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5TH YEAR > CLAH > Flashcards

CLAH Flashcards

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1
Q

Definition of ADHD

A

Neurodevelopmental disorder which manifests in children and young people as persistent and disabling levels of restlessness and impulsiveness, or inattention, or all three, beyond developmental norms

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2
Q

Diagnosis criteria for diabetes

A

Random plasma glucose > 11mmol/L in the presence of symptoms of hyperglycaemia
Fasting plasma glucose > 6.9mmol/L
Plasma glucose >11mmol/L 2 hours after a 75g oral glucose
HbA1c >48mmol/mol

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3
Q

What are the causes of death in DKA?

A

Cerebral oedema
Hypokalaemia
Aspiration pneumonia

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4
Q

How do you diagnose DKA

A

Acidosis pH <7.3 or bicarb <18
Ketonaemia >3
NOT GLUCOSE- this can be normal in young people with known diabetes

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5
Q

Features of DI

A 
Polyuria
Polydipsia
Dehydration
Postural hypotension
Hypernatraemia
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6
Q

How to differentiate between cranial and nephrogenic DI

A

Water depreciation test
Cranial DI- high urine osmolality after desmopressin
Nephrotic- still low

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7
Q

Features of appendicitis

A 
Abdominal pain- worse on movement
Anorexia
McBurney's sign
Low grade fever
Nausea
Tachycardia
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8
Q

Guidelines on initial fluid boils in DKA

A

Don’t give routinely
Only give if shocked
10ml/kg 0.9% saline

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9
Q

Classic age of presentation of croup

A

6 months to 3 years

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10
Q

Typical organisms causing croup

A

Parainfluenza virus
RSV
Adenovirus

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11
Q

Clinical features of croup

A 
Coryza followed by difficulty breathing
Increased work of breathing
Barking cough
Hoarse voice
Low grade fever
Symptoms worse at night
Symptoms worse on irritation
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12
Q

Management of croup

A

Dexamethasone
Adrenaline
Supportive

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13
Q

Investigation of croup

A

Clinical diagnosis

DO NOT DO A THROAT SWAB

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14
Q

What are the main allergy diseases?

A 
Allergic rhinitis
Allergic asthma
Eczema
Food allergy
Latex allergy
Insect venom allergy
Drug allergy
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15
Q

What are the main food allergens?

A 
Cows milk
Soya
Shellfish
Peanuts
Egg
Tree nuts
Fish
Wheat
Sesame
Kiwi
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16
Q

Common feeding problems in preterm babies

A

Slow gut transit

GORD

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17
Q

What are the most common bacterial causes of UTIs in children?

A

E.coli
Klebsiella
Enterococci

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18
Q

Risk factors for UTI

A 
<1 y/o
Female (male if <6 months)
Lack of circumcision
Constipation
Previous history
Voiding dysfunction
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19
Q

Clinical features of UTI

A 
Irritability
Foul smelling urine
Dysuria
Abdominal pain
Fever
Nausea/ vomiting
Poor growth
Poor feeding
Suprapubic tenderness
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20
Q

Investigations carried out in suspected UTI

A

URINE CULTURE- x2
Urina dipstick
Renal USS
DMSA

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21
Q

Management of UTI

A

Infants < 3 months referred to hospital immediately
Not admitted: cephalosporin or co-amoxiclav for 7-10 days
If > 3 months: 3 days of Trimethoprim, Co-amoxiclav, Nitrophenotoin

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22
Q

Complication of UTI

A 
Sepsis
Renal abscess
AKI
Hypertension
Hydronephrosis
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23
Q

