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yr 4 - passmed corrections > Paeds 2 > Flashcards

Paeds 2 Flashcards

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1
Q

At what age would the average child acquire the ability to sit without support?

A

6-8 months

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2
Q

At what age would the average child start to play alongside, but not interacting with, other children?

A

2 years

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3
Q

What scan can be done to look for renal scarring in VUR?

A

DMSA scan

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4
Q

1st line in paeds BLS if there are no signs of breathing on initial assessment?

A

Give 5 rescue breaths

Follow this with CPR 15:2

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5
Q

At what age would the average child acquire a good pincer grip?

A

12 months

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6
Q

Describe rash in chickenpox

A

The rash starts as a macular rash before quickly developing into vesicular lesions which later scab over and heal.

The rash is itchy and associated with constitutional symptoms such as a fever, headache, and general malaise.

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7
Q

Gastroschisis vs omphalocele?

A

Both are examples of congenital visceral malformations.

Gastroschisis –> refers to a defect lateral to the umbilicus

Omphalocele –> refers to a defect in the umbilicus instead

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8
Q

What can be provided to parents for prophylaxis of febrile seizures? (2)

A

1) Rectal diazepam

2) Buccal midazolam

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9
Q

In what situations would Abx be indicated in otitis media?

A

1) >4 days of illness

2) Systemically unwell

3) Perforation of TM

4) Bilateral otitis media ≤2 y/o

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10
Q

Mx of otitis media (if no indications for Abx)?

A

Supportive

Safetynetting advice –> if temperature rises in the next few days, the child deteriorates, or swelling behind the ear develops.

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11
Q

What are the complications of otitis media?

A

1) Perforation of TM

2) Mastoiditis

3) Meningitis

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12
Q

What is the most common cause of ambiguous genitalia in newborns?

A

Congenital adrenal hyperplasia

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13
Q

Head size in fragile X syndrome?

A

Typically larger than normal

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14
Q

What is a reflex anoxic seizure?

A

A syncopal episode (or presyncope) that occurs in response to pain or emotional stimuli.

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15
Q

Features of a reflex anoxic seizure?

A
  • child goes very pale
  • falls to floor
  • 2ary anoxic seizures are common
  • rapid recovery
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16
Q

What class of medication is alprostadil?

A

Prostaglandin E1

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17
Q

Cause of congenital adrenal hyperplasia (CAH)?

A

Absence of 21-hydroxylase enzyme.

This results in the underproduction of cortisol & aldosterone, and overproduction of androgens.

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18
Q

What is the role of 21-hydroxylase?

A

Responsible for converting progesterone into aldosterone and cortisol.

Progesterone is also used to create testosterone, but this conversion does NOT rely on the 21-hydroxylase enzyme.

Therefore, because there is extra progesterone floating about that cannot be converted to aldosterone or cortisol, it gets converted to testosterone instead.

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19
Q

How do females with CAH typically present?

A

Ambiguous genitalia

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20
Q

How do males with CAH typically present?

A

Salt losing:

  • hyponatraemia
  • vomiting
  • excessive dehydration
  • hypotension
  • hypoglycaemia
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21
Q

How is a diagnosis of CAH made?

A

1) Elevated cortisone precursors (17-hydroxyprogsterone)

2) Steroid profile

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22
Q

Mx of early onset vs late onset sepsis?

A

Early onset –> IV benzylpenicillin + gentamicin

Late onset –> IV flucloxacillin or vancomycin + gentamicin

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23
Q

What is the most common organism causing late onset neonatal sepsis?

A

Coagulase-negative Staphylococci e.g. Staph. epidermidis

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24
Q

What are 2 ABSOLUTE contraindications to lumbar puncture in neonates?

A

1) GCS <8

2) Raised ICP e.g. bulging fontanelle

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25
Q

In which condition is there REDUCED functioning of UGT enzyme in liver?

A

Gilbert’s syndrome

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26
Q

In which condition is there NO functioning of UGT enzyme in liver?

A

Crigler-Najjar syndrome

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27
Q

Causes of prolonged neonatal jaundice?

A

1) Biliary atresia

2) Breast feeding jaundice

3) Hypothyroidism

4) Congenital infections e.g. CMV, toxoplasmosis

5) UTI

6) Prematurity

7) Galactosaemia

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28
Q

Which investigation is used to monitor bilirubin levels AFTER starting treatmnet?

