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MC > Specific Problems in Children > Flashcards

Specific Problems in Children Flashcards

1
Q

What is the PURPLE cyring

P = P eak—your baby may cry more each week, the
most at _______, then less at 3–5 months
U = _________—crying can come and go and you
won’t know why
R = ________—your baby may not stop crying
no matter what you try
P = _________—babies may look like they are in
pain, even when they’re not
L =_________—crying can last as much as 5 hours
a day, or more
E =_________—your baby may cry more in the
late afternoon or evening

A

2 months

U nexpected

R esists soothing

P ain-like face

L ong-lasting

E vening cluster

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2
Q

Babies usually cut their teeth from age ______

A

6 months until 2–3 years

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3
Q

The first teeth to appear (which seldom cause

discomfort) are usually the _______

A

lower incisors (during the first year).

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4
Q

The _____ and _______ (ages 1–3) tend to

cause problems

A

first and second molars

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5
Q

Usually the first set (20 teeth) is complete soon

after the ______

A

second birthday

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6
Q

In teething, Paracetamol should be used only for ______

A

significant discomfort

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7
Q

Teething gels are _______ and are

not recommended.

A

salicylate-based

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8
Q

Some children who are breastfed for long periods

(e.g. 3 years) may develop ________

A

unsightly pitting of the front surface of their teeth

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9
Q

________ involves placing the thumb or finger
on the roof of the mouth behind the teeth (hard
palate) and sucking with the mouth closed

A

Thumb sucking

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10
Q

Thumb sucking

It occurs in children up to the age of 12 years but is most common under the age of ______

A

4 years.

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11
Q

Thumb sucking

One effect is that the pressure on the front teeth may
cause protrusion of the front teeth _________

A

(i.e. buck teeth);

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12
Q

Thumb sucking

Effect another is a narrowing of the bite with a gap between the top and bottom incisors, referred to as an ___________

A

open anterior bite

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13
Q

Snuffling in older infants is usually caused by

rhinitis due to an ___________

A

intercurrent viral infection

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14
Q

About 20% of infants develop watery eyes, but

most resolve by _______

A

12 months

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15
Q

Excessive eye watering

in infants is the key sign that there is ______

A

inherited

narrowing of the nasolacrimal ducts

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16
Q

When is Blocked nasolacrimal duct usually obvious?

A

It usually becomes obvious in infants between 3 and 12 weeks and affects one or both eyes.

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17
Q

T or F

Blocked nasolacrimal duct

Self-correction usually occurs from 6 months of
age onwards or even earlier

A

T

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18
Q

Problems on growth charts

A

They are based on Caucasian children and are
not fully representative for some other groups (e.g.
Asian children tend to be smaller).

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19
Q

Classically, failure to thrive (FTT) has been defined

as children whose :

A

weight <3 rd percentile on ≥ 2
occasions, or whose weight crosses two centile lines
over time.

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20
Q

Weight gain slows further after _________

A

12 months of age.

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21
Q

Traditionally, FTT was divided into____ and_____

A

organic and nonorganic

causes

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22
Q

Basic labs to investigate FTT

A
  • FBC, CRP
  • iron studies
  • UEC/LFTs
  • urine MC&S
  • coeliac screen
  • stool fat globules/fatty acid crystals
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23
Q

______ is considered to be below the 3rd

percentile.

A

Short stature

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24
Q

Short stature cause

_______________—this follows the family
trend of a genetically small family

A

Familial short stature

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25
Q

Short stature cause

__________—a common
and normal variant in which the growth spurt is
later than average. Bone age is delayed

A

Constitutional delay in maturation

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26
Q

Pathological causes of short stature

A

some are rare but serious conditions, such as coeliac

disease, Crohn disease and chronic kidney failure.

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27
Q

Rough rule for expected adult height

based on parental height

A
  • Boys—mean of parents’ heights + 5 cm

* Girls—mean - 5 cm

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28
Q

___________
for those children with idiopathic short stature (ISS,
a diagnosis of exclusion) increases height in some
children, with the range of benefit usually between
3 cm and 7 cm

A

Recombinant human growth hormone treatment

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29
Q

Tall stature is considered to be above the _______

percentile

A

97 th

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30
Q

Causes of tall stature

A

• familial (predicted final height should roughly
match mid-parental height)
• precocious puberty
• growth hormone excess (pituitary gigantism)
• hyperthyroidism
• syndromic: Marfan, Klinefelter, homocystinuria

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31
Q

Tall Stature Tx

If treatment is considered appropriate, ________ is used in very tall girls (accelerates epiphyseal maturation and reduces final height) while __________ is used
for boys.