Risk factors for HSP

A

Male

3-10 y/o

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24
Q

Clinical features of HSP

A

Purpuric rash
Arthralgia
Abdominal pain
Glomerulonephritis

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25
Management of HSP
Analgesia | Corticosteroids if nephrotic syndrome present
26
Ways to monitor HSP
BP Urine dip Renal function Albumin
27
Complications of HSP
Glomerulonephritis Orchitis Pulmonary vasculitis
28
Age of presentation of Kawasaki’s disease
< 5 years | Peak incidence 10 months
29
Complications of Kawasaki disease
``` Aseptic meningitis Gall bladder hydrops Hepatitis Pancreatitis Arthritis Myositis Pericarditis Myocarditis Coronary artery aneurysm ```
30
Ages affected by febrile convulsions
6 months to 6 years
31
Risk factors for asthma
Male Parental smoking Prematurity Previous bronchiolitis infection
32
Clinical features of asthma
``` Expiratory wheeze Shortness of breath Chest tightness Coughing Reduced air entry Hyper-expanded chest ```
33
Triggers for asthma
``` Exposure to allergens URTI Exercise Exposure to cold air Certain emotions (anxiety or excitement) ```
34
Diagnosis of asthma
Older children- lung function tests | Younger children- bronchodilator reversibility
35
Symptoms of cystic fibrosis
``` Steatorrhoea Chronic cough Persistent wheeze Recurrent chest infections Malabsorption and failure to thrive Bloating Nasal polyps Thick mucus Abdominal pain Finger clubbing ```
36
What are the features of an IgE mediated reaction?
``` Quick onset Anaphylaxis Easy to diagnosis Validated tests Swelling Urticaria Vomiting Wheezing Coughing ```
37
What are the features of non IgE mediated reaction?
``` Delayed onset Vomiting Diarrhoea Abdominal pain Malabsorption Slow weight gain Eczema ```
38
Clinical features of allergy
``` Sneezing Rhinorrhoea Red itchy eyes Wheeze Cough Urticarial rash ```
39
Management of CMPI
Dairy free for 9-12 months then gradually reintroduced
40
Features of tetralogy of fallot
VSD Overriding aorta Right ventricular hypertrophy Pulmonary stenosis
41
What will investigations show in tetralogy of fallot?
ECG- right axis deviation; right ventricular hypertrophy Chest X-ray shows boot shaped heart ECHO
42
What is acute lymphoblastic leukaemia?
Abnormal proliferation of immature lymphocytes (usually B cells)
43
Peak incidence of ALL
2-3 years
44
Virus responsible for slapped check syndrome
Parovirus B19
45
What virus is responsible for Hand, foot and mouth disease?
Coxsackie A16
46
Ejection systolic murmurs
Aortic stenosis Pulmonary stenosis HOCM
47
What diet is recommended in patients with cystic fibrosis?
High calorie High fat Pancreatic enzyme supplementation at every meal
48
What are the requirements for the Fraser Guidelines?
the young person understands the professional's advice the young person cannot be persuaded to inform their parents or allow the professional to contact them on their behalf the young person is likely to begin, or continue having, sexual intercourse with or without contraceptive treatment unless the young person receives contraceptive treatment, their physical or mental health, or both, is likely to suffer the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent
49
Murmur of PDA
Continuous crescendo decrescendo 'machinery'
50
Pansystolic murmurs
Mitral regurgitation Tricuspid regurgitation VSD
51
Murmur heard in TOF
Ejection systolic murmur
52
Murmur of ASD
Mid systolic crescendo decrescendo | Fixed split second heart sound
53
Risk factors for PDA
Prematurity | Maternal rubella infection
54
Clinical features of PDA
Shortness of breath Difficulty feeding Poor weight gain Lower respiratory tract infection
55
Conditions associated with a VSD
Foetal alcohol syndrome Downs Turners
56
What congenital heart condition increases your risk of infective endocarditis?
VSD
57
