Pediatrics: Iron Deficiency and Near Miss Events

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Questions and Answers

What is the primary treatment for Primary Biliary Cholangitis (PBC)?

Ursodeoxycholic acid (correct)

Cholestyramine

Steroids

Immunosuppressive drugs

Which medication is recommended for treating hyperthyroidism during the first trimester of pregnancy?

Methimazole

Radioactive iodine

Levothyroxine

Propylthiouracil (PTU) (correct)

What is the contraindication for administering the HPV vaccine?

Age above 26

Ongoing chemotherapy

Pregnancy (correct)

Prior allergic reaction to vaccines

What should be the first line treatment for hypotension after tumor removal?

Normal saline bolus (A) Signup and view all the answers

Which antibiotic is not recommended for treating chlamydia in pregnancy?

Doxycycline (C) Signup and view all the answers

What is the common complication of Primary Biliary Cholangitis (PBC)?

Osteoporosis/osteopenia (A) Signup and view all the answers

Which treatment is recommended for cardiac tachyarrhythmia resulting from increased catecholamine release?

Esmolol (A) Signup and view all the answers

What is the recommended first-line treatment for hepatic hydrothorax?

Sodium restriction and diuretics (A) Signup and view all the answers

What should be done for patients with localized lymphadenopathy after a 3-4 week observation period?

Perform a biopsy to rule out lymphoma (A) Signup and view all the answers

What is the mechanism of EBV exanthema when inappropriate dosages of ampicillin or amoxicillin are given?

Immune-mediated response (B) Signup and view all the answers

Indications for performing a C-section in twin pregnancies include all of the following except:

If presenting twin is underweight (A) Signup and view all the answers

What initial test should be performed in the treatment of pulmonary artery hypertension?

Vasoreactivity test (C) Signup and view all the answers

What treatments are typically used in stroke patients to prevent DVT?

Low-dose heparin or LMWH (A) Signup and view all the answers

What is the most common cause of early death following a stroke?

Pulmonary embolism due to DVT (D) Signup and view all the answers

Which of the following is NOT a contraindication for thrombolytic therapy in cases of ischaemic stroke?

Recent minor surgery (B) Signup and view all the answers

What is typically used in hospitals for managing hyperglycemia in stroke patients?

Insulin (B) Signup and view all the answers

What is the recommended duration for acyclovir/valacyclovir treatment after the onset of symptoms?

7-10 days (B) Signup and view all the answers

What is the primary characteristic distinction between varicella zoster transmission and primary chickenpox infection?

Zoster transmission occurs only through direct contact. (B) Signup and view all the answers

What scoring system is used to predict the necessity of labor induction?

Bishop scoring (D) Signup and view all the answers

Which of the following treatments is NOT commonly used for post-herpetic neuralgia?

Salicylic acid (C) Signup and view all the answers

What is the maximum score possible on the Bishop scoring system?

13 (C) Signup and view all the answers

What is the primary reason for hospitalization in patients with varicella?

Mild varicella in immunocompromised individuals (D) Signup and view all the answers

In which situation is a statin recommended?

For all diabetics aged 40-75 years (D) Signup and view all the answers

Which condition is characterized as neurocardiogenic syncope?

Vasovagal syncope (B) Signup and view all the answers

What is the preferred treatment for Bartonella hensellae infections?

Azithromycin (A) Signup and view all the answers

Which cardiovascular finding is associated with mitral stenosis?

Mid-diastolic rumble (C) Signup and view all the answers

In patients with Ehlers-Danlos syndrome, what skin characteristic is typically observed?

Velvety, dough-like skin (B) Signup and view all the answers

What echocardiographic finding is expected in hypertrophic obstructive cardiomyopathy (HOCM)?

Asymmetric septal hypertrophy (B) Signup and view all the answers

What does the 'pinkish-purplish plaques on the face' in mitral stenosis indicate?

Inadequate perfusion of facial skin (B) Signup and view all the answers

What is the risk categorization of drug class 'C' during pregnancy?

May be safe, but animal studies show risk (A) Signup and view all the answers

What is an expected laboratory finding confirming 21-beta-hydroxylase deficiency?

Increased 17-hydroxyprogesterone levels (C) Signup and view all the answers

What can result from an atrial septal defect (ASD)?

Increased pulmonary blood flow leading to a mid-systolic murmur (C) Signup and view all the answers

What is the recommended management for a patient with mild lead intoxication (5-44 ug/dL)?

Observation and recheck levels in one month (C) Signup and view all the answers

Which of the following indicates a need for carotid endarterectomy in asymptomatic men?

60% stenosis (D) Signup and view all the answers

What first-line treatment is recommended for sulfonylurea poisoning?

Dextrose (C) Signup and view all the answers

In the management of symptomatic peripheral arterial disease, which is the preferred medication?

Cilostazol (B) Signup and view all the answers

What is the next step after conservative treatment with ice for priapism?

Phenylephrine injection (C) Signup and view all the answers

What is the effect of estrogens on thyroid metabolism in patients taking thyroxine?

Increase TBG levels (C) Signup and view all the answers

Which condition necessitates performing an abdominal CT scan regarding varicocele?

Bilateral or right-sided varicocele (D) Signup and view all the answers

In the context of shoulder dystocia, which neurological complication can arise?