A

Serum bilirubin

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29
Q

What is the 1st line managment option for biliary atresia?

A

Portoenterostomy (Kasai procedure)

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30
Q

Which investigation is used to monitor bilirubin levels in jaundiced neonates with a gestational age <35 weeks?

A

Serum bilirubin

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31
Q

What is involved in a Kasai procedure (portoenterostomy)?

A

Damaged bile ducts outside of liver are removed.

Loop of infant’s small intestine is used to replace the damaged bile ducts.

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32
Q

What happens in phototherapy in the management of neonatal jaundice?

A

Phototherapy converts unconjugated bilirubin (neurotoxic) into lumirubin (excreted in bile & urine).

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33
Q

What is unconjugated bilirubin converted into in phototherapy?

A

Lumirubin

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34
Q

Which investigation is used to monitor bilirubin levels in neonates that are jaundiced <24 hours of life?

A

Serum bilirubin

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35
Q

What is the key complication of neonatal jaundice?

A

Kernicterus (bilirubin encephalopathy) - unconjungated bilirubin is neurotoxic.

This can lead to cerebral palsy, cognitive impairment & sensorineural hearing loss.

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36
Q

When can phototherapy for neonatal jaundice be stopped?

A

When bilirubin level is >50 umol/l below the treatment line on the threshold graphs.

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37
Q

When should you check for REBOUND hyperbilirubinaemia after stopping phototherapy?

A

12-18 hours after stopping phototherapy

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38
Q

What is the gold standard diagnostic method for biliary atresia?

A

Percutaneous biopsy

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39
Q

When would serum bilirubin be used over transcutaneous bilirubinometry? (3)

A

1) Jaundice <24h after birth

2) Premature <35 weeks gestation

3) Monitoring bilirubin after treatment

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40
Q

What can be used as adjunct to intensified phototherapy in rhesus haemolytic disease or ABO haemolytic disease?

A

IV immunoglobulin

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41
Q

How does kernicterus present?

A
  • lethargy
  • hypotonia
  • poor suck reflex
  • seizures
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42
Q

How does biliary atresia present?

A

1) Prolonged conjugated jaundice

2) Pale stools

3) Dark urine

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43
Q

1st line investigation in jaundice <24h?

A

Coombs test

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44
Q

When are doses of anti D routinely given?
(2)

A

1) 28 weeks gestation

2) Within 24 hours after birth

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45
Q

Give 4 endocine or metabolic causes of unconjugated neonatal jaundice

A

1) Gilbert’s syndrome

2) Crigler-Najjar syndrome

3) Hypothyroidism

4) Galactosaemia

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46
Q

What is GAS also known as?

A

S. pyogenes

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47
Q

What is GBS also known as?

A

S. agalactiae

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48
Q

What is the Abx of choice for GBS prophylaxis?

A

Intrapartum IV benzylpenicillin

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49
Q

How quickly should bilirubin be measured in babies presenting with jaundice <24h after birth?

A

Urgent - within 2 hours

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50
Q

When would you conisder attempting to delay birth in women <24 weeks gestation?

A

1) Previous hitory of preterm birth

2) US demonstrating cervical lenght of ≤25mm

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51
Q

What are 2 options for delaying preterm birth in gestational age <24 weeks?

A

1) Prophylactic vaginal progesterone

2) Prophylactic cervical cerclage

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52
Q

At what gestation age should resuscitation not be performed in premature babies?

A

<23 weeks

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53
Q

What age gestation does RoP typically present?

A

<32 weeks gestation

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54
Q

What is a key risk factor for triggering retinopathy of prematurity?

A

High flow oxygen in premature infants

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55
Q

What length defines a short cervix on US?

A

<25mm before 24 weeks of pregnancy

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56
Q

Under what 2 circumstances would babies be screened for RoP?

A

1) Born <31 weeks gestation

2) Birth weight <1.5kg

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57
Q

What are the 2 mainstays of management of RoP?

A

1) Transpupillary laster photocoagulation

2) Anti-VEGF

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58
Q

Define tocolysis

A

Medications used to PREVENT premature labour

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59
Q

What is the role of nifedipine in premature labour?

A

Tocolytic

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60
Q

What are the 3 key complications of RoP?