Clinical features of VSD
Can present as a simple heart murmur in a well child if small or heart failure if large Murmur is pansystolic heart at the lower left sternal edge Pulmonary hypertension may occur Poor feeding Dyspnoea Tachypnoea Failure to thrive
58
What are the clinical features of Eisenmenger Syndrome?
``` Right ventricular heave Loud P2 Raised JVP Peripheral oedema Cyanosis Clubbing Dyspnoea Plethoric complexion ```
59
What genetic condition is associated with coarctation of the aorta?
Turner's syndrome
60
Clinical features of coarctation of the aorta
``` Weak femoral pulses High blood pressure Systolic murmur Tachypnoea Poor feeding Grey and floppy baby ```
61
Risk factors for developing ToF
Rubella infection Increased maternal age Alcohol consumption in pregnancy Diabetic mother
62
What is Ebstein's Anomaly?
Tricuspid valve is set lower in the right side of the heart. Results in poor flow to the pulmonary vessels
63
What condition is associated with Ebstein's anomaly?
Wolff- Parkinson- White syndrome
64
Why are babies given vitamin K?
Unable to synthesise in the first 3 months of life | Causes haemorrhage disease of the newborn
65
What is tested for in the Guthrie test and when is it carried out?
``` 5 days PKU Sickle cell Congenital hypothyroidism CF ```
66
Causes of neonatal jaundice <24 hours
``` Rhesus incompatibility ABO incompatibility G6PD deficiency Spherocytosis Congenital infection ```
67
Causes of neonatal jaundice 24 hours to 2 weeks
Physiological
68
Clinical features of otitis media
Otalgia Pyrexia Systemic illness Red bulging tympanic membrane
69
Bacterial causes of otitis media
Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis
70
Viral causes of otitis media
RSV Rhinovirus Adenovirus Parainfluenza virus
71
Which patients are given antibiotics in otitis media?
Bilateral OM Systemic upset Neonates
72
Complications of otitis media
Tympanic membrane perforation Chronic otitis media with effusion Labrynthitis Mastoiditis
73
What are the different causes of epilepsy?
``` Idiopathic Genetic Structural Metabolic Immune Infectious ```
74
What are the stages of newborn resuscitation?
Dry baby and maintain temperature Assess tone, RR, HR If gasping or not breathing give 5 inflammation breaths Reassess If the HR is not improving start compressions and ventilation breaths at a rate of 3:1
75
Investigations in epilepsy
``` Diagnosis is generally clinical Home video recording Intracranial EEG is gold standard MRI- recommended if onset before 2 years Genetic testing ```
76
Treatment for absence seizures
1st Ethosuximide or sodium valproate | 2nd Lamotrigine
77
Treatment for focal seizures
1st Carbamazepine or lamotrigine
78
Treatment for tonic clonic seizures
1st Sodium valproate | 2nd Lamotrigine
79
Treatment for myoclonic seizures
1st Sodium valproate | 2nd Levetiracetam or topiramate
80
Treatment for infantile spasms
1st Corticosteroids or vigabatrin
81
Complications of epilepsy
Cardiac or respiratory arrest due to prolonged seizure Haematomas, bruising, abrasions and burns during seizures Sudden unexplained death in epilepsy
82
How long are children infective with whooping cough?
3 weeks after the onset of symptoms
83
Incubation period of whooping cough
10-14 days
84
Clinical features of whooping cough
Starts with mild coryzal symptoms Low grade fever Cough Apnoeas Severe coughing starts a week later Inspiratory whoop Can cough so much they faint, vomit or develop a pneumothorax Symptoms take 2 months to go
85
Management of whooping cough
Children under 6 should be admitted Notifiable disease Oral macrolides or co- trimoxazole Household contacts should be given prophylaxis antibiotics
86
Clinical features of Kawasaki Disease
High grade fever lasting >5 days. Resistant to anti-pyrexials Conjunctival injection Bright red cracked lips Strawberry tongue Cervical lymphadenopathy Red palms and soles of the feet which later peel
87
Sites of non-accidental injury
``` Ears Black eyes Soft tissues of cheeks Triangle of safety Inner aspect of arms Back and side of trunk Forearms Chest and abdomen Groin and genital injury Inner aspect of thighs ```
88
Clinical features oligoarticlar JIA
``` Five times more common in girls 6 months to 6 years Affects one to four joints Joint pain Stiffness Reduced range of movement Remission in 4-5 years is usual ANA positive ```
89
Clinical features of RF negative polyarthritis
Girls aged 10-14 years Affects 5 or more joints Can be symmetrical with large and small joints swelling Pain and stiffness with minimal swelling
90
Clinical features of RF positive polyarthritis
Symmetrical large and small joint swelling with finger joint involvement Destructive and aggressive
91
Clinical features of Still's disease
Aged 2 Daily spiking of temperature for at least 2 weeks Rash, lymphadenopathy, hepatomegaly, splenomegaly Most remit after 3-5 years Anaemia, leukocytosis, thrombocytosis, and elevated inflammatory markers
92
Bacterial causes of meningitis in <3 month
Group B strep E.coli Listeria
93
Bacterial causes of meningitis in >3 month
Strep pneumonia N. meningitides Haemophilus influenzae type B
94
Non infective causes of meningitis
Malignancies (leukaemia, lymphoma, CNS tumours) Chemotherapy Kawasaki SLE
95
Presentation of meningitis in neonates
``` Lethargy Irritability High pitched cry Poor feeding High temperature Tense fontanelle Reduced tone Apnoeas Bradycardia ```
96
Signs and symptoms of meningitis in older children
``` Headache Neck stiffness Photophobia Confusion Muscle aches and pains Kernigs positive ```
97
Absolute contraindications of LP
Signs of raised ICP Cardio-pulmonary compromise Infection overlying the skin Coagulopathy or thrombocytopenia
98
Signs of raised ICP
Relative hypertension and bradycardia Focal neurological signs, Papilloedema Doll’s eyes
99
Management of meningitis
``` Give high flow oxygen Take blood cultures Give IV antibiotics Give fluid challenge Measure lactate Measure urine output Report to public health ```
100
Acute complications of meningitis
``` Septic shock DIC Raised ICP SIADH Hydrocephalus Cerebral abscess ```
101
Long term complications of meningitis
``` Hearing loss Subdural effusion Learning difficulties Motor and neurodevelopmental deficits AKI and CKD Amputation Growth plate damage Arthritis ```
102
Risk factors for nephrotic syndrome
``` Asian ethnicity Male Previous infections NSAIDs SLE Diabetes HIV Family history Previous nephrotic syndrome ```
103
What are the three features of nephrotic syndrome
Proteinuria Hypoalbuminemia Oedema
104
Cause of nephrotic syndrome
Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy
105
Autosomal dominent conditions
``` Myotonic dystrophy Marfan syndrome Neurofibromatosis type 1 Tuberous sclerosis Achondroplasia ```
106
Autosomal recessive conditions
``` Cystic fibrosis Thalassaemia Sickle cell disease Congenital adrenal hyperplasia Inborn errors of metabolism (PKU) ```
107
X-linked recessive conditions
``` Haemophillia A and B Duchenne muscular dystrophy Fragile X syndrome G6PD deficiency Colour blindness ```
108
Clinical features of nephrotic syndrome
``` Periorbital oedema- earliest signs Weight gain Abdominal distention Tiredness Foamy urine Increased infections Poor growth and development ```
109
``` Major motor milestone: 6-8mo 9-11mo 11-12mo 12-14mo 15mo 16mo 20-24mo 3y 4y 5y 6-7y ```
``` 6-8mo- sit without support 9-11mo- creep on hands and knees 11-12mo- cruise holding on to furniture 12-14mo- walk 15mo- climb up stair on hands and knees 16mo- run stiffly 20-24mo- walk down stairs 3y- walk up stairs 4y- hop on one foot 5y- skip 6-7y- balance on foot for 20sec ```
110
Investigation for SUFE
AP and frog leg x-ray
111
Clinical features of achondroplasia
``` Short limbs with shortened fingers Lead head with frontal bossing and narrow foramen magnum Midface hypoplasia with flattened nasal bridge ‘Trident’ hands Lumbar lordosis Motor development delay Normal intelligence Recurrent otitis media ```
112
Clinical features of fragile X syndrome
``` Learning difficulties Macrocephaly Long face Large low set ears Macro-orchidism Hypotonia Autism is more common Mitral valve prolapse ```
113
Clinical features of necrotising enterocolitis
``` Feeding intolerance Abdominal distention Bloody stools Abdominal discolouration Perforation Peritonitis ```
114
Signs of life threatening asthma
``` Cyanosis Poor respiratory effort- normal CO2 Peak expiratory flow rate <33% Silent chest Altered level of consciousness SpO2 <92 Agitation Altered consciousness ```
115
Signs of a severe asthma attack
``` SpO2 <92% PEF 33-50% Too breathless to talk or feed HR: >140 RR: >40 ```
116
School exclusion criteria for measles
4 days from onset of rash
117
School exclusion criteria for roseola
None
118
School exclusion criteria for threadworms
None
119
School exclusion criteria for threadworms
None
120
School exclusion criteria for scarlet fever
24 hours after commencing antibiotics
121
School exclusion criteria for whooping cough
2 days after commencing antibiotics
122
School exclusion criteria for rubella
4 days from onset of rash
123
School exclusion criteria for chicken pox
All lesions have crusted over
124
School exclusion criteria for mumps
5 days from he onset of swollen glands
125
School exclusion criteria for impetigo
Until symptoms have settled for 48 hours
126
School exclusion criteria for scabies
Until treated
127
School exclusion criteria for influenza
Until recovered
128
Features of foetal alcohol syndrome
``` Short palpebral fissure Thin vermillion border Smooth/ absent filtrum Learning difficulties Microcephaly Growth retardation Epicanthic folds Cardiac malformations ```
129
Features of Patau syndrome
Microcephalic Small eyes Polydactyly Scalp lesions
130
Features of Edward''s syndrome
Micrognathia Low set ears Rocker bottom feet Overlapping fingers
131
Features of Noonan Syndrome
Webbed neck Pectus excavatum Short stature Pulmonary stenosis
132
Features of Pierre-Robin Syndrome
Micrognathia Posterior displacement of the tongue Cleft Palate
133
Features of Prader- Willi syndrome
Hypotonia Hypogonadism Obesity
134
Features of William's syndrome
``` Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supraclavicular aortic stenosis ```
135
Which vaccinations are live attenuated?
``` Mumps Yellow fever MMR Oral polio Oral typhoid BCG Influenza (intranasal) Oral rotavirus ```
136
Which vaccinations are inactivated preparations?
Rabies Hep A Influenza (IM)
137
Which vaccinations are toxoid?
Tetanus Diphtheria Pertusus
138
What are the causes of GORD?
Immature lower oesophageal sphincter Food allergy Increased gastric pressure Foregut intestinal dysmotility
139
Clinical features of GORD
``` Persistent regurgitation particularly after meals Feeding difficulties, food refusal Arching of the back and neck Chronic cough Wheeze Sore throat or hoarseness Apnoeic episodes ```
140
Differentials for vomiting in children
``` Overfeeding GORD Pyloric stenosis Gastritis or gastroenteritis Appendicitis Infections such as UTI, tonsillitis or meningitis Intestinal obstruction Bulimia ```
141
What are the red flags for vomiting?
Not keeping down any feed (pyloric stenosis or intestinal obstruction) Projectile or forceful vomiting (pyloric stenosis or intestinal obstruction) Bile stained vomit (intestinal obstruction) Haematemesis or melaena (peptic ulcer, oesophagitis or varices) Abdominal distention (intestinal obstruction) Reduced consciousness, bulging fontanelle or neurological signs (meningitis or raised intracranial pressure) Respiratory symptoms (aspiration and infection) Blood in the stools (gastroenteritis or cows milk protein allergy) Signs of infection (pneumonia, UTI, tonsillitis, otitis or meningitis) Rash, angioedema and other signs of allergy (cows milk protein allergy) Apnoeas are a concerning feature and may indicate serious underlying pathology and need urgent assessment
142
Management of GORD
Reduce feed volume Raise the cot bed at the head end by 30 degrees Feed thickeners- if bottle fed Alginate therapy Antacids if breast fed If these aren’t effective, a 4 weeks course of ranitidine or omeprazole should be started
143
Complications of IBD
Fissures Fistulas Strictures Acute severe colitis
144
What are the complications of nephrotic syndrome?
``` Hypovolaemic Thrombosis Infection AKI/ CKD Relapse ```
145
Management of nephrotic syndrome
High dose steroids- 4 weeks then weaned over the next 8 weeks Low salt diet Diuretics to treat oedema Albumin infusion
146
What are the indications for examining urine?
``` Temp > 38 with no definitive cause Unexplained vomiting or abdominal pain Frequency; Dysuria; Enuresis Failure to thrive Prolonged jaundice in a newborn Non specific illness Suspected sexual abuse Haematuria or HTN Abdominal mass ```
147
How long should you treat a neonate with a UTI?
5 days IV then 5 days oral
148
How long should you treat an infant <6 months with a UTI?
3-5 days then 5 days oral
149
How long should you treat an infant >6 months with an upper UTI?
7 days oral | IV initially if high risk serious illness/ vomiting
150
How long should you treat an infant >6 months with a lower UTI?
3 days oral
151
Risk factors for prematurity
``` Social deprivation Smoking Alcohol Drugs Overweight / underweight mother Maternal Comorbidities Twins ```
152
Common problems in premature babies
``` Hypothermia Hypoglycaemia Apnoeas Respiratory Distress Syndrome Neonatal Jaundice Intraventricular Haemorrhage Retinopathy of Prematurity Necrotising Enterocolitis Weak Immune System (susceptible to infection) ```
153
What is the criteria for diagnosing failure to thrive?
Weight-for-length or body mass index (weight in kg/height in m^2) of <5th percentile on an appropriate growth chart Weight-for-age dropping >2 major percentile lines, after having achieved a stable pattern Length-(or height)-for-age <5th percentile or dropping >2 major percentile lines.
154
What are the risk factors for pyloric stenosis?
3-6 weeks | Male
155
What are the clinical features of pyloric stenosis?
``` Projectile vomiting Mass palpable in the upper right quadrant Hungry Dehydrated Poor weight gain ```
156
What are the signs of dehydration in infants?
``` Sunken fontanelle Mottled skin Cold hands and feet Sunken eyes Dry mucous membranes Cap refill time > 2 seconds Tachycardia ```
157
Management of pyloric stenosis
Ramstedt pyloromyotomy
158
Management of anaphylaxis
``` Adrenaline: - >12y/o: 0.5 mg - 6-12 y/o: 0.3mg - >6 y/o: 0.15mg Chlorpheniramine Hydrocortisone ```
159
Pathogen causing roseola infantum
Human herpes virus 6
160
Ages affected by roseola infantum
6 months- 2 years
161
Clinical features of roseola infantum
High grade fever followed by a maculopapular rash Nagayama spots Febrile convulsions Diarrhoea and cough
162
How do you distinguish between necrotising enterocolitis and intussusception?
NE: younger child/ premature I: distended abdomen, red current jelly stool, older children (5m-12m)
163
Criteria for immediate request of CT head in children
* Loss of consciousness lasting more than 5 minutes (witnessed) * Amnesia (antegrade or retrograde) lasting more than 5 minutes * Abnormal drowsiness * Three or more discrete episodes of vomiting * Clinical suspicion of non-accidental injury * Post-traumatic seizure but no history of epilepsy * GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department * