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Paediatrics Flashcards

1
Q

Causes of vomiting in an infant

A 
Normal posseting (effortless regurg of milk during feed)
Gastro-oesoph reflux, gastritis
Over-feeding
Pyloric stenosis
Infection
Adverse food reaction
Infective gastroenteritis
Pharyngeal pouch
Raised ICP
Metabolic - diabetic KA

-> If bilious, get urgent help (may be duodenal obs)

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2
Q

Paediatric red flags

A 
Pale, mottled, ashen, blue
Doesn't stay awake when roused
Dec consciousness - apathy, coma
Dec skin turgor
GRUNTING signs
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3
Q

What are the GRUNTING signs in paeds?

A

G-grunting, weak or continuous high-pitched cry
R-rib recession, nasal flaring, wheeze, stridor
U-unequal or unresponsive pupils, focal CNS signs, fits
N-not using limbs, odd posture, decorticate or decerebrate
T-temp >38 if <6m, or >39
I- ‘I have a bad feeling’
N-neck rigidity, non-blanching rash, meningism, bulging fontanelle
G-green bile in vomit

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4
Q

Paediatric amber flags

A 
Taking <1/2 of feeds
Pale
Not responding to social cues
Hard to wake
Dec activity
Tachypnoea
Sats <95%
Crepitations
Nasal flaring if <1yr
Cap refill >3sec
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5
Q

Green paediatric flags

A 
Taking most feeds ok
Normal colour
Responds to social cues
Alert or wakens quickly
Lusty cry
Breathing calmly
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6
Q

RR, HR & systolic BP for <1yr

A

RR: 30-40
HR: 110-160
Syst BP: 70-90

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7
Q

RR, HR & systolic BP for 2-5yrs

A

RR: 20-30
HR: 95-140
BP: 80-100

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8
Q

RR, HR & systolic BP for >12yrs

A

RR: 12-16
HR: 60-100
BP: 100-120

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9
Q

When would you admit a child with fever?

A

Green features - manage at home

Amber or red - admit

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10
Q

Investigations for fever of unknown origin

A

Bedside - normal obs, urine dip
Investigations:
- Blood - culture, FBC, CRP, electrolytes
- Urine - UTI
- Lumbar puncture - if clinical assessment dictates
Imaging:
- CXR - if resp symptoms or signs

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11
Q

Management of fever of unknown origin

A

ABx - 3rd gen ceph

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12
Q

Risk factors for early-onset (<48hrs) neonatal sepsis

A

(Usually caused by organisms acquired from mum)
Prolonged ROM (>18hrs)
Maternal infection, pyrexia, chorioamnionitis, UTI
GBS +ve mother
Preterm labour
Fetal distress
Breaks in neonatal skin or mucosa

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13
Q

Risk factors for late-onset (>48hrs) neonatal sepsis

A 
(Usually due to environmental organisms)
Central line &amp; catheters
Congenital malformations (spina bifida)
Severe illness
Malnutrition
Immunodeficiency
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14
Q

Management of early-onset neonatal sepsis

A

Broad spec ABx - e.g. benzylpenicillin + gent

If meningitis is susp give cefotaxime

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15
Q

Management of late-onset neonatal sepsis

A

Broad spec ABx - e.g. fluclox + gent

If meningitis is susp give cefotaxime

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16
Q

Causes of neonatal seizures

A

Hypoxic-ischaemic encephalopathy (antenatal or intrapartum hypoxia)
Infection
IC haem/infarction
Structural CNS lesions
Metabolic disturb (hypoglyc, hypocalc, hypo/hypernat, hypomag)
Neonatal withdrawal from maternal drugs/substance abuse
Kernicterus
Idiopathic seizures

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17
Q

Management of neonatal seizures

A

Rule out and treat reversible causes
Empirical ABx
IV access, bloods for FBC, U+E, LFTs, Ca, Mag, Gluc
Imaging - US, MRI
Treat if prolonged or repeated - phenobarbital

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18
Q

Examination of a neonate

A

Check birth weight and details of pregnancy + labour
Head - circumference, shape, fontanelles
Eyes - red reflex, corneal opacities, conjunctivitis
Ears - shape, position
Complexion - cyanosed, pale, jaundiced
Mouth - look then insert a finger, intact palate, sucking
Arms - single palmar creases (trisomy 21), Erb’s palsy, no. of fingers, clinodactyly (trisomy 21)
Thorax - grunting, IC recession, apex beat, ausc, vertebral column (spina bifida)
Abdo - liver, umbilicus, skin turgor, genitalia (testes descended) and anus
Legs - hip dysplasia, femoral pulses, toes (no. + colour)
Sacrum - mongolian spots, tufts of hair (bifida occulta)
CNS - posture, some control of head, floppy?, Moro reflex, grasp reflex

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19
Q

Causes of physiological jaundice in neonates (from 24hrs)

A

Inc bilirubin production due to dec RBC lifespan
Dec bilirubin conjugation due to hepatic immaturity
Absence of gut flora dec elimination of bile pigment
Exclusive breastfeeding (esp if difficulties)

Jaundice within 24hrs is always abnormal!

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20
Q

Causes of prolonged jaundice (14d)

A 
Breastfeeding
Sepsis
Hypothyroidism
CF
Biliary atresia
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21
Q

How does phototherapy work for jaundice?

A

Light energy converts bilirubin to soluble products that can be excreted without conjugation

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22
Q

What is kernicterus?

A

Clinical features of acute bilirubin encephalopathy (lethargy, poor feeding, hypertonacity, shrill cry).
Long term sequelae include deafness and dec IQ

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23
Q

Management of a neonate with blood glucose 2.2

A

Observe them and encourage early feeding as transient hypoglycaemia is common in the first few hours after birth (this is more likely if there’s a maternal Hx of diabetes)

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24
Q

Cyanosed and tachypnoeic neonate with chest wall retraction and patchy infiltrates on CXR. What is the likely diagnosis?

A

Meconium aspiration syndrome

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25
Q

Which babies are most at risk of meconium aspiration?

A

Post-term deliveries (44% in those >42wks)

Maternal HTN, pre-eclampsia, chorioamnionitis, smoking, substance abuse

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26
Q

What features in a Hx/exam would make you suspect cows’ milk protein intolerance?

A 
Regurg + vomiting
Diarrhoea
Urticaria, atopic eczema
Colic symptoms (irritability, crying)
Wheeze, chronic cough
Multi-system involvement
Faltering growth
(Rarely - angioedema + anaphylaxis)
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27
Q

How is a diagnosis of cows’ milk protein intolerance made?

A

Often clinical

Investigations incl: skin prick/patch testing, total IgE + specific IgE for cows’ milk protein

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28
Q

How would you manage a cows’ milk protein intolerance in a formula-fed baby?

A

Extensive hydrolysed formula milk (eHF)

Amino-acid based formula if there’s no response to eHF

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29
Q

How would you manage a cows’ milk protein intolerance in a breastfed baby?

A

Continue breastfeeding
Eliminate cows’ milk protein from maternal diet
Use eHF milk when breastfeeding stops

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30
Q

Which fine motor and visual milestones would you expect a 3m old to have reached?

A

Reaches for object
Holds rattle briefly if given
Visually alert (particularly human faces)
Fixes and follows to 180’

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31
Q

Which fine motor and visual milestones would you expect a 6m old to have reached?

A

Holds in palmar grasp
Pass objects from one hand to another
Visually insatiable, looking around in every direction

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32
Q

Which fine motor and visual milestones would you expect a 9m old to have reached?

A

Points with finger

Early pincer

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33
Q

Which fine motor and visual milestones would you expect a 12m old to have reached?