A

1) Infections

2) Cataracts

3) Retinal detachment

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61
Q

What are 2 key risk factors for NEC?

A

1) Prematurity

2) Low birth weight

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62
Q

Role of laser therapy in the management of RoP?

A

This burning process prevents abnormal blood vessel proliferation.

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63
Q

What is the most common surgical emergency in neonates?

A

Necrotising enterocolitis (NEC)

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64
Q

What is NEC?

A

Inflammation & death of the bowel tissue –> perforation, peritonitis & shock.

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65
Q

What will U&Es show in NEC?

A

Hyponatraemia

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66
Q

What is the difference between pneumatosis intestinalis and pneumoperitoneum?

A

Pneumatosis intestinalis –> describes abnormal intramural gas of the digestive tract.

Pneumoperitoneum –> refers to the presence of gas in the peritoneal cavity, out of the digestive tract.

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67
Q

Define apnoea

A

Periods where breathing stops spontaneously for more than 20 seconds, or shorter periods with oxygen desaturation or bradycardia.

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68
Q

What criteria is used to stage NEC?

A

Bell’s staging criteria

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69
Q

What can be used to prevent apnoea and bradycardia in babies with recurrent episodes of apnoea of prematurity?

A

IV caffeine

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70
Q

AXR features in NEC?

A

1) Distended bowel loops

2) Thickened bowel wall (oedema)

3) Intramural gas (pneumatosis intestinalis)

4) Pneumoperitoneum: in the later stages due to bowel perforation

5) Gas in portal vein

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71
Q

What is retinal blood vessel development stimulated by?

A

Hypoxia (which is a normal condition in the retina during pregnancy).

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72
Q

At what age would the average child acquire the ability to walk unsupported?

A

13-15 months

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73
Q

Age of presentation of NEC vs intussusception?

A

NEC –> 2nd to 3rd week of life

Intussusception –> 5m to 12m

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74
Q

What is included in the 6 in 1 vaccine?

A

1) diptheria
2) tetanus
3) polio
4) pertussis
5) Hib
6) hepatitis B

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75
Q

What are the 2 most serious long-term health problems for women with Turner’s syndrome?

A

1) aortic dilatation

2) aortic dissection

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76
Q

Which organism is responsible for causing scarlet fever?

A

GAS

77
Q

What triad is seen in shaken baby syndrome?

A

1) retinalhaemorrhages

2) subdural haematoma (due to shearing of bridging veins)

3) encephalopathy

78
Q

When do all breech babies require USS for DDH?

A

At 6 weeks (regardless of mode of delivery)

79
Q

What is the most likely cause of worsening neurological function in a premature infant born at 34 weeks gestation?

A

Intraventricular haemorrhage

80
Q

What occurs in intraventricular haemorrhage?

A

There is bleeding into the ventricular system of the brain.

This is more common in premature infants due to fragility of their blood vessels.

This can lead to: hydrocephalus, cerebral palsy, and developmental delays.

81
Q

Give some causes of obesity in childhood

A

1) Lifestyle

2) GH deficiency

3) Hypothyroidism

4) Down’s syndrome

5) Cushing’s syndrome

6) Prader-Willi syndrome

82
Q

Between what ages do febrile convulsions typically occur?

A

6 months to 5 years

83
Q

What is roseola infantum caused by?

A

HHV-6

84
Q

At what age would the average child acquire the ability to crawl?

A

9 months

84
Q

What is a complication of roseola infantum?

A

Febrile convulsion

84
Q

What is considered 1st line pharmacological mx of enuresis?

A

Desmopressin

84
Q

How does roseola infantum typically present?

A

High fever followed by maculopapular rash.

84
Q

When should a child with suspected UTI be referred to specialist paediatrics services?

A

<3 months

84
Q

Mx of scarlet fever?

A

10 days of oral penicillin V

85
Q

Is the corrected gestational age taken into consideration when looking at milestones?

A

Yes - until the age of 2

85
Q

What is the corrected age of a premature baby?

A

The age minus the number of weeks he/she was born early from 40 weeks.

85
Q

What is the normal age at which a child should show a responsive smile?

A

6-8 weeks

85
Q

What is the most common heart lesion associated with Duchenne muscular dystrophy?

A

Dilated cardiomyopathy

85
Q

how long should a child with whooping cough/pertussis be excluded from school for following commencement of Abx?

