstick exam - perform urinalysis for confirmation

Answer 308

- Hypothyroidism (check TSH) - Excessive caloric intake - Cushing's disease (ACTH, cortisol)

Answer 309

Streptococcus pneumoniae

Answer 310

- preoccupations with activities - objects - delayed speech language development - Aggression and irritability - poor communication with friends and avoiding eye contact

Answer 311

1. Onset during infancy and early childhood 2. Lack of socila interactions least two of the following: - No awareness of the feelings of others - No or abnormal comfort seeking in response to distress - No imitation - No social play - cannot socialize, (no eye contact ) 3- Impaired communication least one of the following: - No babbling, gesture, mime or spoken language No non-verbal communication - abnormal form of speech - inability to make conversation -abnormal speech 4- Restricted or repetitive activities, interests and imaginative development, shown in at least one of the following: - stereotyped body movements - persistent preoccupations and rituals with objects or activities - gets troubled over changes in routine or surroundings - No imaginative and symbolic play 5- Behavioral problems: - tantrums - hyperactivity - risk-taking activity

Answer 312

- one kidney smaller than the other

Answer 313

1. Impairment of social interaction 2. Impairment of communication 3. Restricted, repetitive and stereotyped patterns of activities, behavior and interest

Answer 314

DMSA (gold standard) - Clinical suspicion of renal injury - Reduced renal function - Suspicion of VUR - Suspicion of obstructive uropathy on ultrasound in older toilet-trained children

Answer 315

voluntary or involuntary passageof stools - place other than the toilet - >1/month for 3months - >4years

Answer 316

- walking upstairs - Scribbling - points to body part - knowing 2 pronouns -Toilet trained - self feeding by spoon/cup

Answer 317

- sits without support - repeats syllables 'mama/dada' - enjoys peekaboo

Answer 318

- crawls - stranger anxiety

Answer 319

- 'Cruises' -thumb grasp - imitates speech with meaning - waves goodbye

Answer 320

- pulls string on toy

Answer 321

- neat pincer grasp

Answer 322

- walks without support - can build 2 tower blocks - say 3 words - drinks from cup

Answer 323

- runs/jumps - throws ball - build 4 blocks - 2 word sentences

Answer 324

- ride tricycle - copes vertical line/ circle - can use scissors - 3-word sentences

Answer 325

- learns bicycle -copies square - first and last name - dress with supervision

Answer 326

- hops on one foot - draw a person with 3 parts triangles - knows colours - dress without supervision

Answer 327

primary- child has never been continent secondary- previously continent.

Answer 328

<3/week bowel movements -stool partially emptied remaining - stool leak out, often during the child's daily activities. - if constipation resolves encoperesis resoleves

Answer 329

there's no constipation, and the child’s faeces have normal consistency. Unlike in cases associated with constipation and overflow, soiling of this type is intermittent. Feces may be emitted in a prominent location (e.g., as an act of defiance) or may be an unintentional consequence of anal selfstimulation (e.g., a variety of masturbation). Encopresis without constipation and overflow incontinence is less common than the first type of encopresis, and is often associated with oppositional defiant disorder and conduct disorder. It has been estimated that 3% of children with psychiatric issues may have encopresis.

Answer 330

- 10-12 years

Answer 331

Congenital sensorineural deafness.

Answer 332

- Self-limiting - Coxsackie A virus. - Erythematous macular rash, progressing to gray vesicles vesicles seen in buccal mucosa, gums and tongue. - doesn't involve the buttocks and the genitalia - no scarring. School Exclusion: until lesions dried up

Answer 333

- no loss of consciousness - no pos ictus

Answer 334

- CNS tumours (medulloblastoma) - temporal lobe epilepsy

Answer 335

- loss of consciousness - pos ictus - 30-60s duration

Answer 336

- 3-7 months sudden bending of the trunk and flexion of upper limbs - 1st line: Corticosteroids (prednisolone) for 8 to 10 week. Vigabatrin - Clonazepam for acute presentation?

Answer 337

- variant of migraine preceeds - migraine in future

Answer 338

exanthem subitum/sixth disease/three-day fever

Answer 339

3 to 5 days of high fever may exceed) 40°C. fever resolves abruptly macular papular rash (trunk extremities) after 3 days

Answer 340

human herpes virus 7 (HHV-7), enteroviruses (coxackievirus A and B, echovirus), adenovirus, and parainfluenza virus type 1.

Answer 341

- opposite of vomiting

Answer 342

mid-diastolic rumbling murmur best heard over the apex. In Severe Aortic Regurgitation In MFS

Answer 343

1st -beta blockers 2nd- verapamil, ACEinhibitors

Answer 344

echocardiogram

Answer 345

Reduced frequency of breastfeeding.

Answer 346

- most common cause of paediatric hydronephrosis - periodic abdominal pain with vomiting - exacerbation on UPJ can also lead to pelvic distention, flank pain or even tenderness

Answer 347

acute (<3 weeks), subacute (3-8 weeks) chronic or persistent (>8 weeks).

Answer 348

US during painful episode

Answer 349

- following an URTI - acute (~90%) or chronic (~10%) - no pallor, lymphadenopathy or hepatosplenomegaly. - if platelets > 20 x 109/L: bed rest - if platelets < 20 x 109/L: oral steroids (prednisolone)

Answer 350

- benign hamartomas - ages 2 and 8 years, peak at 3 to 4 years - mostly painless rectal bleeding palpable polyp on rectal examination >60%

Answer 351

- most common cause of painful rectal bleeding in children - associated with constipation - bright blood on the surface of stool, on the nappy or toilet paper

Answer 352

- most common intraocular tumor in children - Leukocoria (white cornea or Cat’s eye) -strabismus - initial: US (intraocular calcification) - best dilated indirect ophthalmoscopic examination under anesthesia

Answer 353

Post viral cough

Answer 354

Voiding cystoureterogram

Answer 355

- **Infants less than 6 months of age** - Any child with complications (i.e. apnoea, cyanosis, pneumonia, encephalopathy, pneumothorax)

Answer 356

3 weeks start of symptoms 2 weeks start of **cough** <5 days of antibiotics

Answer 357

- failure of canalization of the bucconasal membrane. CHARGE SYNDROME - coloboma - heart defect, - atresia choanae - retarded growth - genital abnormality - ear abnormality

Answer 358

-bilateral choanal atresia coloboma - heart defect, - atresia choanae - retarded growth - genital abnormality - ear abnormality

Answer 359

pass nasogastric tube (also managment) no use in giving oxygen

Answer 360

Mild hypoxemia: nasogastric tube Severe hypoxemia: intubation and ventilation

Answer 361

- Affects males - An autosomal disorder involving **mutation in chromosome 11** - **Pulmonary valve stenosis** - **Webbed neck** - Abnormalities in cardiac conduction and rhythm - flat nasal bridge - single palmar crease - protruding tongue - eyes that are apart more than usual - low set ears