Erb Duchenne palsy (C) Signup and view all the answers

What is the primary use of docusate sodium?

To increase stool hydration (A) Signup and view all the answers

At what age is routine Pap screening no longer indicated for women with negative prior screens?

Age 65 (B) Signup and view all the answers

What is the recommended screening for women aged 30-64?

Cytology every 3 years or cytology + HPV testing every 5 years (A) Signup and view all the answers

For women aged 21-24 with atypical squamous cells of undetermined significance (ASCUS), what should be done?

Repeat Pap smear in one year (D) Signup and view all the answers

What should be the next step if a woman is diagnosed with CIN I?

Cytology and colposcopy every 6 months for one year (D) Signup and view all the answers

What defines the screening recommendations difference for women aged 21-29 versus 30-64 regarding HPV?

Transience of HPV infection in younger women (A) Signup and view all the answers

What is NOT a reason for performing colposcopy?

Negative Pap smear results (A) Signup and view all the answers

What is the association of infantile botulism?

Raw honey and environmental dust (D) Signup and view all the answers

Study Notes

Iron Deficiency in Infants

Iron deficiency in infants is often due to supplementation with cow/goat/soy milk under the age of 1, or exclusively breastfeeding after 6 months.
Perform a full blood count (FBC) and administer oral iron supplementation if anaemia is present.
Reticulocyte count increases first, followed by haemoglobin and haematocrit levels.

Near-Miss Events

Report medical errors that are caught before reaching the patient to hospital administration.
Reporting near misses to the patient is not mandatory, only errors that have occurred.

Caput Succedaneum vs Cephalohematoma

Caput succedaneum crosses suture lines. Cephalohematoma does not.
Caput succedaneum is often ecchymotic and resolves on its own within weeks.
Cephalohaematoma is associated with underlying skull fractures in 10-25 % of cases; it is not visible for several hours.
It resolves in two weeks to three months. Neither condition requires treatment.

Mammograms and Ultrasound

Mammograms should be performed every two years between the ages of 50 and 75.
An ultrasound should be performed alone on patients under the age of 30.
For patients over 30, both a mammogram and ultrasound should be performed.

Digoxin Toxicity

Verapamil, quinidine, amiodarone, and spironolactone can all cause digoxin toxicity.

Bezold Abscess

A Bezold abscess is a neck abscess that develops as a result of the spread of mastoiditis in the neck.
It usually presents in the sternocleidomastoid muscle.

Hepatitis C

In patients with a positive ELISA test for Hepatitis C, a confirmatory test for HCV RNA is the next best step.
This test can distinguish between persistent, resolved, and false-positive infections.

Type 1 Diabetes Mellitus

A child has a 3% risk of developing type 1 diabetes if only the mother has it; and a 6% risk if only the father has it.
Identical twins have a 50% risk of developing type 1 diabetes.

Apnea Testing

Apnea testing can be used to confirm brain death in patients with absent cortical and brainstem reflexes.

Herbs Associated with Increased Bleeding Risk

Ginkgo biloba, ginseng, saw palmetto (likely platelet dysfunction), black cohosh, and garlic, and horse chestnut,

Herbs Associated with Hepatotoxicity

Black Cohosh, Kava Kava

Malignant Otitis Externa

Tx of malignant otitis externa requires intravenous anti-pseudomonals (e.g., ciprofloxacin) initially followed by oral therapy for 6-8 weeks.

Hypoglycaemia

If low blood sugar is suspected and serum insulin and C-peptide both elevated, an oral hypoglycaemic serum screen (e.g., sulfonylurea levels) should be performed.
In this case, insulinoma is not the only likely diagnosis.

Restless Legs Syndrome

Restless leg syndrome can be caused by iron deficiency.
Ferritin should be measured in patients with restless legs syndrome, as iron deficiency can be present in the absence of anaemia.
It can also be caused by chronic renal failure, uraemia, diabetes, pregnancy, and several drugs (e.g., some antidepressants).

Peripartum Cardiomyopathy

A transthoracic echocardiograph can evaluate the risk of future peripartum cardiomyopathy in patients with a history of decreased EF

Breast Abscess

If suspected breast abscess (secondary to mastitis), an initial ultrasound is necessary to confirm diagnosis before considering needle aspiration or incision and drainage.

HIV Post-Exposure Prophylaxis

Post-exposure prophylaxis for HIV usually involves two NRTIs + one of the following: NNRTI, integrase inhibitor, or protease inhibitor for a period of four weeks

Hypercalcaemia

Excess calcium can cause anxiety, depression, weakness, constipation, peptic ulcer diseases and/or diastolic hypertension.

Hypocalcaemia

Hypocalcaemia may cause hyperpigmentation, seizures, and hypotension.

Kidney Injury

Monitor fluid status (e.g., IV fluids) closely in patients with kidney injury (Acute Tubular Necrosis-ATN) to prevent pulmonary edema and hyperchloraemic metabolic acidosis.

Otitis Externa

Intravenous anti-pseudomonals (e.g., ciprofloxacin) followed by oral antibiotics is the common treatment for malignant otitis externa

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Description

This quiz covers key topics in pediatrics, focusing on iron deficiency in infants, the importance of reporting near-miss medical events, and distinguishing between caput succedaneum and cephalohematoma. Test your knowledge on these critical aspects of infant healthcare and medical error prevention.