A

48h

85
Q

Describe the Barlow manouevre

A

attempted dislocation of a newborns femoral head

86
Q

What is a poor prognostic factor for congenital diaphragmatic hernia?

A

The presence of the liver in the thoracic cavity

87
Q

Which best describes the typical distribution of atopic eczema in a 10-month-old child?

A

Face & trunk –> infants

88
Q

When do children require screening for DDH?

A

If breech position at ≥36 weeks gestation or delivery (if earlier) –> require US scans to screen for DDH.

89
Q

Define small for gestational age in infants

A

<10th centile

90
Q

Define large for gestational age in infants

A

> 90th centile

91
Q

Define appropriate weight for gestational age in infants

A

10th - 90th centile

92
Q

If a baby is small in NIPE, what should you perform?

A

Head circumference (see if weight is disproportionately low)

93
Q

What is asymmetrical growth restriction (i.e. low weight, normal head) commonly due to?

A

Placental insufficiency

94
Q

What is symmetrical growth restriction (i.e. small head and weight) commonly due to?

A

Fetal factors such as genetic abnormalities or intrauterine infection.

95
Q

How are hypotonic infants often described as feeling?

A

Like a ‘rag doll’ due to floppiness.

96
Q

Why do hypotonic infants often have difficulty feeding?

A

As their mouth muscles cannot maintain a proper suck-swallow pattern or a good breastfeeding latch.

97
Q

What congenital condition is hypotonia common in?

A

Down’s syndrome

98
Q

What is caput succedaneum?

A

A diffuse subcutaneous fluid collection with poorly defined margins (often crossing suture lines) caused by pressure on the presenting part of the head during delivery.

It does not usually cause complications and resolves over the first few days.

99
Q

What may a bulging fontenelle suggest?

A

Raised ICP e.g. hydrocephalus

Meningitis

100
Q

What may a sunken fontenelle suggest?

A

Dehydration

101
Q

Give 3 examples of facial birthmarks

A

1) Salmon patch

2) Haemangioma

3) Port-wine stain

102
Q

What are some causes of an absesnt fundal reflex in neonates? (3)

A

1) retinal detachment

2) vitreous haemorrhage

3) retinoblastoma

An absent fundal reflex or the presence of a white reflex requires immediate ophthalmology referral.

103
Q

What is a cystic hygroma?

A

A congenital lymphatic lesion which is typically identified prenatally or at birth.

A cystic hygroma can arise anywhere but typically develops in the left POSTERIOR triangle of the neck.

Cystic hygromas are benign but can be disfiguring and typically require surgical treatment including drainage and use of sclerosing agents to prevent reaccumulation of lymphatic fluid.

104
Q

Mx of 2ary bleeding post-tonsillectomy? (i.e. 5-10 days later)

A

1) ENT referral

2) Admit & Abx

105
Q

What are 3 key complications of mastoiditis?

A

1) meningitis
2) hearing loss
3) facial nerve palsy

106
Q

What does unilateral glue ear in an adult need to be investigated for?

A

Posterior nasal space tumour

107
Q

What vaccine can help protect against otitis media?

A

Pneumococcal

108
Q

What 2 conditions can predispose to otitis media?

A

1) CF
2) PCD / Kartagener’s syndrome

Due to affecting ciliary motility

109
Q

What age is OM typically seen?

A

<4 y/o

110
Q

What is the most common cause of hearing impairment in children?

A

Otitis media with effusion

111
Q

How long must OM be present for to support a diagnosis of ‘chronic’?

A

3 months

112
Q

Where does infection come from in OM?

A

Back of the throat and through the eustachian tube

113
Q

How can OM be categorised? (2)

A

Duration: acute or chronic

Presence of effusion or not

114
Q

Management of acute OM with perforation?

A

Oral amoxicillin for 5-7 days

115
Q

What are the 2 most common organisms causing OM?

A

1) Strep. pneumoniae

2) Hib (reducing due to vaccine)

116
Q

Chronic suppurative OM vs chronic OM with effusion?

A

Suppurative –> leakage of fluid from PERFORATED tympanic membrane

Effusion –> build up of fluid behind an INTACT tympanic membrane

117
Q

What EXTRINSIC factors can predispose to otitis media?

A

1) passive smoking

2) not receiving pneumococcal vaccine

3) bottle feeding

4) daycare

118
Q

How can bottle feeding increase the risk of otitis media?

A

1) The strong swallow required to feed from a BREAST induces a sizeable negative pressure in the infants oral cavity allowing eustachian tube insufflation.

2) Breast milk provides maternal antibodies against common OM pathogens

119
Q

When should admission be considered in OM?

A

Fever >38 degrees in children <3 months

or

Fever >39 degrees in children 3-6 months

120
Q

What does a flat waveform finding on tympanometry indicate?

A

Perforated TM or fluid in middle ear

121
Q

What 2 congenital abnormalities would you refer to 2ary care in chronic OM with glue ear?

A

1) Down’s syndrome

2) Cleft palate

122
Q

What hearing investigation is indicated in glue ear?

A

Pure tone audiometry

123
Q

What are the most common pathogen causing OM/mastoiditis in young children prior to vaccination?

A

HiB

124
Q

What is mastoiditis usually the result of?

A

OM

125
Q

What is a bacterial infection of the middle ear often preceded by?

A

Viral URTI

126
Q

Perforations in what area of TM are more likely to lead to mastoiditis?

A

Upper portion of drum

127
Q

What pathogen can cause OM or mastoiditis in diabetics?

A

Pseudomonas aeruginosa

128
Q

Abx of choice in mastoiditis?

A

1st line –> cephalosporins e.g. ceftriaxone

129
Q

Which groups is it recommended to prescribe Abx in OM?

A

1) Children <2 y/o with bilateral OM

2) Children <3m with temp >38

3) OM with ear discharge

4) Systemically unwell

5) High risk of complications or immunosuppressed

130
Q

1st line Abx in OM?

A

Amoxicillin

(erythromycin or clarithromycin in allergy)

131
Q

What is the most common cause of bacterial tonsillitis?

A

GAS (S. pyogenes)

132
Q

What are some risk factors for chronic suppurative OM?

A
  • pollution
  • poor hygiene
133
Q

What branch of the facial nerve runs through the middle ear?

A

Corda tympani branch of facial nerve

134
Q

What is the most common virus causing tonsillitis?

A

Rhinovirus

135
Q

What investigation is useful as an aid for the diagnosis of middle ear conditions?

A

Tympanometry

136
Q

What Abx is indicated in tonsillitis caused by group A streptococcus (Streptococcus pyogenes)?

A

Penicillin V (phenoxymethylpenicillin)

137
Q

What FeverPAIN score would you consider prescribing Abx in tonsillitis? What Centor score?

A

FeverPAIN ≥4

Centor ≥3

138
Q

Under what circumstances should Abx be prescribed immediately in acute OM?

A

1) Symptoms for 4 or more days / not improving

2) Systemically unwell (but not requiring admission)

3) Immunocompromised

4) <2 y/o with bilateral OM

5) OM with perforation and/or discharge

139
Q

What are the NICE indications for Abx in tonsillitis?

A

1) features of marked systemic upset 2ary to the acute sore throat

2) unilateral peritonsillitis

3) history of rheumatic fever

4) an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)

5) 3 or more Centor criteria are present

140
Q

1st line Abx in tonsillitis in penicillin allergy?

A

Clarithromycin

141
Q

A history of what condition indicates the need for Abx in tonsillitis?

A

Rheumatic fever

142
Q

Choice of Abx in quinsy?

A

Usually co-amoxiclav (broad spectrum)

143
Q

When it is indicated, what test is used for the confirmation of GAS infection in tonsillitis?

A

1) Rapid antigen test for GAS

2) If negative –> throat culture

144
Q

Active observation of children with OM with effusion is appropriate for how long?

A

6-12 weeks (as spontaneous resolution is common)

145
Q

Mx of quinsy?

A

IV Abx and surgical drainage (and consideration of a tonsillectomy in 6 weeks)

146
Q

What is the usual post-exposure prophylaxis against meningococcal infection?

A

Ciprofloxacin (single dose)

147
Q

Patients with meningococcal meningitis are at risk of Waterhouse-Friderichsen syndrome.

What is this?

A

Failure of adrenals

148
Q

What should be added to drug treatment of bacterial meningitis if there is a risk of penicillin-resistant pneumococcal infection (e.g. recent foreign travel or prolonged antibiotic exposure)?

A

Vancoymycin

149
Q

Which types of meningitis are notifiable diseases to the UK Health Security Agency?

(2)

A

1) bacterial meningitis
2) meningococcal infection

150
Q

When are pregnant women advised to have the whooping cough (pertussis) vaccine?

A

Between 16-32 weeks gestation

151
Q

What are 2 options for prophylaxis for contacts of patients with meningococcal meningitis?

A

1) ciprofloxacin
2) rifampicin

both oral

152
Q

What CSF result is indicative of Guillain Barre syndrome?

A

Isolated result of high protein in the CSF

153
Q

What can parvovirus B19 infection in patients with a background of haemolytic anaemia (e.g. sickle cell) cause?

A

Aplastic anaemia

154
Q

What is aplastic anaemia?

A

A deficiency of all types of blood cell caused by failure of bone marrow development.

155
Q

An US should be organised when there are signs of an atypical UTI in infants under 6 months.

What are some features of an atypical UTI?

A
  • Seriously ill
  • Poor urine flow
  • Abdominal or bladder mass
  • Raised creatinine
  • Septicaemia
  • Failure to respond to treatment with suitable antibiotics within 48 hours
  • Infection with non-E. coli organisms.
156
Q

What may urinary problems in a man with a history of gonorrhoea be due to?

A

A urinary stricture

157
Q

What nerve root is implicated in Horner’s syndrome?

A

T1

158
Q

What nerve roots are affected in Erb’s palsy?

A

C5 & C6

159
Q

What nerve roots are affected in Klumpke’s palsy?

A

C8 & T1

160
Q

What is the main complication of a fractured clavicle at birth?

A

Injury to the brachial plexus with a subsequent nerve palsy.

161
Q

What is key in mx of HIE?

A

Therapeutic cooling

162
Q

CXR findings in neonate RDS?

A

Ground glass appearance

163
Q

What are some causes of HIE?

(4)

A

1) Maternal shock

2) Intrapartum haemorrhage

3) Nuchal cord

4) Prolapsed cord

164
Q

What support may premature neonates need to reduce RDS?

(4)

A

1) Intubation & ventilation

2) CPAP (keep lungs inflated whilst breathing)

3) Endotracheal surfactant

4) O2 (91-95% aim)

165
Q

What are oxygen targets in preterm infants?

A

91-95%

166
Q

Effect of meconium on surfactant?

A

Meconium inhibits surfactant

167
Q

What is the key respiratory complication of MAS?

A

Respiratory distress

168
Q

What Apgras score indicates the need for additional monitoring after birth?

A

≤8

169
Q

What are 2 key risk factors for MAS?

A

1) Foetal hypoxia

2) Post-term

170
Q

How can foetal hypoxia cause MAS?

A

Foetal hypoxia can stimulate colonic activity –> results in passage of meconium.

171
Q

When is the Apgar score assessed?

A

1 and 5 minutes of age

Repeated at 10 mins if low score

172
Q

What does the Apgar scores indicate?

A

0-3: very low (bad)

4-6: moderately low

7-10: good

173
Q

What makes up the Apgar score?

A

Appearance (colour):
- pink all over (2)
- pink body, blue extremities (1)
- blue all over (0)

Pulse:
- >100 (2)
- <100 (1)
- absent (0)

Grimace (reflex irritability):
- crying on stimulation, sneezes, coughs (2)
- grimace (1)
- nil (0)

Activity (muscle tone):
- active movement (2)
- limb flexion (1)
- flaccid (0)

Respiratory effort:
- strong, regular cry (2)
- weak irregular (1)
- nil (0)

174
Q

Management of MAS?

A

1) Supportive e.g O2, ventilation

2) Surfactant therapy

3) Abx

175
Q

How long are babies kept in hospital for after birth if mothers were taking SSRIs?

A

48h

176
Q

How long are babies kept in hospital for after birth if mothers were taking opiates?

A

72h

177
Q

What is the medical treatment option for moderate to severe symptoms for opiate withdrawal in neonates?

A

Oral morphine sulphate

178
Q

What is the medical treatment option for moderate to severe symptoms for non-opiate withdrawal?

A

Oral phenobarbitone

179
Q
A

yr 4 - passmed corrections (36 decks)

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