Answer 362

- **refer to surgeon** Surgeon will make call on conservative or surgical - conservative: brace - surgical: osteotomy/femoral head fixation, hip replacement worst case

Answer 363

- NSAIDs 48 hours - bed rest

Answer 364

- neonates from **breech delivery** - Female 6xt more likely - unilateral or bilateral (positive family hx) - **Diminished abduction in flexion of the affected hip** - Apparent inequality of legs: affected leg being shortened and externally rotated - Asymmetrical skin creases of the groin and thigh - ‘clicking’ on hip movements

Answer 365

Barlow test —‘telescoping’ movements in the long axis of the flexed and abducted thighs. **Ortolani test** — flexed hips are abducted. thighs are the grasped between the thumbs in front and other fingers behind. The child’s knees are flexed and hip flexed to a right angle. **positive sign makes audible and palpable ‘jerk’ or ‘clunk’ (not a click). ** - Ortolani and Barlow tests but is usually negative after two months - **Ultrasound** is excellent especially up to **3-4 months**

Answer 366

Grade I: Reflux into the nondilated ureter 2. Grade II — Reflux into the ureter and renal calyces without dilation 3. Grade III — Reflux with mild to moderate dilation and minimal blunting of the fornices 4. Grade IV — Reflux with moderate ureteral tortuosity and dilation of pelvis and calyces 5. Grade V — Reflux with gross dilation of ureter, pelvis and calyces, loss of papillary impressions, and ureteral tortuosity **NEED SURGERY**

Answer 367

Transposition of great vessels

Answer 368

management depends on grading: Grade I-IV: **continuous antibiotics** Grade V: **Surgery**

Answer 369

4 defects - blood going from left to right ( acyanotic) - all have VSD (systolic murmur) - pulmonary stenosis - right ventricle hypertrophy - overriding aorta

Answer 370

-acyanotic - pansystolic machinery murmur (harsh) at the left sternal border - wide pulse pressure. - Definite treatment surgical closure

Answer 371

Tetrology of fallot

Answer 372

Hypoplastic left heart

Answer 373

- holosystolic murmur at left sternal border - acyanotic

Answer 374

- acyanotic - mid-systolic murmur at the pulmonary area, a split-second heart sound and a loud P2 2 main types: - Ostium Primum: most dangerous type, can lead to pulmonary hypertension and heart failure, Prophylactic antibiotics recommended - Ostium Secundum: most common type, e hole is higher in the septum, not serious, symptoms uncommon in infancy

Answer 375

- central cyanotic after 10-12 hours Aorta and pulmonary arteries are reversed - no murmur as there is no hole - **prescribe PG e1** - definite treatment: surgery to correct the transposition

Answer 376

- preceding viral infection - s frequently < 20,000/μL - other lab tests normal -

Answer 377

7S -soft - systolic - short duration - sounds (S1 &S2) - symptomless - Special tests normal (X-ray, ECG) - Standing/Sitting changes (not fixed) (increased when supine)

Answer 378

Family hx of sudden cardiac death or congenital heart disease - in utero exposure to certain medications (lithium) or alcohol - Maternal diabetes mellitus - History of rheumatic fever - History of Kawasaki disease - Grade 3/6 or higher murmurs - Harsh quality - Abnormal S2 - The presence of a systolic click - Increased intensity with decreased venous return (e.g., when the patient stands) - The patient has any symptoms that could be related to a cardiac condition (e.g. shortness of breath, chest pain, poor feeding, etc.)

Answer 379

1. hypertrophic obstructive cardiomyopathy (HOCM) 2. mitral valve prolapse 3. venous hum (low-pitched continuous murmurs produced by blood returning from the great veins to the heart)

Answer 380

dust mites 90% sheepskin 2nd most common

Answer 381

- Neonate w/ vomiting (after first feeds) - Down syndrome 5% distal obstruction to the papilla of Vater 80% -bilious vomiting - M > F -X-ray: 'double-bubble’ - drooling - abdominal distension (very late symptom)

Answer 382

social smile 6 weeks

Answer 383

- hold the neck - recognize mother’s face

Answer 384

- Sits without support - Rolls from prone to supine vice versa - palmar grasp - hand to hand transfer - turns head to loud noise - understands bye bye and no - puts object to mouth (stops at 1 year) - shakes rattle reaches for bottle/breast - Ability to explore things by holding, looking at them and putting them in mouth

Answer 385

- Want to stay at home with parents - Get upset about going to school aches or headaches, or do not feel well without a physical cause -Do not have any serious behavior problems - Do not try to hide their wish regarding not going to school from their parents - Are more likely to be the youngest memberof a family

Answer 386

Children: Nasopharyngeal aspiration Adults: nasopharyngeal swab

Answer 387

- streptococcus pneumoniae - high fever - **chest auscultation deceitfully normal** -high fever - pallor -respiratory distress

Answer 388

- >93% - RR 50

Answer 389

- acute LRTI <12 months (2 weeks to 9 months) - respiratory syncytial virus (RSV) - irritating cough and rhinorrhoea - distressed wheezing breathing - Hyper-inflated chest (barrel-shaped) - Use of accessory muscles and subcostal recession - fine inspiratory crackles - supportive with oxygen and hydration - bilateral perihilar congestion on X-ray (not necessary)

Answer 390

- congenital softening of the tissues of the larynx - **noisy breathing ** worsens when agitated, feeding, crying or sleeping on back - High pitched sound - symptoms present at birth, can become more obvious within the first few weeks - outgrow by 18 to 20 months

Answer 391

suggests obstruction above the glottis.

Answer 392

inadequate caloric intake

Answer 393

- fever is not often that high. - insidious onset - prodromal state

Answer 394

initial step: chest X-ray (to see consolidation)

Answer 395

100% oxygen via nasal prongs. - severe bronchiolitis and requires rehydration using intravenous fluids or nasogastric tube.

Answer 396

- Hemorrhage common complication, also life thereatening - bleeding may occur in the early post-operative period or may be as delayed as 5 to 10 days - bleeding secondary to tonsillar fossae infection

Answer 397

- Resuscitation - 2 large bore cannula with bloods - Reservation of cross-matched packed red cells - IV antibiotics: with 1.2g Benzyl Penicillin, 6-hourly + 500mg of metronidazole, 12-hourly - NSAIDs - Hydrogen peroxide gargle - 20mls of hydrogen peroxide diluted with water in a ratio of 1:6.

Answer 398

- 15-20 % of newborn intestinal obstructions - 80% in the first 6 weeks of life - male > female - congenital anomaly by absence of ganglia in a segment of colon and paralysis of this aganglionic segment -starts at the anus and progresses up the rectum towards the colon. (Delayed meconium passage) - Failure to pass meconium in the first 24 hours but w/ gradual onset of abdominal distension of days to weeks. - Persistent and progressive constipation -Vomiting late

Answer 399

enterocolitis

Answer 400

Rectal suction biopsy – Gold standard

Answer 401

- Laxatives (mild cases) - Surgery

Answer 402

- suspect vesicoureteric reflux - < 3 years (2-36 months) US of the kidney, ureter & bladder - If US normal then voiding cystoureterogram (VCU)

Answer 403

- Recurrent urinary tract infections (more than 2 times during childhood) - Dimercaptosuccinic acid scintigraphy (DMSA) - Gold Standard

Answer 404

- Clinical suspicion of renal injury - Reduced renal function - Suspicion of VUR - Suspicion of obstructive uropathy on ultrasound in older toilet-trained children

Answer 405

- Most of children less than 3 months. - Children who are seriously unwell such as those with toxic appearance or dehydration. - Oral antibiotics cannot be tolerated.

Answer 406

- Fever, nausea, vomiting - abdominal pain - Leukocytes and nitrites on urinalysis

Answer 407

- Overweight adolescent of 10 to15 years - bilateral in 20% - Limp and irritability of hip on movement - Knee pain — referred from the affected hip - On flexion of the hip, it rotates externally. Hip is often in external rotation on walking. - Most movements restricted, especially internal rotation.

Answer 408

- Cease weight-bearing and refer urgently. - lf acute slip, gentle reduction via traction is better than manipulation for prevention of later avascular necrosis. - Once reduced, perform pinning

Answer 409

- Autumn, winter and spring months - IgA mediated vaculitis - anaphylactoid purpura - arthralgia (not arthritis), - non-thrombocytopenic purpura (the purpura is vascular due to leukocratic activity) -typical symmetrical distribution over legs and buttock. - **colicky abdominal pain** 2 to 4 weeks - melena - ankle swelling - nephritis

Answer 410

-Clinical presentation + urinalysis for nephritis

Answer 411

- Vitamin K IM injection to avoid intercranial haemorrhage

Answer 412

- Asymptomatic microscopic hematuria - Repeat UA after fever settles if no UTI (2 positive UA)

Answer 413

- most common umbilical mass - overgrowth of tissue during the healing process - soft pink or red lump - leaks small amounts of clear or yellow fluid - presence of non-purulent discharge

Answer 414

topical silver nitrate - cauterisation may need to be repeated at 3-day intervals if drainage persists

Answer 415

salbutamol

Answer 416

- less than one episode of asthma in 6 weeks and no symptoms in between the flare-ups - inhaled short-acting beta2 agonist (SABA)

Answer 417

- 6 months -bilious vomiting - crampy abdominal pain - abdominal distention - bloody, mucoid stool

Answer 418

- hold the neck - recognize mother’s face

Answer 419

- eye contact with people - look for mother when she speaks - happy or settled most of the time -follow activities with eyes

Answer 420

- 2 and 6 weeks of age - gastric outlet narrowing - projectile vomiting a few minutes after feeding - non bloody, non bilious vomiting - delayed capillary refill > 2 seconds

Answer 421

-Formula feeding -Male -Caucasian background -Firstborn -Maternal smoking during pregnancy -Positive family history -Both erythromycin and azithromycin < 2weeks

Answer 422

- gonorrhoea: fast and aggressive (3 and 7 days after birth) - chlamydia: slow and less aggressive (end of 1st week - 1 month after birth)

Answer 423

- 21-hydroxylase deficiency -

Answer 424

Palpable gonads: -Pelvic ultrasound -Testosterone and dihydrotestosterone (DHT) ratio. -LH and FSH. -ACTH stimulation test. -hCG stimulation test No palpable gonads: - markedly elevated 17-hydroxyprogesterone 90% -Serum electrolytes. -Plasma renin activity

Answer 425

- recurrent angioedema without pruritis in: - upper respiratory tract - gastrointestinal tract - subcutaneous tissues - autosomal dominant reduced C-1 esterase inhibitor levels (HAE type I) or poorly functional (HAE type II)

Answer 426

- hypertension 50-90% - haematuria 30-50% - oedema 60% - Decreased complement (C3) levels

Answer 427

- Fluid restriction - Loop diuretics/dialysis - Steroids (caution, could be wrong)

Answer 428

CSF analysis/Lumbar puncture FIRST: - turbidity - low glucose (less than 1.7 mmol/L) - elevated proteins - elevated white cells (20 to 30 cells/microL) - Gram stain may be negative 60% > 7 days **E. Coli most common** IF signs of ICP (seizure, papilledema) then CT head

Answer 429

- nephrotic syndrome - <6 years - Absence of hypertension Absence of hematuria by Addis count - Normal complement levels - Normal renal function

Answer 430

- Corticosteroid (Prednisolone)

Answer 431

**1. Nephrotic range proteinuria-urinary protein excretion greater than 50 mg/kg per day.** **2. Hypoalbuminemia-serum albumin concentration less than 30 g/L.** 3. Edema. 4. Hyperlipidaemia

Answer 432

- 90% of blood is shunted across ductus arteriosus (well tolerated) - low cardiac output and shock once the ductus arteriosus closes

Answer 433

- hypotension, - cyanosis, - respiratory distress, - **shock with normal or weak upper extremity pulses ** - **absent femoral pulses** - Metabolic acidosis is seen as compensation to respiratory alkalosis - prostaglandin E1 infusion to maintain a patent ductus arteriosus and surgical repair

Answer 434

- acute onset of fever more than 39C -inadequate response to paracetamol - sole, palm and tongue erythema - desquamation of fingertips (vasculitis) - tender mass in the right hypochondrium - elevated CRP and ESR

Answer 435

- aspirin and immunoglobulins -Steroids must be avoided

Answer 436

- vasculitis leading to coronary artery aneurysm 17-31% (second week and second month of illness) -

Answer 437

1 child: 2% to 6% 2 children: 20% to 30%

Answer 438

Ventricular Septal Defect (VSD) 1 in 100 Australian infants

Answer 439

-<5 years - mass in right upper quadrant - abdominal distension - right-sided abdominal pain - familial adenomatous polyposis high risk - lost appetite and weight - vomiting and jaundice (very rare)

Answer 440

secondary to Respiratory failure and hypoxia

Answer 441

- anusol cream (lignocaine) - pain for anal fissure is under control, laxatives and fibre diet

Answer 442

- passage of hard stools

Answer 443

Food allergy 80%

Answer 444

Constitutional delay of growth and puberty - lack of breast development-thelarche in girls above 13 years - testicular volume less than 4ml by the age of 14 years

Answer 445

-should be equal - difference <2 years = normal (reassure) - difference > 2 years = constitutional delay