A

high-dose oestrogen

high-dose testosterone

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32
Q

__________ is associated with growth
acceleration and advancement of bone age, while
__________has the opposite effect

A

Nutritional obesity

endocrine obesity

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33
Q

Delayed puberty

This is the absence of pubertal development
(testicular enlargement in boys or breast development
in girls) in:

  • girls >________
  • boys >_______
A

13 years

14 years

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34
Q

MCC of delayed puberty

A

constitutional delay of growth and puberty (CDGP)
is usually familial and the commonest cause. It is
associated with delayed growth and bone age

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35
Q

Other causes of delayed puberty

A

• chronic illness (e.g. severe asthma, cystic fibrosis,
kidney failure)
• poor nutrition and exercise
• anorexia nervosa

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36
Q

Puberty is trending earlier than in previous
generations, known as the ‘secular trend’, and is
presumed to be due to improved nutrition and
absence of chronic disease

A

Precocious puberty

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37
Q

True precocious puberty is considered to be:

A
  • girls <8 years

* boys <9 years

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38
Q

In precocious puberty:

Growth spurts will be earlier and bone growth
will be advanced, though final adult height may be
reduced from what would otherwise be expected
due to __________

A

premature fusion of the long bones

39
Q

True precocious puberty is ______ more common in girls

than boys

A

20 times

40
Q

Precocious puberty

It is usually idiopathic, though _______ are a rare cause and more common as a
cause in boys (boys always require brain imaging).

A

pituitary

adenomas

41
Q

Precocious puberty

Treatments are often not required, but may include
____ and _______

A

gonadotrophin releasing hormone (GnRH) analogues

and cyproterone

42
Q

This is breast development in girls under 8 years old

without other pubertal signs.

A

Premature thelarche

43
Q

This is the isolated appearance of pubic hair in
boys or girls aged 6–9 years old. There are no other
features of virilisation or oestrogenisation, and the
hair remains until other signs of puberty appear at
the normal time.

A

Premature adrenarche

44
Q

Premature adrenarche

It is usually a normal variant (no
specific treatment necessary) but may rarely signify
atypical __________

A

congenital adrenal hyperplasia

45
Q

This is a normal variant of male puberty, with a
prevalence of about 40–50% and is usually a transient
phenomenon, subsiding in 2–3 years

A

Pubertal gynaecomastia

46
Q

A breast ‘bud’ is common in most term babies and may
enlarge with breastfeeding. Milk may
discharge from some (‘witches’ milk) but reassurance
is all that is required

A

Infant breast hyperplasia

47
Q
  • Typical age 3–12 years
  • Positive family history
  • Usually bilateral and non-articular
A

Growing pains

48
Q

localization for growing pains

A

typical sites include

shins, calves, thighs, popliteal fossa

49
Q

True about growing pains
a. Problem resolves spontaneously in time
b. Reassurance
6. Consider analgesic and heat packs (usually
unsuccessful)
d. Massage is a reasonable option—appears to
help

A

AOTA

50
Q

Many children and infants will be found to have
systolic murmurs on routine examination, especially
in the presence of a__________

A

fever, anxiety or fear

51
Q

Criteria of innocent murmur

A

• there are no other abnormal physical findings
• the child is asymptomatic
• no history of risk factors for structural heart
disease
• auscultatory features typical of an innocent
murmur

52
Q

T or F

In murmurs heard in infants under 12 months of
age, the risk of asymptomatic structural heart disease
is higher, and further assessment is warranted.

A

T

53
Q

What are the 7S of innocent murmur

A

1 S ensitive (changes with child’s position or with
respiration)
2 S hort duration (not holosystolic)
3 S ingle (no associated clicks or gallops)
4 S mall (murmur limited to a small area and nonradiating)
5 S oft (low amplitude)
6 S weet (not harsh sounding)
7 S ystolic (occurs during and is limited to systole)

54
Q

__________ or bedwetting, is urinary
incontinence occurring during sleep in a child with
a developmental age of 5 or older

A

Nocturnal enuresis (NE),

55
Q

_________ (80% of cases) occurs in a child who has never had urinary continence for 6 months,

A

Primary enuresis

56
Q

______(20%) occurs after 6 months or more of day
and night dryness, and is more commonly associated
with organic or psychological causes

A

secondary enuresis

57
Q

The spontaneous resolution of NE is _______ per year

A

15%

58
Q 
The causes of NE are not fully understood, but are
thought to be multifactorial, including:
1
2
3
A
  • disturbance in arousal
  • overactive bladder
  • nocturnal polyuria
59
Q

It takes
around _______ for the child to recognise the sensation
of a full bladder, and around_____ to achieve
dryness (success is measured as 14 consecutive dry
nights).

A

3 weeks

12 weeks

60
Q

_______ (giving additional fluids at bedtime to those who achieve dryness) can improve the child’s response to a
full bladder signal and reduce the risk of relapse,
especially in those who are sleeping through dry.

A

‘Overlearning’

61
Q

Meds for eneuresis

_______: while this vasopressin analogue
is very effective, it has a high relapse rate

A

Desmopressin acetate

62
Q

Constipation is defined as having 2 or more of the
following over the previous 2 months:

• ______ bowel motions per week
•______ episode of faecal incontinence per week
(previously referred to as encopresis)
• large stools in rectum or palpable on abdominal
examination
• _________ (e.g. ‘stiff as a board’
standing/lying, tip toes, crossed legs, braces
against furniture) and withholding behaviour
(e.g. refuses, hides, requests nappy, denies need
to go)
• _______

A

<3

> 1

retentive posturing

painful defecation

63
Q

The key feature in functional constipation is _____

A

chronic faecal retention leading to rectal dilatation and insensitivity to the normal defecation reflex

64
Q

For acute faecal impaction, _______ can
be used until liquid stools are achieved, and then
revert back to maintenance treatment

A

high-dose laxatives

65
Q

_______ are suitable only for children with acute severe

rectal pain or distress and are rarely required

A

Enemas

66
Q

This benign condition occurs in around half of babies,
usually 1–2 days after birth (but may appear up to 2
weeks later) with 2–3 mm erythematous macules and
papules developing into pustules, with a surrounding
blotchy area of erythema, described as a ‘flea-bitten’
appearance

A

Toxic erythema of newborn

67
Q

Rash of Toxic erythema of newborn

A

The rash starts on the face and spreads
to the torso and proximal limbs, and spares the palms
and soles. The rash usually fades over a week, but may
recur for a few weeks. No treatment is required

68
Q

These are flat patches of pink or red skin with poorly
defined borders. They occur in 40% of all newborns,
and are seen at the nape of the neck (‘stork bite’) or
between the eyebrows/on the eyelids (‘angel’s kiss’)

A

Salmon patch (naevus flammeus nuchae)

69
Q

Types of Infantile Hemangioma

A

(‘strawberry haemangioma

(‘cavernous haemangioma

70
Q

What type of hemangioma

flat or lumpy, resembling
strawberry jam splashed on the skin

A

strawberry haemangioma

71
Q

Large, deep
or multiple haemangiomas can be associated
with _______

A

malformations of organs,

72
Q

True about infantile hemangioma

________ is a very promising new
treatment for more significant lesions, especially if
used early in the growth phase, and is now usually
preferred over oral steroids

A

Propanolol

73
Q

These dark red to purple lesions (a type of naevus
flammeus) are present from birth and affect 3
in 1000 neonates. They are usually flat at birth,
though they can become lumpy

A

Capillary vascular malformation

‘port wine stain’

74
Q

port wine stain
on the skin supplied by the ophthalmic division of
the trigeminal nerve is accompanied by glaucoma
and seizures, and patients are at increased risk of
developmental delay and hemiplegia

A

Sturge–Weber syndrome

75
Q

Port wine stains will often respond well to_______

A

pulse dye laser (the

treatment of choice).

76
Q

These are present at birth but can subsequently
grow. They can vary from large fluid-filled spaces
(cystic hygromas) down to clusters of small firm
blisters resembling frogspawn

A

Lymphatic malformation (lymphangioma

77
Q

This condition presents as blue-grey discolouration
of the skin over the lower back and sacrum in
babies of east Asian and other dark-skinned ethnic
backgrounds.

A

Dermal melanocytosis

‘Mongolian spot’

78
Q

_________ glands appear as tiny yellow–
white papules on the nose or forehead. They disappear
in several weeks.

A

Hyperplastic sebaceous

79
Q

This is related to overheating and occurs in skin folds
such as around the neck and armpits, but also on the
face.

A

Miliaria (‘sweat rash’)

80
Q

Types of Miliaria (‘sweat rash’)

• ‘________—beads of sweat trapped under the
epidermis with surrounding erythema
• ________—itchy red papules

A

crystallina

rubia

81
Q

These common fleshy pink-red growths can cause a
persisting seropurulent discharge after the separation
of the umbilical stump

A

Umbilical granuloma

82
Q

These are round or oval pale skin patches usually
on the face of children and adolescents, and are
more visible in tanned or dark-skinned patients.
• They can occur on the nec

A

Pityriasis alba

83
Q

This common condition may appear typically in
infants on the cheeks of the face, the folds of the
neck and scalp and extensor surface of the limbs

A

Atopic dermatitis (eczema)

84
Q

In nappy rash,

Sometimes ammonia is formed, resulting in a chemical burn (hence the alternative term _____

A

ammoniacal dermatitis

85
Q

Other conditions such as ______ and ________
also need to be considered, especially for resistant or
recurrent nappy rash.

A

psoriasis and atopic dermatitis

86
Q

_______is infantile seborrhoeic dermatitis
confined to the scalp. The seborrhoeic dermatitis may
also involve other areas

A

Cradle cap

87
Q

Cradle cap is very common, usually occurring in the _________ of life and settling over the next few weeks to months, but it sometimes takes much longer.

A

first 6 weeks

88
Q

Cradle cap

The yeast ______ may be involved.

A

Malassezia furfur

89
Q

What shampoo to use in Cradle cap

A

2% ketoconazole shampoo (Nizoral) twice weekly

90
Q

________ is usually diagnosed by its distinct

pink pearly appearance and central punctum

A

Molluscum

91
Q

Spread of molluscum

A

and is usually spread by direct contact

92
Q

Molluscum rarely leaves tiny pit-like
scars. It can have a reactive dermatitis surrounding
the lesions (especially in children prone to atopic
dermatitis) and ________ cream can be used to
help this

A

hydrocortisone

93
Q

Warts in children

Even without treatment, 50% of them will go in_____ and
90% in 2 years.

A

6 months, and

MC (90 decks)

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