A

Good pincer grip

Bangs toys together

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34
Q

At what age would you expect to see a hand preference?

A

From 12m (any earlier may indicate cerebral palsy)

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35
Q

Most common cause of nephrotic syndrome in children?

A

Minimal change

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36
Q

Medical name for slapped-cheek syndrome + causative organism

A

Erythema infectiosum

Parvovirus B19

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37
Q

Describe the features of chickenpox

A

Fever initially
Itchy rash starting on head/trunk before spreading
Initially macular, then papular, then vesicular
Systemic upset is usually mild

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38
Q

Describe the features of measles (incl prodrome)

A

Prodrome (4 Cs): cough, coryza, conjunctivitis, cranky + fever
Koplik spots: white spots on palate
Rash that starts behind the ears then to whole body, discrete maculopapular rash becoming blotchy + confluent

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39
Q

Describe the features of mumps

A

Prodrome: malaise.
Fever
Lymphadenopathy - suboccipital and postauricular

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40
Q

Describe the features of erythema infectiosum

A

Lethargy, fever, headache

Rash on cheeks that spreads to proximal arms and extensor surfaces

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41
Q

Describe the features of scarlet fever

A

Fever, malaise, tonsilitis, ‘strawberry’ tongue

Rash - fine punctate erythema that spares the face

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42
Q

What is the cause of scarlet fever?

A

Reaction to erythogenic toxins produced by Group A haemolytic strep

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43
Q

Describe the features of fetal alcohol syndrome

A 
Short palpebral fissure
Thin upper lip
Smooth/absent filtrum
Learning difficulties
Microcephaly
Growth restriction
Epicanthic folds
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44
Q

What pulse abnormality would you expect in a patient with patent ductus arteriosus?

A

Large volume, bounding, collapsing

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45
Q

Describe the typical presentation of Perthes disease

A 
Hip pain (may be referred to the knee)
Usually between 5 and 12yrs
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46
Q

Describe the typical presentation of slipped upper femoral epiphysis

A

Obese male adolescent
Pain often referred to knee
Limitation of int rotation
Knee pain usually begins 2m before hip slipping

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47
Q

Causes of constipation in children

A 
Dehydration
Low-fibre diet
Medications (e.g. opiates)
Anal fissure
Over-enthusiastic potty-training
Hypothyroidism
Hirschsprung's disease
Hypercalcaemia
Learning disabilities
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48
Q

Characteristic features of maternal rubella infection

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus)
Glaucoma

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49
Q

Characteristic features of cytomegalovirus

A

Growth retardation

Purpuric skin lesions

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50
Q

What are you attempting to do in the Barlow + Ortolani tests?

A

Barlow - to dislocate an articulated femoral head

Ortolani - to relocate a dislocated femoral head

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51
Q

In which condition might you see meconium ileus in the neonatal period?

A

CF

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52
Q

What electrolyte results would you expect in pyloric stenosis?

A

Excessive vomiting = hyponat, hypochlo, hypokal

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53
Q

Features of pyloric stenosis in a neonate

A

Projectile vomiting (30mins after feed)
Constipation and dehydration
Palpable mass in the upper abdo
Hypochlo hypokal alkalosis

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54
Q

Management of a 15m old with bow legs

A

Reassure - bow legs in child <3y is a normal variant and usually resolves by 4yrs

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55
Q

Describe the presentation and management of mesenteric adenitis

A

Central abdo pain + URTI

Conservative management with ABx

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56
Q

What is the likely diagnosis for a child with fever >5ds that is resistance to anti-pyretics with redness of palms and soles of feet?

A

Kawasaki disease

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57
Q

Features of Kawasaki disease

A 
High-grade fever >5d
Conjunctival infection
Red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles
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58
Q

Management of Kawasaki disease

A

High-dose aspirin
IV immunoglobulin
Echocardiogram (coronary a. aneurysms)

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59
Q

Main risk factors for necrotising enterocolitis

A

Low birth weight

Prematurity

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60
Q

AXR features in necrotising enterocolitis

A

Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis (intramural gas)
Portal venous gas
Pneumoperitoneum (due to perforation)
Air both inside + outside bowel wall (Rigler sign)
Air outlining the falciform ligament (football sign)

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61
Q

Features of fragile X syndrome in males

A 
Learning difficulties
Large, low set ears
Long thin face
High arched palate
Macroorchidism
Hypotonia
Autism is more common
Mitral valve prolapse
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62
Q

Location of thyroglossal cysts in children

A

Ant triangle

Usually midline + below the hyoid

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63
Q

Location of branchial cysts in children

A

Ant to SCM, near angle of mandible

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64
Q

1st line treatment for recurrent minor nose bleeds in children

A

Short course of topical chlorhexidine and meomycin

Discourage child from nose-picking

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65
Q

Describe innocent murmurs in children

A

Ejection murmurs - due to turbulent blood flow at outflow tract (varies with posture)
Venous hums - due to turbulent blood flow in great veins returning to heart (continuous blowing noise)
Still’s murmur - low-pitched sound at lower LSE

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66
Q

How might you tell if an infant is suffering from colic?

A

Paroxysmal crying with pulling up of the legs
For >3h on >3d/wk
Often an association with feeding difficulties

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67
Q

Symptoms of Cows’ milk protein allergy

A

Colic symptoms with GORD, blood/mucus in stools

May result in faltering growth

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68
Q

Management of Cows’ milk protein allergy

A

If breastfed, ask mother to exclude cows’ milk protein from diet
If formula-fed, change to hypoallergenic extensively hydrolysed or amino acid formula

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69
Q

Describe the rash seen in nappy dermatitis

A

Red desquamating rash, sparing skin folds

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70
Q

Describe the aetiology and management of nappy dermatitis

A

Due to moisture retention (not ammonia as prev thought)
Responds to frequent nappy changes, or nappy-free periods, careful drying and emollient creams
Best treatment - leave nappy off and use barrier cream

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71
Q

How would you determine if there is a candida infection with nappy dermatitis? How would you treat it?

A

Hallmark = satellite spots beyond the main rash
Treat as normal nappy rash + clotrimazole
Avoid oral antifungals if possible

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72
Q

Outline the APGAR scoring system

A

Score of 0-2 (2 best, 0 worst)

A - Pink all over no cyanosis - 2 points
P - Pulse rate over 100 - 2 points
G - Grimace - 1 point
A - Activity flexed arms and legs - 2 points
R - Respiration slow irregular cry - 1 point

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73
Q

How are babies monitored on the NICU?

A 
Temp
Pulse
BP
RR
Blood gas
U+Es
Bilirubin
FBC
Weight
Weekly head circumference
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74
Q

Describe the incidence of intravascular haemorrhage in neonates and the possible cause of this

A

Occurs in 1/4 of those born <1500g due to unsupported blood vessels and instability of BP

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75
Q

Signs of intravascular haemorrhage in neonates

A

Seizures
Bulging fontanelle
Cerebral irritability

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76
Q

Investigations for intravascular haemorrhage

A

US

MRI

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77
Q

Complications of intravascular haemorrhage

A

Dec IQ
Cerebral palsy
Hydrocephalus

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78
Q

Describe the prevalence of neonatal apnoea

A

25% neonates <2.5kgs, higher in lower birth weights

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79
Q

Causes of neonatal apnoea

A 
Prematurity
Infection
Hypothermia
Aspiration
Congenital heart disease
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80
Q

Prevention of neonatal apnoea

A

Maternal corticosteroids for fetal lung maturation to inc surfactant production in those at risk of preterm delivery

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81
Q

Outline the potential complications of mechanical ventilation of neonates

A

Lung - pneumothorax, pul haem, bronchopulmonary dysplasia, interstitial pul emphysema, pneumonia, atelectasis
Airway - upper airway obs, laryngomalacia, GORD
Other - patent DA, inc ICP

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82
Q

Causes of sepsis in the neonate

A

Bacteria acquired transplacentally, via birth canal, or the environment

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83
Q

Aetiology of respiratory distress in a neonate

A

Due to deficiency of alveolar surfactant (esp in premature babies) leading to atelectasis

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84
Q

Signs of resp distress in a neonate

A 
Inc work of breathing shortly after birth
Tachypnoea (>60/min)
Grunting
Nasal flaring
Intercostal recession
Cyanosis
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85
Q

DDx of resp distress syndrome of a neonate

A 
Sepsis
Transient tachypnoea of the newborn (TTN)
Congenital pneumonia
Tracheo-oesophageal fistula
Congenital lung abnormality
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86
Q

What is necrotising enterocolitis of the neonate, and what are the risk factors?