Answer 446

- resistant to treatment with intravenous calcium - **test Serum magnesium level**

Answer 447

Simple: - duration of less than 15 minutes - do not occur more than once in 24 hours Complex seizures: - MAY last for longer than 15 minutes - recur in the course of 24 hours

Answer 448

- good head control - head stabilises when sitting - track objects - startes at loud noise - social smile

Answer 449

symptoms at night >1 canister beta 2 aginists every 3mon using beta 2 agonists >2days /week asthma attacks >2/month infrquent asthma attacks but severe spirometry with reversible airflow obstruction

Answer 450

- Most common childhood cancer - Peak age: 2-5 years - Male > female

Answer 451

Acute lymphoblastic leukemia

Answer 452

- Nonspecific systemic symptoms - Bone pain - Lymphadenopathy - Hepatosplenomegaly - Pallor (from anemia) - Petechiae (from thrombocytopenia)

Answer 453

Bone marrow biopsy with >25% lymphoblasts

Answer 454

Multidrug chemotherapy

Answer 455

- Live-attenuated vaccines contraindicated (MMRV, rotavirus, yellow fever)

Answer 456

- immune mediated demyelination - Campylobacter infection - 10 days after a nonspecific viral illness - acute polyneuropathy - progressive, mostly symmetric muscle weakness (days or weeks) beginning in the lower extremities and progressing toward the trunk - absent or depressed deep tendon reflexes

Answer 457

- spinal fluid protein measurement (elevated protein 2x normal) - glucose and cell counts are normal - Nerve conduction studies (NC) - needle electromyography (EMG)

Answer 458

- observation (24-48 hours) - intravenous immunoglobulin - steroids - plasmapheresis (respiratory failure)

Answer 459

Neuromuscular respiratory failure (30%) - order spirometry after dx

Answer 460

- peroneal and intrinsic foot muscle atrophy (strange feet) - extending to the intrinsic hand muscles and proximal leg

Answer 461

- inherited disorder - Fragile X Mental Retardation 1 (FMR1) gene expansion - associated primary ovarian insufficiency & tremor ataxia syndrome - All males with the full mutation - Relative macrocephaly - Strabismus *Pale blue irises *Midface hypoplasia with sunken eyes *Arched palate *Mitral valve prolapse (seemingly benign) *Joint hyperlaxity (particularly of the thumbs, fingers, and wrists) *Hypotonia *Doughy skin over the dorsum of hands *Flexible flat feet

Answer 462

- 2 to 6 months - **Retinal cherry red spots 90%** - progressive weakness and loss of motor skills - with hypotonia - hyperreflexia - retinal ganglion cells become distended with glycolipid

Answer 463

- **occurs in the post-pubertal male 25%, usually unilateral** - Paramyxovirus isolated from CSF, saliva and nasopharynx - fever, - lethargy, - **bilateral parotid swelling** - parasternal oedema

Answer 464

- Aseptic meningitis - testes causing orchitis, usually unilateral,

Answer 465

- diarrhoea

Answer 466

-Gastrointestinal fluid losses. -Administration of hypotonic fluids. -Severe infections-meningitis, encephalitis, pneumonia, bronchiolitis, sepsis etc can lead to SIADH

Answer 467

– Congenital Adrenal Hyperplasia. – Addison’s Disease. – Psychogenic polydipsia. – Obstructive uropathy

Answer 468

Acute epiglottitis - intubation at hospital

Answer 469

- also known as habit spasms - individually recognisable, intermittent movements - aware in the urge to perform the movement - blinking, - facial grimacing, - shoulder shrugging, - head jerking

Answer 470

Dorsal penile nerve block

Answer 471

- 3 vaccinations at 2,4 and 6 months - 1st booster at 4 years - 2nd booster between 12-17 years

Answer 472

- no immunoglobulins required - check to see vaccination status and vaccinated in indicated

Answer 473

- immunoglobulins required

Answer 474

Preterm babies should not get vaccinated until after leaving hospital (might spread the live vaccine virus to other babies in the hospital) - inactivated polio vaccine can be used instead

Answer 475

- supplemental oxygen - intubate

Answer 476

- scrotal swelling - A bluish discoloration of the skin if the hydrocele is large. - Fluctuation in the size of the swelling (mainly in infants). - The area of the hydrocoele is clearly defined. - Hydroceles are not painful but may cause discomfort if they are large.

Answer 477

- wait until 18 months (resolve spontaneously) - surgery if not resolved after 18 months

Answer 478

positive transillumination test

Answer 479

- increasing irritability - increasing lethargy, - increasing tonic-clonic generalised seizures - respond poorly to conventional anticonvulsants (phenytoin, phenobarbitone) - address hyponatraemia by 3% NaCl solution

Answer 480

- autosomal recessive - 1:3700 - Sweat chloride test - DNA testing (CFTR) diagnostic 72%

Answer 481

pathogenic sign of bilirubin staining of the brain stem nuclei and cerebellum – Athetoid cerebral palsy with or without seizures. – Developmental delay. – Hearing deficit. – Oculomotor disturbances including paralysis of upward gaze. – Dental dysplasia. – Intellectual impairment.

Answer 482

If seizure is of short duration and doesn't reoccur = reassurance if the following situations: 1. A child with a pattern of prolonged seizures (usually longer than ten mins.) which have previously responded to intravenous or rectal diazepam. 2. A child with clusters of repeated seizures in whom oral treatment is inappropriate. 3. A child with severe epilepsy who is remote from emergency services. = Rectal diazepam

Answer 483

- X-linked recessive trait - after - deficiency of dystrophin beginning to walk features become more evident - Pseudohypertrophy limited to the calf muscle - hip girdle weakness at 2 years - Gower sign (use of the hands to “climb up” the legs in order to assume the upright position) at 3-5 years - use of a wheelchair after 12 years - mental impairment and cardiomyopathy - Death respiratory failure, heart failure, pneumonia, or aspiration

Answer 484

- Mid-line defects (Congenital pituitary deficiency) - Hepatomegaly (glycogen storage diseases and fatty acid oxidation disorders) - Micro penis (congenital gonadotropin deficiency, possible pituitary, cortisol deficiency) abnormalities - Macrosomia (maternal history of gestational diabetes)

Answer 485

- strawberry naevus - around 1 to 4 weeks of age, then get bigger, for a few months - stop growing between 6-12 months - **gradually disappear over the next few years** - if naevus at eyes, nose, ears or trachea then laser therapy - If anywhere else, then observation

Answer 486

Haemolysis due to ABO incompatibility - always pathological

Answer 487

- Infants younger than 3 months of age - Preterm or low birth weight infants. – Infants with chronic lung disease. – Infants with congenital acyanotic heart disease.

Answer 488

- account for 25% - 30% of all paediatric malignancies - 1 to 10 years infratentorial (posterior fossa) - After 10 years of age, supratentorial tumour's (eg, diffuse astrocytoma)

Answer 489

- topical antibiotics mupirocin - mild inflammation without pus or other signs of cellulitis = topical steroids

Answer 490

cerebellar and brainstem tumours (medulloblastoma, cerebellar astrocytoma) - ICP - nausea - vomiting, - ataxia, - vertigo, - papilloedema - Cranial nerve VI to X palsies

Answer 491

- Erythema toxicum 50% of term newborns - commonly greasy, scaly, and erythematous rash - face, neck, axilla, and diaper area

Answer 492

- a bluish-grey lesion over buttocks, lower back, and occasionally extremities extensor surfaces - blacks, Asians, and Latin Americans - tend to disappear by 1 to 2 years

Answer 493

- < 1 month old - fever - poor feeding - jaundice - bulging fontanelle - seizures - nuchal rigidity - irritability/lethargy - Usually GBS

Answer 494

- pneumonia, - pulmonary thromboemboli - sepsis NOTE: with sickle-cell anaemia, these can be rapidly progressive and quickly fatal - require hospitalisation

Answer 495

Howell-Jolly bodies

Answer 496

- Excluded until discharge has resolved

Answer 497

- “doughy” skin - Isotonic (normal) saline for an initial bolus

Answer 498

- Mortality 50% - transmittal of abdominal contents across a congenital or traumatic defect in the diaphragm - profound respiratory distress - birth at a tertiary-level centre - scaphoid abdomen - bowel sounds in the chest

Answer 499

- high-frequency oscillatory ventilation - extracorporeal membrane oxygenation (ECMO)

Answer 500

- hyponatraemia with hyperkalaemia - 21-hydroxylase deficiency - Dehydration, hypotension, and shock

Answer 501

maternal analgesic narcotic drug (meperidine) - depression of the newborn via crossing of the placenta - administration of naloxone, 0.1 mg/kg, IM, IV, or endotracheal

Answer 502

- failure of bone mineralization - Vitamin D deficiency - a flattened occiput - prominent forehead -significant dental caries, - bumpy ribs - bowed extremities

Answer 503

Fundoscopy: retinal cherry red spots in 90%

Answer 504

Hexosaminidase A & B enzyme

Answer 505

- short stature - microcephaly - centrally placed hair whorl - small ears - redundant skin on the nape of the neck - flat nasal bridge - Cardiac lesions 30% to 50% (endocardial cushion defect, VSD, tetralogy of Fallot (all 30%) - Duodenal atresia

Answer 506

- irritability - low-grade fever - swelling - tachypnoea - and poor appetite - impaired wound healing - diffuse tenderness, worse in legs

Answer 507

- If not bleeding: monitoring/observation - If bleeding: IVIG and corticosteroids (prednisone)

Answer 508

- Oligohydramnios - Kidney US (bilateral renal agenesis)

Answer 509

- Affects females -Madelung deformity - short stature, - webbed neck - low-set ears - low hairline at the back of the neck - epicanthal folds

Answer 510

Madelung deformity

Answer 511

- aortic coarctation - Complete atrioventricular septal defect (CAVSD) – 37 percent - Ventricular septal defect (VSD) – 31 percent - ASD – 15 percent - Partial atrioventricular septal defect (PAVSD) – 6 percent - Tetralogy of Fallot (TOF) – 5 percent - PDA – 4 percent

Answer 512

4 weeks - booster doses 10 years and 20 years after primary course

Answer 513

- C7, C8 & T1 injury - affects elbow - hand palsy

Answer 514

night blindness drying of the conjunctivas and sclera dry skin Poor growth and impaired cognition

Answer 515

autoimmune-demyelinating <10 years of age preceeding URTI high-dose corticosteroids to treat

Answer 516

- raw meat consumption - Tapeworm Taenia solium - MRI single focal white matter lesions - Blood test serology - Albendazole

Answer 517

positive direct Coombs test

Answer 518

Direct = autoimmune haemolytic anaemia Indirect = antibodies in blood to see if there's reaction to blood transfusion

Answer 519

- autosomal recessive - absence of an enzyme that metabolizes phenylalanine to tyrosine mental retardation - Treatment consists of a diet that maintains phenylalanine at levels low enough to prevent brain damage but adequate to support normal physical and mental development.

Answer 520

- galactose-l-phosphate uridyl transferase enzyme deficiency - serious damage to liver, brain, and eyes after being fed lactose milk -

Answer 521

-lethargy, vomiting and diarrhoe, -hypotonia, -hepatomegaly - jaundice (liver failure) -failure to thrive - cataracts

Answer 522

autosomal recessive trait dermatitis, alopecia, ataxia, hypotonia, seizures, developmental delay, deafness, immunodeficiency, and metabolic acidosis Treatment is lifelong administration of free biotin.

Answer 523

- elimination of lactose-containing milk from the diet - exclusion of foods that contain casein, dry milk solids, whey, or curds

Answer 524

hypoplastic radii, thumb abnormalities, and cardiac anomalies. pectoralis major muscle is missing

Answer 525

- Mortality is 50% in the first week and 90% in the first year - low-set ears, - a prominent occiput, - a short sternum, - a closed hand with overlapping fingers, - cardiac defects, rocker-bottom (rounded) feet, - cleft lip and/or palate

Answer 526

may produce aqueductal stenosis hydrocephalus

Answer 527

- Female gonads do not secrete Müllerian-inhibiting factor (MIF) - Male testes secrete MIF - empty scrotum - testes are impalpable in inguinal canal

Answer 528

beets, blackberries, and rhubarb chloroquine metronidazole phenytoin rifampinsulfasalazine

Answer 529

- 5 and 7 years - awaken suddenly, appear frightened and unaware of surroundings - cannot recall the event in the morning - Sleepwalking is common - reassurance

Answer 530

- hypotonia, hypogonadism - hyperphagia after the newborn period - hypomentia - obesity - deletion of a portion of chromosome 15 - Feeding difficulties and failure to thrive in 1st year - defect in the satiety center in the hypothalamus. - Stringent caloric restriction is the only known treatment

Answer 531

- Perform throat swab+ start antibiotics - If swab+ve = continue antibiotics - if swab-ve = discontinue antibiotics

Answer 532

- inflamed prevertebral soft tissue - inability to extend the neck - lateral neck film demonstrates a widened prevertebral soft tissue strip - typically not present with airway compromise and hypoxia

Answer 533

known as Ritter disease commonly in children less than 5 years of age fever, irritability, erythema,tender skin Circumoral erythema crusting of the eyes, mouth, and nose blisters on the skin Postive Nikolsky sign- Peeling of the epidermis in response to mild shearing forces

Answer 534

- Microsomal triglyceride transfer protein (MTP) gene mutation - impaired VLDL formation - decreased vitamin E delivery to PNS/CNS -

Answer 535

I: - 0–15 years - None II: - Commencement of puberty -8–15 - Pubic hair first, along with breast budding - Scrotal/Testicular growth, penis growth after a year III: - Increase in hair and pigmentation

Answer 536

- Fifth disease (erythema infectiosum) - **Low haemoglobin** patients with haemolytic conditions (such as sickle-cell anaemia) thus develop a transient aplastic crisis - poorly functioning bone marrow (for a week or more)

Answer 537

- autosomal recessive -Obesity - mental retardation - hypogonadism - retinitis pigmentosa with night blindness - polydactyly

Answer 538

- adiposogenital dystrophy - obesity associated with a hypothalamic tumour

Answer 539

(low serum calcium and high serum phosphorus levels - high levels of endogenous parathyroid hormone short,round-faced, and mildly retarded. - Metacarpals and metatarsals are shortened - subcutaneous and basal ganglia - - calcifications - cataracts can be present. - Treatment: large doses of vitamin D and reduction of the phosphate load.

Answer 540

- Pseudohypertrophy routinely is limited to the calf muscles - lordotic posture as weakness evolves in the hip girdle musculature - waddling gait -

Answer 541

- Coarse, tremulous movements accompanied by ankle clonus - harlequin color change (a transient, longitudinal division of a body into red and pale halves) softness of parietal bones at the vertex (craniotabes) a liver that is palpable down to 2 cm below the costal margin

Answer 542

- S aureus - joint aspiration

Answer 543

Werdnig-Hoffmann disease hypotonia, and muscle atrophy Anterior horn cell disease

Answer 544

Kugelberg-Welander disease Anterior horn cell disease hypotonia, and muscle atrophy

Answer 545

- X-linked recessive - Thrombocytopenia - Eczema - Increased susceptibility to infection - bloody diarrhea and easy bruising - impaired humoral immunity - low serum IgM and a normal or slightly low IgG - low T cells and lymphocyte - Few live past their teens, frequently succumbing to malignancy caused by EBV infection.

Answer 546

- Type of severe combined immunodeficiency (SCID) - Lymphopenia from birth - Platelets are not affected

Answer 547

Most are affected: males and femailes

Answer 548

A few are affected: males and females

Answer 549

A few are affected: only males

Answer 550

- S aureus - “menstrual” TSS (associated with intravaginal devices like tampons, diaphragms, and contraceptive sponges) - “nonmenstrual” TSS associated with pneumonia - skin infection - bacteremia - osteomyelitis

Answer 551

D -dystrophy myotonia O - osteogenisis imperfecta M - Marfan's I - intermittent porphyria N - Noonan's A - achondroplasia, familial adenomatous polyposis (FAP) N - neurofibromatosis T - Tuberous sclerosis V- Von Willebrand H - Huntington's HNPCC H - hereditary spherocytosis H- familial hypocholesteraemia R - retinoblastoma

Answer 552

A - albinism B - thalassaemia C - cystic fibrosis D - deafness E - emphysema F - Friederich's ataxia (trinucleotide test, repeat GAA) G - Gaucher's disease H Hemochromatosis, homocystinuria S - sickle cell P - phenylketonuria N - Wilson's X - xeroderma pigmentosa

Answer 553

D- diabetes insipidus D - Duchenne's C - colour blindness C - chronic granulomatous disease (membranous type) F - Fabry's disease (alpha- glucosidase deficiency) F - fragile X syndrome (Martin Bell Syndrome) 2 blood - haemophilia. G6PD 2 syndrome Lesch Nylon syndrome, Wiskots Aldrich yndrome

Answer 554

Antibiotics against S aureus (penicillin)

Answer 555

PE: - diffuse adenopathy - tonsillar enlargement - enlarged spleen - small haemorrhages on the soft palate - periorbital swelling Blood: - predominance of atypical lymphocytes with at least 10% - heterophil antibodies present (may not be present in young children)

Answer 556

- Self-limiting symptomatic management - avoid contact sports to protect spleen

Answer 557

V- vertebral defect, A- anal atresia, C- cardiac defects, TE- tracheoesophageal fistula -R renal/radial defect L- limb defects

Answer 558

descend into the scrotum during the first two weeks of life - the descent is unlikely to take place after the age of 1year - 20 percent of premature males - Orchidopexy is best performed by 12-18 month - 5-10 times greater risk of developing a malignancy

Answer 559

Salmonella Typhi

Answer 560

- benzathine penicillin IM -Roxithromycin if allergic to penicillin/NSAIDs

Answer 561

Atypical antipsychotics (Risperidone)

Answer 562

severe dehydration

Answer 563

10-20ml/kg boluses of 0.9% normal saline

Answer 564

birth to 6 weeks, surgery is recommended within 2 days, 6 weeks to 6 months-surgery within 2 weeks and over 6 months surgery within 2 months

Answer 565

Chlamydia trachomatis - notifiable disease

Answer 566

oral erythromycin and sulfacetamide eye drops

Answer 567

Atypical Kawasaki

Answer 568

- South/South East Asia: azithromycin 1 g (child: 20 mg/kg up to 1 g) Not India: ciprofloxacin 500 mg

Answer 569

Neuroblastoma - originates from adrenal glands

Answer 570

nephroblastoma (Wilm's tumour)

Answer 571

– Maternal group B streptococcus colonization in current pregnancy. – A previous baby with GBS infection.

Answer 572

– Artificial ventilation with an endotracheal tube. – Extreme prematurity. – Total parenteral nutrition. - Central catheter

Answer 573

gluten challenge for 4-6 weeks and then should have coeliac serology performed

Answer 574

2ml/kg of 10% dextrose IV

Answer 575

- type 1 diabetes mellitus - autoimmune (diseases celiac, autoimmune thyroiditis)

Answer 576

- egg and yeast allergy

Answer 577

Septic arthritis

Answer 578

- Joint drainage & debridement - IV antibiotics - orthopaedic surgeon referral

Answer 579

1st line: trimethoprim cephalexin

Answer 580

Initial: Fluid resuscitation Best: Ramstedts Pyloromyotomy

Answer 581

- Green vomiting: gangrene of the bowel

Answer 582

Osgood-Schlatter disorder

Answer 583

Gentle quadriceps stretching exercises - self limiting up to 12 months NOTE: Corticosteroids are absolutely contraindicated

Answer 584

- FBC - urea & electrolytes - ESR - Coeliac serology NOTE: GH is pulsatile therefore not diagnostic

Answer 585

infantile haemangioma

Answer 586

reassure -Gradual regress in size

Answer 587

-Airway, Breathing, Circulation, Disability, Exposure (Primary Survey). -Obtain immediate intravenous access (an intraosseous needle may be required). -Administer intravenous dexamethasone (0.15 mg/kg). -Intravenous ceftriaxone (100 mg/kg). -Take blood cultures.

Answer 588

– Excessive intake of cow’s milk. – Prematurity. – Low birth weight. – Coeliac disease. – Lead poisoning.

Answer 589

Precocious puberty

Answer 590

- serum FSH & LH estradiol - MRI - Bone age

Answer 591

- 1st: US - micturating cystourethrogram (MCU): rule out vesicoureteric reflux

Answer 592

no voiding difficulties: reassure voiding difficulties: topical oestrogen or oestradiol cream applied twice daily severe obstruction to urinary flow with retention or recurrent infections: Manual or surgical separation

Answer 593

Vaginal non-bloody pus-like discharge 95%

Answer 594

anticholinergic toxicity (TCA)

Answer 595

Sodium bicarbonate Sodium bicarbonat

Answer 596

Deafness 11% Intellectual disability (mental retardation)-4%. -Spasticity and/or paresis-4 %. -Seizure disorder-4 %

Answer 597

In more than 50% of px with ADHD, ODD is also a part of the clinical picture

Answer 598

1st line: Antipsychotics (risperidone) 2nd line: mood stabilisers (sodium valproate) SSRIs

Answer 599

Intussusception (due to intestinal oedma and bleeding)

Answer 600

1st day - chemical irritation 6 days - Gonorrhoea 14 days- Chlamydia

Answer 601

increased frequency * bronchitis, * chronic diarrhoea, * conjunctivitis * otitis media in children

Answer 602

(a)they are low birth weight. (b)premature. (c)born after prolonged labour. (d)premature rupture of membrane. Streptococcus B Group

Answer 603

Fifth disease Parvo B 19 slapped cheek macular papular rash Myalgia / Arthralgia

Answer 604

1. Most common: Autoimmune adrenalitis 2. Infection (tuberculosis) 3. Metastatic infiltration (primary tumours of the lung, breast, kidney, and skin)

Answer 605

- Fatigue, weakness, anorexia/weight loss - Nausea, vomiting, abdominal pain - Salt craving, postural hypotension - Hyperpigmentation Acute adrenal crisis: confusion, hypotension/shock

Answer 606

- Hyponatremia, hyperkalaemia, eosinophilia - Low morning cortisol, high ACTH

Answer 607

Glucocorticoids (eg, hydrocortisone, prednisone) Mineralocorticoids (eg, fludrocortisone)

Answer 608

Aldosterone/adrenal insufficiency (Addison's)

Answer 609

Known dx: parenteral administration of corticosteroids (Hydrocortisone) Previous dx: dexamethasone

Answer 610

Primary aldosteronism (Conn's)

Answer 611

75-250 nanomole/L

Answer 612

saddle anaesthesia - investigate by MRI

Answer 613

pulled muscle/muscle spasm - analgesia + normal activity

Answer 614

Osteoarthritis (OA)

Answer 615

Rheumatoid arthritis (RA)

Answer 616

Vitamin D level (symptomatic hypocalcaemia) renal function test (creatinine > 35mL)

Answer 617

- oesophagitis - jaw osteonecrosis

Answer 618

- proximal pole fracture 20% - Distal pole fractures are 10% - Most common site of fracture is waist of the bone 70%

Answer 619

distal pole fractures is better than proximal pole because of low risk of vascular compromise - may take up to 1-2 weeks to become visible radiologically

Answer 620

chronic back pain persisting longer than 3 months, have to exclude: - central canal stenosis - nerve root compression

Answer 621

1- Acute low back pain lasts less than 6 weeks. 2- Sub-acute low back pain lasts between 6 and 12 weeks. 3- Chronic low back pain persists for more than 12 weeks.

Answer 622

Reactive arthritis

Answer 623

Psoriatic arthritis

Answer 624

septic arthritis

Answer 625

- IV antibiotics (flucloxacillin) for 2 weeks - Oral antibiotics after 6 weeks

Answer 626

- female - breech presentation - positive family history of hip dysplasia

Answer 627

Severe - orthopaedic consult for knee replacement

Answer 628

Developmental dysplasia of the hip

Answer 629

Osgood-Schlatter disease

Answer 630

Legg-Calve-Perthes Disease

Answer 631

sacroiliitis

Answer 632

– Psoriasis. – Reactive arthritis. – Ankylosing spondyloarthropathy. – Arthritis related to inflammatory bowel disease

Answer 633

1-HLA-B27 2-Chlamydia and Gonorrhoea serology 3-RA factor, anti-ccp to rule out Rheumatoid arthritis 4-Inflammatory markers such as ESR and C-reactive protein

Answer 634

Septic knee

Answer 635

- DEXA - 25-hydroxy vitamin D

Answer 636

anterior cruciate ligament (ACL) injury

Answer 637

Adhesive capsulitis (Frozen shoulder)

Answer 638

prednisolone 30 mg daily for 3 weeks - wean after 6 weeks

Answer 639

fat embolism

Answer 640

compartment syndrome

Answer 641

- walking stick on the contralateral hand

Answer 642

throbbing pain increasing after wiggling fingers/toes

Answer 643

permanent nerve damage or loss of limb due to decreased circulation and oxygen to the tissue

Answer 644

IV Zoledronic acid Bisphosphonate, Alendronate - paracetamol, NSAIDs - vitamin D and calcium supplementation (prevent hypocalcaemia and secondary hyperparathyroidism)

Answer 645

- < 6 months: Hip examination (Ortolani), US - > 6 months: X-ray

Answer 646

– Menopause – Age over 70 – Corticosteroid use longer than three months – Rheumatoid arthritis – Alcoholism – Smoking – Anorexia nervosa. – Inflammatory Bowel Disease

Answer 647

Internal rotation

Answer 648

– Isolated patellar tenderness. – Tenderness at the head of the fibula. – Inability to flex at 90 degrees. – Inability to bear weight immediately after trauma and in an emergency

Answer 649

Medial meniscus tear

Answer 650

- barefooted with the knee flexed to 20 degrees and rotates the body and knee three times internally and externally (Thessaly test) most useful Flexion/rotation test (McMurray test) for screening

Answer 651

Mallet finger

Answer 652

L5 radiculopathy

Answer 653

L5-S1 radiculopathy

Answer 654

S1 radiculopathy

Answer 655

L4 radiculopathy

Answer 656

Slipped capital femoral epiphysis

Answer 657

Achilles tendon rupture

Answer 658

Thompson Test - absent plantar reflex

Answer 659

anterior shoulder dislocation

Answer 660

Morton Neuroma

Answer 661

Axillary nerve

Answer 662

Maintain hyper-extension of the distal interphalangeal joint for 6-8 weeks

Answer 663

- stretching exercises for the plantar fascia and calf muscles - Avoid flat shoes and barefoot walking - arch supports and/or heel cups - Decreasing causative or aggravating exercise - NSAIDs - glucocorticoids and a local anesthetic

Answer 664

- Alendronate, risedronate and zoledronic acid: first-line therapy in **postmenopausal osteoporosis ** and prevent vertebral, Non-vertebral and hip fractures. - bisphosphonates: primary prevention of fractures in px who never had minimal trauma fracture, secondary prevention of **fractures** - Strontium ranelate: primary prevention of osteoporosis in women - bisphosphonates and raloxifene: secondary prevention of fractures in women who have had minimal trauma fractures

Answer 665

- BMD T-score of =<-3 - > 1 symptomatic new fracture after at least 12-months of continuous therapy - > 2 minimal trauma fractures despite being on sufficient doses of bisphosphonates. switch to **teriparatide** for 18 months

Answer 666

Pelvis 70%

Answer 667

Percutaneous pin fixation

Answer 668

- Sacroilitis is the earliest manifestation - In only 5% cases, onset is after the age of 40 years - Median age of onset is 23 years of age - More than 40% patients present with unilateral ocular pain, lacrimation and photophobia - Limited chest expansion - Limitation of movement of lumbar spine in both sagital and frontal planes - inflammatory back pain

Answer 669

Diagnostic: joint aspiration

Answer 670

- bilateral 20% - Diabetic 80% - painful freezing phase, adhesive phase and a recovery phase 6months-2years

Answer 671

– 1st line: NSAIDS. – 2nd line: - Intra-articular steroids - Physiotherapy /Occupational Therapy – Oral steroids (prednisolone) if NSAIDs not working

Answer 672

Spinal stenosis

Answer 673

-1 to -2.5

Answer 674

- S aureus - secondary to deep cellulitis -MRI investigation

Answer 675

Acute osteomyelitis

Answer 676

Pseudogout

Answer 677

Long thoracic nerve

Answer 678

Mycobacterial tenosynovitis due to Mycobacterium avium complex

Answer 679

– Non-union. – Avascular necrosis. – Carpal instability. – Osteoarthritis.

Answer 680

Acute prepatellar bursitis (housemaid's knree)

Answer 681

- NSAIDs - glucocorticoid injection

Answer 682

tarsus and tarsometatarsal joints(midfoot)

Answer 683

Plantar Fasciitis

Answer 684

Metastatic tumor

Answer 685

- Alcohol (increase urate)

Answer 686

-Elevated alkaline phosphatase (early finding) - bone pain (most common symptom)

Answer 687

Paget’s disease

Answer 688

1st line: NSAIDs 2nd: TnF alpha inhibitors - Infliximab - Adalimumab - rituximab

Answer 689

Common peroneal nerve damage

Answer 690

Dupuytren’s contracture

Answer 691

depends on severity low/moderate: Steroid injection severe: Open fasciectomy

Answer 692

- Alcohol - DM - epilepsy - male

Answer 693

at least 3 months

Answer 694

Band support below the elbow

Answer 695

De Quervain tenosynovitis

Answer 696

De Quervain tenosynovitis

Answer 697

Achilles tendon lesion/rupture

Answer 698

anterior: ACL posterior: PCL

Answer 699

Posterior dislocation of shoulder

Answer 700

supracondylar fracture

Answer 701

Volkmann ischemic contracture - permanent damage to nerves and muscles of the forearm leading to contractures

Answer 702

osteomyelitis - Do MRI

Answer 703

Resisted extension

Answer 704

radial nerve

Answer 705

wrist drop - decreased or absent thumb extension and abduction - Decreased sensation over dorsum of the hand (thumb, index, middle and half of the ring fingers)

Answer 706

crushed cauda equina

Answer 707

- loss of bladder - loss of bowel control - paraparesis/paraplegia

Answer 708

Carpal tunnel syndrome

Answer 709

spinal injury - do Spinal x-ray series

Answer 710

suprascapular nerve entrapment (SNE) - shoulder abduction (supraspinatus) - external rotation (infraspinatus)

Answer 711

Metatarsus adductus (MA) - corrects spontaneously;

Answer 712

congenital clubfoot

Answer 713

serial manipulation and casting -surgery if dire

Answer 714

- Colles fracture - acute carpal tunnel syndrome - impaired thumb abduction - paraesthesia

Answer 715

median nerve

Answer 716

transient synovitis transient synovitis (TS),

Answer 717

Tibial nerve

Answer 718

the wrist should be in 10° flexion and 10° ulnar deviation 4-6 weeks

Answer 719

Ischemic Volkmann contracture

Answer 720

Ulnar nerve injury

Answer 721

distal to proximal

Answer 722

proximal pole fracture 20%

Answer 723

-Persistent joint pain and swelling affecting at least three joint areas 2-Symmetrical involvement of the MCP or MTP joints 3-Morning stiffness lasting more than 30 minutes. (if there's a rash: Psoriatic arthritis)

Answer 724

NSAIDs + DMARDS

Answer 725

symptomatic pain treatment

Answer 726

all planes of movement but especially internal rotation

Answer 727

– Isolated patellar tenderness. – Tenderness at the head of the fibula. – Inability to flex at 90 degrees. – Inability to bear weight immediately after trauma and in an emergency.

Answer 728

* MUSCULOCUTANEOUS NERVE ( C5,C6,C7) - REMEMBER IT SUPPLIES- BICEPS BRACHII, BRACHIALIS * AXILLARY NERVE ( C5,C6)- it wraps around the neck of humerus. REMEMBER DELTOID AND REGIMENTAL BADGE SIGN * MEDIAN NERVE ( C5-T1)- REMEMBER - ALL FLEXORS OF FOREARM EXCEPT 1.5 * RADIAL NERVE (C5-T1) - REMEMBER ALL THE EXTENSORS * ULNAR NERVE (C8-T1)- 1.5 FLEXORS + ALL THE INTRICATE MUSCLES OF THE Hand

Answer 729

Kids/adults: Sodium Valproate Child bearing age woman: Leveltiracetam

Answer 730

- Phenytoin - Lamotrigine

Answer 731

- Ethosuximide - Valproate

Answer 732

- Clonazepam -Lamotrigine

Answer 733

- Sodium Valproate

Answer 734

- Clonazepam - Lamotrigine

Answer 735

Carbamazepine

Answer 736

- Phenytoin - Valproate - Phenobarbitone - lamotrigine

Answer 737

- prednisolone - Tetracosactin

Answer 738

- Clonazepam - Vigabatrin

Answer 739

Infantile spasm

Answer 740

M- monitor O - oxygen V - vein/troponin E - ECG M - morphine O - oxygen N - Nitrates/nitroglycerin A - aspirin B - beta blockers C - clopidogrel H - heparin

November 2024 Flashcards

(807 cards)