A

Inflammatory bowel necrosis

Risk factors = prematurity, low birth weight (<1.5kg), enteral feeds, bacterial colonisation, mucosal injury

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87
Q

Signs of necrotising enterocolitis

A 
Abdo distension
Blood/mucus PR
Tenderness
Shock
DIC
Pneumatosis intestinalis (gas in gut wall seen on XR)
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88
Q

Treatment of necrotising enterocolitis

A 
Stop oral feeding
Barrier nursing
Culture faeces
Cross match
ABx (cefotaxime + vanc)
Laparotomy
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89
Q

Which infants are most at risk of meconium aspiration syndrome?

A

Term/near term

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90
Q

Define meconium aspiration syndrome

A

Resp distress in infant born with meconium-stained amniotic fluid which cannot otherwise be explained

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91
Q

Consequences of meconium aspiration syndrome

A 
Airway obstruction
Surfactant dysfunction
Pulmonary vasoconstriction
Infection
Chemical pneumonitis
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92
Q

Vitamin K deficiency bleeding occurs at what age?

A

2-7d postpartum

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93
Q

How is vitamin K def bleeding prevented and treated?

A

Vit K 1mg IM

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94
Q

Signs of DIC in neonates

A

Septic signs
Petechiae
GI bleeding

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95
Q

Tests for DIC in neonates

A 
Platelets (low)
INR (inc)
Fibrinogen (low)
Partial thromboplastin time (inc)
D-dimer (inc)
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96
Q

Treatment of DIC in neonates

A

Treat cause

Give vit K <1mg IV SLOW +/- platelet transfusion

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97
Q

Neonate with 1-2mm cream papules on forehead, nose and cheeks. Diagnosis?

A

Milia
Caused by retention of keratin in dermis
Resolves spontaneously

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98
Q

Neonate with erythematous patches with central white pustule. Diagnosis?

A

Erythema toxicum - harmless red blotches, ‘flea bitten’

Last 24h

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99
Q

What are stork marks?

A

Areas of capillary dilatation on eyelids, central forehead, and back of neck
Blanch on pressure + fade with time

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100
Q

Contraindications to breastfeeding

A 
HIV +ve mother in developed countries
Amiodarone
Antimetabolites
Antithyroid drugs
Opiates
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101
Q

Define preterm babies

A

Neonate whose calculated gestational age is <37 completed wks

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102
Q

Define low birth weight

A

Birth weight <2500g regardless of gestational age

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103
Q

Define very low birth weight

A

<1500g regardless of age

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104
Q

Define small for gestational age

A

Birth weight below the 10th percentile for gestational age

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105
Q

Define intrauterine growth restriction

A

Failure of growth in utero, which may or may not result in the baby being SGA

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106
Q

Define symmetrical SGA. What does it suggest?

A

All growth parameters are small
Suggests fetus was affected from early pregnancy
Seen in those with chromosomal abnormalities and those that are constitutionally small

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107
Q

Define asymmetrical SGA. What does it suggest?

A

Weight centile is < length and head circumference
Usually due to IUGR and an insult later in pregnancy eg. pre-eclampsia
Higher risk of complications

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108
Q

List some causes of prematurity

A 
Smoking
Poverty
Malnutrition
Hx of prematurity
GU infections
Pre-eclampsia
DM
Polyhydraminos
Multiple pregnancies
Recent prev pregnancy
Placenta praevia
PROM
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109
Q

What is Hirschprung’s disease?

A

Congenital absence of ganglia in a segment of colon leading to functional GI obstruction, constipation, and megacolon

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110
Q

Complications of Hirschprung’s disease?

A 
GI perforation
Bleeding
Ulcers
Enterocolitis
Short-gut syndrome after surgery
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111
Q

Investigations for Hirschprung’s disease

A

Diagnosed through rectal biopsy of the aganglionic section.

AXR may be warranted if perforation suspected

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112
Q

Management of Hirschprung’s disease

A

Initial = bowel irrigation

Excision of the aganglionic section +/- colostomy

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113
Q

What is the most common tracheo-oesophageal abnormality?

A

Oesophageal atresia with a distal tracheo-oesophageal fistula (86%)

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114
Q

Prenatal signs of oesophageal atresia and tracheo-oesophageal fistula

A

Polyhydraminos

Small stomach

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115
Q

Postnatal signs of oesophageal atresia and tracheo-oesophageal fistula

A 
Cough
Airway obstruction
Inc secretions
Blowing bubbles
Distended abdomen
Cyanosis
Aspiration
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116
Q

Management of oesophageal atresia and tracheo-oesophageal fistula

A

NBM

1’ surgical repair

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117
Q

Describe a congenital diaphragmatic hernia

A

A developmental defect in the diaphragm allowing herniation of abdo contents into the chest, leading to impaired lung development (pul hypoplasia and pul HTN)

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118
Q

Signs of congenital diaphragmatic hernia

A 
Difficult resus at birth
Resp distress
Bowel sounds in one hemithorax
pH <7.3
Cyanosis
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119
Q

Management of congenital diaphragmatic hernia

A

Prenatal - fetal surgery

Postnatal - large-bore NG tube, aim to prevent air entering bowel

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120
Q

Cause and presentation of inguinal hernia in neonates

A

Patent processus vaginalis

Present as bulge lateral to pubic tubercle

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121
Q

Management of inguinal hernias in neonates

A

Repair promptly to prevent incarceration

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122
Q

Describe imperforate anus in neonates. What investigations and management options are there?

A

Covers a variety of anorectal abnormalities
GU imaging
Post sagital anorectoplasty

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123
Q

What is gastroschisis?

A

Paraumbilical defect with evisceration of abdo contents

Most are diagnosed antenatally

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124
Q

Management of gastroschisis

A

At birth, cover exposed bowel with cling film, keep baby warm and hydrated
Corrective surgery, which may incl a silo

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125
Q

What is exomphalos?

A

Ventral defect of the umbilical ring with herniation of abdo viscera

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126
Q

Management of exomphalos

A 
Protect herniated viscera
Maintain fluids and electrolytes
Prevent hypothermia
Gastric decompression
Prevention of sepsis
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127
Q

What may pre-auricular tags be associated with in neonates?

A

GU problems

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128
Q

Describe the management of undescended testis in a neonate

A

2-3% of male neonates
Many are retractile in warm baths etc
Remainder should be fixed early (<1yr) within the scrotum to try and prevent infertility and reduce risk of neoplasia

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129
Q

What are posterior urethral valves?

Describe the diagnosis and management

A

Folds of bladder mucosa blocking the bladder neck, causing outflow obstruction.
Usually diagnosed antenatally with oligohydraminos and renal tract dilatation, or postnatally with absent or feeble voiding
Rx - micturating cystogram with post urethral dilatation

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130
Q

Describe renal agenesis.

Why is it always fatal if bilateral?

A

Absence of kidneys causes oligohydraminos.

Lack of amniotic fluid impairs lung developement, hence mortality

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131
Q

What is the VACTERL association?

A 
(Describes anomalies)
V ertebral
A nal
C ardiac
T racheal
oE sophageal
R enal
L imb
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132
Q

Describe the general signs of congenital HD in neonates

A

May present hrs to days postnatally to adulthood.
Any defect can cause decompensation and CCF, but only R-L shunts cause cyanosis.
Poor feeding, dyspnoea, tachycardia, hepatomegaly, cool peripheries, acidosis

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133
Q

Symptoms, signs and imaging of a VSD in a neonate

A

Symptoms - usually mild
Signs - may incl harsh pansystolic blowing murmur
ECG - ventricular hypertrophy and strain
CXR - pul engorgement, cardiomegaly

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134
Q

Symptoms, signs and imaging of a ASD in a neonate

A

Symptoms - usually none
Signs - widely split fixed s2, systolic murmur ULSE
ECG - RVH, partial RBBB, absence of sinus arrhythmia
CXR - cardiomegaly, globular heart

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135
Q

Symptoms and signs of pulmonary stenosis in a neonate

A

Symptoms - usually asymptomatic

Signs - ESM at ULSE

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136
Q

Symptoms, signs and imaging of patent ductus arteriosus in a neonate

A

Symptoms - rare unless large defect causing CCF
Signs - continuous machine murmur below L clavicle, thrill, collapsing pulse, failure to thrive, pneumonia
CXR + ECG - usually normal

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137
Q

Symptoms, signs and imaging of coarctation of the aorta in a neonate

A

Symptoms - usually none
Signs - HTN, radio-femoral delay, ESM at ULSE
CXR - rib notching
ECG - LVH and strain

138
Q

Signs of TGA in a neonate

A

Symptoms - cyanosis day 1-2

139
Q

Describe Tetralogy of Fallot. How does it present?

A 
Large VSD
Overriding aorta
Subpulmonary stenosis
RVH
Presents as cyanosis or collapse in first m of life, ejection systolic murmur at LSE
140
Q

Cause of cleft lip and palate

A

Failure of fusion of maxillary and premaxillary processes (wk 5) due to genes, BZDs, antiepileptics, rubella

141
Q

What is Pierre Robin?

A

Cleft lip and palate in association with a short mandible causing intermittent upper airway obstruction

142
Q

Features of fetal alcohol syndrome

A 
Microcephaly
Short palpebral fissures
Hypoplastic upper lip
Absent philtrum
Small eyes
Dec IQ
Cardiac malformations
143
Q

Describe the spread and incubation of Measles

A

Spread via droplets

Incubation is 7-12d (inf from prodrome)

144
Q

Symptoms of measles

A

Prodrome (4 Cs) - cough, coryza, conjunctivitis, cranky
Fever until 5d after rash starts
Koplik spots on palate

145
Q

How would you confirm a diagnosis of measles?

A

IgM and IgG +ve

PCR for typing

146
Q

Complications of measles

A 
More common if <5 or >20y/o
Otitis media (most common)
Croup and tracheitis
Pneumonia
Encephalitis
Subacute sclerosing parencephalitis
147
Q

Rx of measles

A

Isolate in hospital
Adequate nutrition
Treat any 2’ bacterial infection

148
Q

Incubation and infectivity of rubella

A

Incubation - 2-3wks

Infective 5d before to 5d after start of rash

149
Q

Signs of rubella

A

Macular rash

Suboccipital lymphadenopathy

150
Q

Complications of rubella

A 
Small joint arthritis
Malformations in utero
Eye anomalies
Cardiac anomalies
Deafness
151
Q

Spread, incubation and infectivity of mumps

A

Spread - droplets/saliva
Incubation - 14-21d
Infectivity - 7d before to 9d after parotid swelling starts

152
Q

Signs of mumps

A

Prodromal malaise
Fever
Painful parotid swelling

153
Q

DDx of mumps

A 
Sjogren's
Leukaemia
Dengue
Herpes-virus
EBV
HIV
Sarcoid
Anaphylaxis
154
Q

Complications of mumps

A 
Usually none
Orchitis
Arthritis
Meningitis
Pancreatitis
Myocarditis
Deafness
155
Q

Management of mumps

A

Supportive

156
Q

What virus causes chickenpox?

A

Varicella-zoster virus

157
Q

Signs of chickenpox

A

Crops of skin vesicles of different ages, often starting on face, scalp, or trunk. Rash is more concentrated on the torso than the extremities

158
Q

Incubation, infectivity, and spread of chickenpox

A

Incubation - 11-21d
Infectivity - 4d before rash until lesions scab
Spread - droplets

159
Q

DDx of chickenpox

A

Hand, foot and mouth
Insect bites
Scabies

160
Q

Describe the course of chickenpox

A

Fever

Rash (starts 2d after fever) - macule -> papule -> vesicle with red surround -> ulcers -> crusting

161
Q

Complications of chickenpox

A

Purpura fulminans - spots become blackish or bluish (necrotising fasciitis)
Pneumonia
Meningitis
Myelitis

162
Q

Management of chickenpox

A

Keeping cool
Calamine lotion
Trim nails
Flucloxacillin if superinfection

163
Q

Risk factors for non-accidental injury

A 
Birthweight <2.5kg
Mother <30y/o
Unwanted pregnancy
Stress
Poverty
164
Q

Define sudden unexplained infant death syndrome. What are the most common causes?

A

Any infant death that is unexpected and initially unexplained (autopsy may give a cause)
Causes incl - obstructive apnoea (milk, airway oedema, passive smoking), central apnoea (faulty CO2 drive, prematurity), other (long QT, staph infection, overheating)

165
Q

6wk milestone

A

Smiling

166
Q

4m milestones

A

Holds head steady when supported whilst sitting

167
Q

6m milestones

A

Bears some weight on legs
No head lag when pulled to sitting
Reaching out
Transferring from hand to hand

168
Q

8m milestone

A

Sits unaided

169
Q

1yr milestones

A 
Stands
Walks with supports
Clashes cubes
Pincer grib
Can say 'mama' and 'dada'
170
Q

18m milestones

A

Walk
Scribbles
2-cube tower
2-4 word

171
Q

2yr milestones

A

Kicks a ball

Gets undressed

172
Q

3yr milestones

A

Jumps
Can stand on one foot
Copies
Can build an 8-cube tower

173
Q

Clinical features of Trisomy 21

A 
Single palmar creases
Hypotonia
Flat face/round head
Protruding tongue
Broad hands
Upward slanted palpebral fissures and epicanthic folds
Speckled irises
Intellectual impairment
Short stature
Pelvic dysplasia
Cardiac malformations
Incurving 5th digit
Intestinal atresia
High-arched palate
174
Q

What conditions are associated with Down’s syndrome?

A 
Lung problems
Congenital HD
GI problems
Hypothyroid
Hearing loss
Leukaemia
Early-onset Alzheimer's
175
Q

Risk factors and causes of HTN in children

A

RFs - high salt intake, obesity, low BW then obesity

Causes - renal parenchymal disease, renal vascular disease, coarctation, endocrine, essential HTN

176
Q

Investigations in paediatric HTN

A 
Urine - albumin + blood
U+E, creatinine, FBC
Renal US
ECG
Echo
Retinal screening
177
Q

Causes of stridor in kids. How would you distinguish between them

A
  • Croup - common, 6m-6y, gradual onset, stridor when upset, hoarse voice, likely to be apyrexial, barking cough
  • Bacterial tracheitis - uncommon, 6m-14y, viral prodrome, cont stridor, biphasic, v hoarse, mod-high fever, toxic, barking cough
  • Epiglottitis - rare, 2-7y, sudden, cont stridor, soft + snoring, drooling, muffled voice, toxic + feverish, cough not prominent
178
Q

Causes of croup

A

Parainfluenza virus
RSV
More common in Autumn

179
Q

Pathology of croup

A

Subglottic oedema, inflammation and exudate

180
Q

Rx of croup

A 
Mild illness (min recession/stridor, no cyanosis, alert, good air entry) may be sent home with dex or pred
Failure to improve with steroids should prompt consideration of bacterial tracheitis
181
Q

Define bacterial tracheitis

A

Presence of thick mucopurulent exudate and tracheal mucosal sloughing that is not cleared by coughing, and risks occluding the airway.
Often Hx of viral infection with acute deterioration

182
Q

Rx of epiglottitis

A

Do not examine the throat as this may precipitate obstruction.
Senior help from anaesthetist and ENT

183
Q

Cause if epiglottitis

A

Haemophilus influenzae type B

184
Q

Treatment of epiglottitis

A

Cefotaxime 25-50mg/kg/8h IV

185
Q

Signs of diphtheria

A 
Tonsilitis +/- false membrane over fauces
Carditis
Toxaemia
Dysphagia
Muffled voice
Bronchopneumonia
Airway obstruction preceded by brassy cough
Nasal discharge
186
Q

Symptoms and signs of acute bronchiolitis

A

Coryza precedes cough, fever, tachypnoea, wheeze, insp crackles, apnoea, intercostal recession +/- cyanosis +/- fever

187
Q

Cause of bronchiolitis

A

Usually RSV

Others - mycoplasma, parainfluenza, adenoviruses

188
Q

When would you admit a child with bronchiolitis?

A

Inadequate feeding
Resp distress
Hypoxia

189
Q

Rx of bronchiolitis

A

O2 (if sats <92%)
NG feeds
May need CPAP

190
Q

Signs of pneumonia in a child

A 
Fever
Malaise
Poor feeding
Resp distress
Tachypnoea
Cyanosis
Grunting
IC recession
Accessory muscles
191
Q

When would you admit a child with pneumonia?

A

If SpO2 <92%

Signs of resp distress

192
Q

Rx of pneumonia in a child

A

Amoxicillin 1st line

Others - co-amoxiclav

193
Q

Causes of pneumonia in a child

A 
Pneumococcus
Mycoplasma
Haemophilus
Staph
TB
Viral
194
Q

Signs of pertussis

A

Apnoea

Bouts of coughing ending with vomiting (+/- cyanosis) worse at night or after feeds

195
Q

What causes the characteristic whoop of pertussis

A

Inspiration against a closed glottis

196
Q

How would you diagnose pertussis?

A

Clinical Hx
PCR via nasal swab
Lymphocytosis

197
Q

Complications of pertussis

A

Prolonged illness

Coughing may cause petechiae, conjunctival + retinal bleeds, apnoea, inguinal hernias

198
Q

Rx of pertussis

A

Macrolide (e.g. clarithromycin or azithromycin)

199
Q

CF presentation in paeds

A

Meconium ileus as neonates
Recurrent pneumonia (+/- clubbing)
Failure to thrive
Slow growth

200
Q

Pitfalls of the CF sweat test

A

False +ve - in atopic eczema, adrenal insufficiency, glycogen storage diseases, hypothyroid, dehydration,
False -ve - oedema, poor technique

201
Q

Tests for CF

A

Sweat test
CXR - hyperinflation, inc AP diameter, bronchial dilatation, cysts,
Random glucose
Spirometry - obstructive picture (dec FVC and inc lung vol)
Sputum culture

202
Q

Management of respiratory problems in CF

A

Start physio (TDS) at diagnosis
Teach parents percussion and postural drainage
Older children learn expiration techniques

203
Q

Which organisms tend to cause chest infections in CF?

A 
Staph aureus
H influenzae
Strep pneumoniae
Eventually >90% are chronically infected with pseudomonas aeruginosa
Aspergillosis in adolescence
204
Q

Complications of CF

A 
Haemoptysis
Pneumonia
Pneumothorax
Pulmonary osteoarthropathy
DM
Cirrhosis
Cholesterol gallstones
Fibrosing colonopathy
Male infertility
205
Q

GI problems associated with CF

A

Most have steatorrhoea from pancreatic malabsorption
Omeprazole helps absorption by inc duodenal pH
GI obstruction if dehydrated
Impaired glucose tolerance - yrly screen with OGTT
Merconium ileus

206
Q

Describe merconium ileus

A

Failure to pass stool or vomiting in the first 2d of life

Distended loops of bowel are seen through the abdo wall

207
Q

Management of merconium ileus

A

NG tube drainage
Washout enemas
Excision of the gut containing most meconium

208
Q

What’s the prognosis like for CF

A

Death from pneumonia or cor pulmonale

Most survive to adulthood (median >31yr) and possibly >50 for those born after 2000

209
Q

Newer Rx of CF

A

Recombinant human deoxyribonuclease - improve lung function, dec no. of pul exac
Ivacaftor - CFTR potentiator, improve lung function
Lung transplant - consider if deteriortating despite max therapy
Gene therapy

210
Q

Risk factors for asthma in younger children

A 
Dec birthweight
FHx
Bottle fed
Atopy
Male
Pollution
Prev lung disease
211
Q

DDx for asthma in a younger child

A 
Foreign body
Pertussis
Croup
Pneumonia/TB
Hyperventilation
Aspiration
CF
212
Q

Describe the stepwise managment of asthma in a child

A

1) Occasional B-agonist -> salbutamol
If 1) needed >3 times per wk, add 2)

2) Inhaled steroid -> beclometasone
If not controlled, add 3)

3) <5yo add montelukast in the evening,
If >5yo add inhaled salmeterol, then inc steroids and try montelukast or theophylline

4) Refer to specialist, inc steroid
5) Add pred

213
Q

Treatment of acute severe asthma

A
  1. Sit-up & high flow 100% O2
  2. Salbutamol 5mg neb with ipratropium bromide 0.25mg
  3. Hydrocortisone 100mg IV (or pred)
  4. Consider dose of magnesium sulfate
  5. Aminophylline
  6. Back-to-back nebs
  7. Consider CPAP in ED, take to ITU if exhausted, confused, coma, or refractory to Tx
214
Q

Requirements for discharge after asthma admission

A 
Peak flow >75% of predicted
Good inhaler technique
Stable on discharge regimen
Taking inhaled steroids + pred
Written management plan
F/U with GP in 1wk
F/U in outpatient clinic in 4wks
215
Q

Criteria for acute severe asthma

A

Any one of:

  • PEFR 33-50% predicted
  • RR >40 (2-5yo), >30 (5-12yo), >25 (>12yo)
  • Pulse >140 (2-5yo), >125 (5-12yo), >110 (>12yo)
  • inability to complete sentences
  • use of accessory muscles
216
Q

Criteria for life-threatening asthma

A

Resp acidosis and/or mechanical ventilation with inc vent pressure

Any one of:

  • PEFR <33% predicted
  • sats <92%
  • Silent chest
  • cyanosis
  • feeble resp effort
  • bradycardia
  • dysrhythmia
  • hypotension
  • exhaustion
  • confusion
  • coma
217
Q

Causes of gastroenteritis in children

A

Rotavirus is the most common cause
Norovirus
Astrovirus
Adenovirus

218
Q

Rx of children with gastroenteritis

A

Rehydrate with ORT

Antiemetics - ondansetron

219
Q

Complications of gastroenteritis in children

A

Dehydration
Malnutrition
Temporary sugar intolerance
Post-enteritis enteropathy

220
Q

How would you classify diarrhoea?

A

Secretory - dec absorption or inc excretion
Osmotic - watery stool
Motility disorders - inc in thyrotoxicosis and IBS, dec in pseudo-obstruction, intussception
Inflammatory - salmonella, shigella, campylobacter, IBD, coeliac

221
Q

Define Kwashiokor and its signs

A

Dec intake of protein and essential amino acids

Signs - poor growth, diarrhoea, apathy, anorexia, oedema, skin/hair depigmentation, distended abdo

222
Q

Management of Kwashiorkor

A

Re-education

Offer a gradually inc, high-protein diet and vitamins

223
Q

Define Marasmus and its signs

A

Lack of calories and a discrepency between height and weight. Associated with HIV
Signs - distended abdo, diarrhoea, constipation, infection, dec albumin

224
Q

Causes of acute abdo pain in kids

A

Gastroenteritis
UTI
Viral illness
Appendicitis

(Rarer - mumps, pancreatitis, DM, volvulus, intussusception, Meckel’s, IBD, Hirschprung’s)

225
Q

Investigations for acute abdo pain in kids

A

Urine dip
Bloods - FBC, CRP
Imaging - AXR, US, renal imaging?

226
Q

Describe the presentation of gastro-oesophageal reflux in children

A 
Regurgitation after feeds
Apnoea
Pneumonia
Failure to thrive
Anaemia
227
Q

How would you confirm a diagnosis of GOR in children

A

Clinical diagnosis

Endoscopy if concerned about eosinophilic oesophagitis

228
Q

Rx of GOR in children

A

Reassurance
Avoid over-feeding
Antacid + Na/Mg alginate

229
Q

Causes of abdo distension in a child

A

Obstruction
Air - faecal impaction, air swallowing, malabsorption
Ascities - nephrosis, hypoproteinaemia, cirrhosis, CCF
Solid masses - Wilms’ tumour, neuroblastoma, adrenal tumour
Cysts - PCK, hepatic, dermoid, pancreatic

230
Q

Causes of hepatomegaly in children

A

Infections - infectious mononucleosis, CMV
Malignancy - leukaemia, lymphoma, neuroblastoma
Metabolic - galactosaemia
Others - sickle-cell disease, haemolytic anaemias

231
Q

Describe neuroblastomas

A

Embryonal neoplasm derived from sympathetic neuroblasts. Some regress, whilst others are highly malignant

232
Q

Common sites of metastases for neuroblastomas

A

Lymph nodes
Scalp
Bone

233
Q

Presentation of infantile hypertrophic pyloric stenosis

A

Presents at 3-8wks with vomiting after feeds (becomes projectile)
Vomit doesn’t contain bile, there’s no diarrhoea, and the vomit is of large vol and within mins of feed
Child is constantly hungry
Olive sized pyloric mass may be palpable
Hypochloraemic, hypokalaemic metabolic alkalosis

234
Q

Investigations for infantile hypertrophic pyloric stenosis

A

Blood - U+Es, ABG

Imaging - US (only if exam is -ve, if +ve just go straight to Rx), barium studies are NEVER indicated

235
Q

Rx of infantile hypertrophic pyloric stenosis

A

Correct electrolyte disturbances

Before surgery, pass a wide-bore NG tube

236
Q

Most common cause of intestinal obstruction in children?

A

Intussusception

237
Q

Typical presentation of intussusception

A

Episodic intermittent inconsolable crying, with drying legs up (colic) +/- vomiting +/- blood PR

238
Q

Investigations and Rx for intussusception

A

US with reduction by air enema
CT may be problematic and is less available
AXR may show RLQ opacity +/- perf
If reduction with air enema fails, reduction at laparoscopy or laparotomy is needed

239
Q

What is phimosis?

A

When the foreskin is too tight, with retraction over the glands impossible.
The foreskin may balloon on voiding +/- balanitis

240
Q

How do UTIs typically present in kids?

A

Often non-specifically ill - may present with collapse and sepsis, toddlers may vomit
~35% have vesico-ureteric refluc
~14% have renal scars
~5% have stones

241
Q

Describe the grading for urinary reflux on a micturating cystogram

A

1 - incomplete filling of upper UT, without dilatation
2 - complete filling +/- slight dilatation
3 - ballooned calyces
4 - megaureter
5 - megaureter + hydronephrosis

242
Q

Tx of UTIs in kids

A

<3m - IV amoxicillin + gent

>3m - trimethoprim PO 3d

243
Q

Cause of acute tubular necrosis in kids

A 
Crush injury
Burns
Dehydration
Shock
Sepsis
Malaria
244
Q

Blood results in AKI

A

Inc K, creatinine, urea, phosphate

Dec Na, Ca, Cl

245
Q

Ix for AKI

A

Bedside - urine dip
Bloods - U+Es, serum osmolality, acid-base status, clotting, plts
Imaging - abdo US

246
Q

Briefly outline haemolytic uraemic syndrome in kids

A

Rare
Acute microangiopathic haemolytic anaemia, thrombocytopenia, renal failure + endothelial damage to glomerular capillaries
Typically associated with diarrhoea

247
Q

Signs of haemolytic uraemic syndrome in kids

A

Colitis > haemoglobinuria > oliguria +/- CNS signs > encephalopathy > coma

248
Q

Rx of haemolytic uraemic syndrome in kids

A

Supportive

249
Q

Causes of chronic renal failure in kids

A 
Congenital dysplastic kidneys
Pyelonephritis
Glomerulonephritis
Recurrent infection
Reflux nephropathy
AKI leading to cortical necrosis
250
Q

How does acute glomerulonephritis usually present in kids?

A 
Haematuria
Oliguria
HTN
Periorbital oedema
Fever
GI disturbance
Loin pain
251
Q

What blood tests would you do if you suspected acute glomerulonephritis?

A 
FBC
U+E - creat, K, bicarb, Ca, phos, albumin
Complement (low C3, norm C4)
ANA
Anti-DNA Antibodies (if susp SLE)
ANCA antibodies (if vasculitis susp)
252
Q

What imaging would you request in glomerulonephritis?

A

Urgent renal US

CXR if fluid o/l susp

253
Q

Rx of acute glomerulonephritis

A

Supportive Tx
Careful attention to fluid balance
Treat HTN and infection

254
Q

Describe the presentation of poststreptococcal glomerulonephritis

A

Presents 7-21d after strep infection (pharyngitis, impetigo)

Gross haematuria, oedema, HTN, malaise, anorexia, fever, abdo pain

255
Q

What investigations would you do if you suspected poststrep glomerulonephritis?

A

Bedside - urine dip (protein, RBC casts)
Bloods - urea (inc), creat (inc), C3 (dec)
Imaging isn’t usually indicated

256
Q

Rx of poststrep glomerulonephritis

A 
Na restriction
Diuretics
AntiHTNs
Restrict protein in oliguric phase
Penicillin PO 10d
257
Q

Presentation of nephrotic syndrome

A 
Oedema (usually periorbital initally)
Anorexia
GI disturbance
Infections
Irritability
Ascites
Oliguria
258
Q

Investigations for nephrotic syndrome

A

Bedside - urine dip (frothy, proteinuria)
Bloods - hypoalb, ur+cr usually normal
Imaging - US guided renal biopsy esp in older children

259
Q

Complications of nephrotic syndrome

A 
Pneumococcal peritonitis (inc susceptibility due to renal loss of Ig)
Inc risk VTE
260
Q

Rx of nephrotic syndrome

A

Fluid restrict to 800-1000ml/d
Diuretics if very oedematous
Alb infusion if symptomatic hypovol
Pred

261
Q

Causes of congenital hypothyroidism

A

Athyreosis
Thyroid dysgenesis
Dyshormonogenesis
Maternal antithyroid drugs

262
Q

Causes of acquired hypothyroidism

A

Prematurity
Hashimoto’s
Hypopituitarism
Trisomy 21

263
Q

Signs of hypothyroidism in the neonate

A 
May be none at birth
Prolonged neonatal jaundice
Widely opened posterior fontanelle
Poor feeding
Hypotonia
Dry skin
Sleepiness
Slow feeding
Constipation
264
Q

Tests to confirm hypothyroidism in the neonate

A

T4 (will be dec)
TSH (will be inc)
Iodine uptake (dec)
Hb (dec)

265
Q

Typical presentation of hyperthyroidism in children

A

Pubertal girl with palpitations, tremor, anxiety, tachycardia
Tests show dec TSH and in T4

266
Q

What is PKU? What is it caused by?

A

Phenylalanine ketonuria

Caused by a mutation of PA hydroxylase gene leading to absent or reduced activity of the PAH enzyme.

267
Q

Clinical features of PKU

A 
Fair hair
Fits
Eczema
Musty urine
Dec IQ
268
Q

Rx of PKU

A

Diet - protein substitute that is low in phenylalanine, but rich in tyrosine

269
Q

Define precocious puberty

A

<8yo in girls

<9yo in boys

270
Q

Causes of precocious puberty

A

Central - damage to inhibitory system (infection, trauma), pituitary tumour releasing GnRH
Peripheral - sex hormones from abnormal sources (gonadal tumours, adrenal tumours, exogenous hormones)

271
Q

Ix for precocious puberty

A

Bedside - Growth charts, puberty staging
Bloods - TFTs, LH, FSH, HCG, GH, oestrogen/test
Imaging - US adrenals, testis/pelvic, CNS CT/MRI

272
Q

Rx of precocious puberty

A

Synthetic GnRH analogues (continuous high levels actually inhibit secretion of pituitary gonadotrophins)

273
Q

Describe the Tanner stages of puberty in males

A

1: prepubertal with no pubic hair
2: scrotum + testes have elarged, slightly pigmented but sparse hair
3: penis has grown (esp in length), hair is darker
4: further penile growth, glans is larger and broader, hair is adult type
5: testes and scrotum are adult in size, pubic hair is adult in quantity and presents on the inner borders of thigh

274
Q

Describe the Tanner stages of breast development in females

A

1: Prepubertal
2: Breast bud beneath areolar enlargement
3: Enlargement of the entire breast with no protrusion of papilla or of 2’ mound
4: Enlargement of the areola and papilla as a 2’ mound
5: Adult configuration of the breast with protrusion of the nipple

275
Q

Describe the Tanner stages of pubic hair development in females

A

1: No pubic hair
2: Straight hair along labia
3: Hair inc in quantity, darker
4: Har is more dense, curlier, adult distribution but less abundant
5: abundant, adult-type pattern

276
Q

Cause of T1DM

A

T cell mediated destruction of pancreatic beta-cells, leading to insulin deficiency and hyperglycaemia

277
Q

Typical presentation of T1DM

A

Several weeks of polyuria, lethargy, polydipsia, weight loss +/- infection, poor growth, ketosis

278
Q

How is a diagnosis of T1DM made?

A

WHO criteria:
Signs of hyperglycaemia with venous blood gluc (>11.1mmol/L random, or >7mmol/L fasting),
OR
Rasied venous blood gluc on 2 occasions without symptoms

279
Q

What is MODY?

A

Maturity onset diabetes of the young
AD kind of non-ketotic diabetes
Defect is pancreatic beta cell dysfunction - leading to impaired insulin secretion

280
Q

Presentation of a child with DKA

A 
Listlessness
Confusion
Vomiting
Polyuria
Polydipsia
Weight loss
Abdo pain
Dehydrated
Deep and rapid breathing (Kussmaul)
Ketotic breath
Shock
281
Q

How would you confirm a diagnosis of DKA?

A

Requires the combination of:

  • hyperglycaemia (>11.1 mmol/L)
  • acidosis (venous pH <7.3, bicard <15)
  • ketones in urine and blood
282
Q

Define the categories of DKA severity

A

Mild - pH <7.3
Moderate - pH <7.2
Severe - pH <7.1

283
Q

Management of DKA in a child?

A
  • Resus - ABC, 0.9% saline to correct dehydration, aim to restore deficit over 48h (avoid cerebral oedema), ITU if low BP
  • Confirm diagnosis - Hx, cap gluc, ketones, VBG
    Investigations - weight, FBC, U+E, gluc, Ca, Phos, ABG, ECG (hyperkal)
  • Fluid status - level of dehydration + maintenance given steadily over 48h
  • IV fluids - 0.9% saline + 20mmol KCL/500ml. When blood gluc falls to 14mmol/L, add in 5% glucose
  • After 1hr of fluids, start IV insulin 0.1 units/kg/h of fast acting.
    -> ensure glucose in fluids when blood gluc <14 -> don’t stop insulin as it’s needed to switch off ketogenesis
284
Q

Ongoing monitoring of a pt with DKA

A 
Hrly blood gluc
CNS status >half-hrly
Headaches/mood changes -> cerebral oedema
Hrly fluid balance
U+Es, BG 4hrly
Weigh BD
Monitor ECG
Infection screen
285
Q

If a child is 8% dehydrated, what is there water deficit in ml/kg?

A

80ml/kg

286
Q

Why should you avoid prescribing aspirin in <16yos

A

Reye’s syndrome

287
Q

What is the therapeutic dose of paracetamol in children? At what level is it toxic?

A

Therapeutic dose = 15mg/kg

Hepatotoxicity = >75mg/kg ingested

288
Q

Commonest childhood leukaemia

A

Acute lymphoblastic leukaemia - malignant disorder of lymphoid progenitor cells

289
Q

Peak age of ALL

A

2-6yrs

Second peak at >50yrs

290
Q

Causes of ALL

A 
Precise cause in unknown
Genetic associations
Inc risk if Tri 21
Prenatal exposure to XRs
In utero exposure to infection
Delayed postnatal exposure to infection
Environmental radiation
291
Q

Presentation of ALL

A 
Pancytopenia (pallor, infection, bleeding)
Fatigue
Anorexia
Fever
Bone pain
Painless lumps in neck, axilla, groin
CNS effects - cranial palsies
292
Q

Investigations for ALL

A

Bloods - WCC (inc, dec or norm), normochromic normocytic anaemia +/- low plts, inc urate, inc LDH
Imaging - CXR (may show mediastinal masses)
Other - marrow (50-98% blasts), CSF (inc protein, inc gluc)

293
Q

Complications of ALL

A 
Neutropenic sepsis
Hyperuriceamia - massive cell death @ induction
Poor growth
Cancer elsewhere
Relapses
294
Q

Causes of paediatric anaemia with MCV <70fL (microcytic)

A

?Iron deficiency anaemia - poor diet, poverty, bleeding, stomatitis, koilonychia
?Thalassaemia - mediterranean/SE Asian, short stature, distended abdo

295
Q

Causes of paediatric anaemia with MCV >100fL (macrocytic)

A

?folate deficiency - malabsorption, phenytoin
?B12 deficiency - breast milk from vegetarian, malabsorption (signs = poor feeding, late milestones)
?haemolysis

296
Q

Causes of paediatric anaemia with MCV 81-97fL (normocytic)

A

?haemolysis

?marrow failure - transient after infection, or thyroid/kidney/liver failure, or malignancy

297
Q

Possible diagnoses if a child is ill with purpura and low plts

A

Meningococcal septicaemia (ceftriaxone)
Leukaemia
DIC
Haemolytic uraemic syndrome

298
Q

Possible diagnoses if a child is ill with purpura and a normal or high plt

A

Viruses - measles, enteroviruses

Vasculitis

299
Q

Possible diagnosis if a child is well with purpura and a normal plt count

A

(if no Hx of trauma)

HSP

300
Q

Possible diagnosis is a chlid is well with purpura and a low plt count

A

Consider ITP (rare)

301
Q

What is HSP?

A

Acute immune complex-mediated vasculitis

302
Q

What are the features of HSP?

A 
Most pts have a preceding URTI
Purpura
Arthritis/arthralgia
Abdo pain
Renal involvement - nephropathy
303
Q

Investigations for HSP

A

Bedside - urine dip (protein), BP

Bloods - ESR (inc), IgA (inc), U+Es,

304
Q

Complications of HSP

A 
Massive GI bleeds
Ileus
Haemoptysis
Acute renal failure
Chronic renal failure in 5%
305
Q

What is ITP? How does it typically present?

A

Idiopathic (immune) thrombocytopenia purpura
Usually presents with acute bruising, purpura, petechiae
Usual Hx of recent URTI or gastroenteritis
May follow CMV, EBV, parvovirus, varicella zoster, liver vaccine virus (MMR)

306
Q

Investigations for ITP

A

Bloods - isolated thrombocytopenia

307
Q

Management and prognosis of ITP

A

Most can be managed at home
Gradual resolution over 3m for 80%
20% become chronic
Admit if there are any unusual features (excess bleeding)

308
Q

Typical signs of primary antibody deficiency

A 
Frequent infections
Bronchiectasis
Chronic sinusitis
Failure to thrive
Absent tonsils
Enteropathy
Hepatosplenomegaly
Anaemia
Arthopathy
Lymphopenia
Dec serum total protein
309
Q

Management of 1’ antibody deficiencies

A

Treat intercurrent infections promptly - postural physio, bronchodilators, ABx
Immunoglobulin replacement

310
Q

Complications of 1’ antibody deficiencies

A

Chest - bronchiectasis, granulomas, lymphoma
Gut - malabsorption, giardia, cholangitis, atropic gastritis, colitis
Liver - acquired hepatitis, chronic active hepatitis, biliary cirrhosis
Blood - autoimmune haemolysis, ITP, anaemia of chronic disease, aplasia
Eyes/CNS - keratoconjunctivitis, uveitis, granulomas, encephalitis
Others - septic arthropathy, arthralgia, splenomegaly

311
Q

Define IgA deficiency and explain how it usually presents

A

Dec IgA + normal/inc levels of other immunoglobulins
Most common 1’ antibody deficiency
Often asymptomatic
Associated with resp and gastro infections

312
Q

Signs of encephalitis

A 
Flu-like promdrome
Dec consciousness
Odd behaviour
Vomiting
Fits
Fever
Meningism
313
Q

Infective causes of encephalitis

A 
HSV
Mumps
Varicella zoster (recent chickenpox?)
Rabies
Parvovirus
Immunocompromise
Influenza
Toxoplasmosis
TB
Mycoplasma
Malaria
Dengue
Rickettsia
Lyme disease
314
Q

Non-infective differentials for encephalitis

A 
Hypoglycaemia
DKA
Kernicterus
Hepatic failure
Lead or other poisoning
Subarachnoid haemorrhage
Malignancy
Lupus
315
Q

Investigations for encephalitis

A

Bloods - FBC, CRP, blood culture
CSF culture + PCR
Test stool for enteroviruses

316
Q

When would you suspect meningitis?

A

In any ill baby or child
Symptoms may be subtle, but can include irritability, abnormal cry, lethargy, difficulty feeding
Signs - fever, seizures, apnoea, bulging fontanelle

317
Q

Immediate management of meningitis

A

IV cefotaxime (200mg/kg/24hr IV/IM 6hrly)

318
Q

Septic signs of meningitis

A 
Usually present before meningeal signs
Fever
Cold extremities
Joint pain
Abnormal skin colour
Rash
Tachycarida
Tachypnoea
Hypotension
319
Q

Meningeal signs of meningitis

A

Comparatively late, less common in young children
Stiff neck (often absent if <18m)
Kernig’s sign (resistance to knee extension with hip flexed)
Brudzinski’s sign (hips flex on bending head forward)
Photophobia
Opisthotonus

320
Q

Differentials for neck stiffness

A

Meningitis
Tonsilitis
Lymphadenitis
Subarachnoid bleed

321
Q

Give come C/I for lumbar puncture

A

Focal signs
DIC
Purpura
Brain herniation

322
Q

Investigations for meningitis

A

LP - Gram stain, culture, virology, glucose, protein
Bloods - FBC, U+E, culture, CRP
Nasal swabs
Stool virology

323
Q

Causes of more severe bronchiolitis

A

Bronchopulmonary dysplasia (e.g. prematurity)
Congenital heart disease
Cystic fibrosis

324
Q

Continuous blowing noise heard below clavicles in children

A

Venous hum - benign

325
Q

Low-pitched noise heard at LLSE in children

A

Still’s murmur - benign

326
Q

Features of fragile X syndrome in males

A 
Learning difficulties
Large low set ear, long thin face, high arched palate
Macroorchidism
Hypotonia
Autism more common
MV prolapse
327
Q

Features of fragile X in females

A

Range from normal to mild

328
Q

Describe Patau syndrome

A

Trisomy 13

  • microcephaly, small eyes
  • cleft lip/palate
  • polydactyly
  • scalp lesions
329
Q

Describe Edward’s syndrome

A

Trisomy 18

  • micrognathia
  • low-set ears
  • rocker bottom feet
  • overlapping of fingers
330
Q

Features of Prader-Willi syndrome

A

Hypotonia
Hypogonadism
Obesity

331
Q

Features of William’s snydrome

A 
Short stature
Learning difficulties
Extrovert
Transient neonatal hypercalc
Supravalvular aortic stenosis
332
Q

Define precocious puberty

A

Development of 2’ sexual characteristics before 8yrs in females, and 9yrs in males

333
Q

Child with asthma not controlled by SABA + ICS. Next step?

A

Add LR antagonist

334
Q

Features of Noonan syndrome

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

335
Q

Features of Pierre-Robin syndrome

A

Micrognathia
Post displacement of tongue
Cleft palate

336
Q

Most likely cause of meningitis in <3m, 3m-6yrs, >6yrs

A 
<3m = group B strep (from mum @ birth)
3m-6y = n meningitidis (also strep pneumoniae, h influenzae)
>6y = n meningitidis + strep pneumoniae
337
Q

Cyanosis congenital HD presenting:

1) within first days of life
2) at 1-2m

A

1) TGA

2) TOF

338
Q

What vaccines are included in the 6 in 1 vaccine?

A 
Diphtheria
Tetanus
Whooping cough
Polio
HIB
Hep B
339
Q

Treatment of ADHD

A

10wk watch and wait
Parental education

Medication if >=5yrs - methylphenidate

340
Q

Managment of croup not settled with dexamethasone

A

High-flow O2

Neb adrenaline

Finals (25 decks)

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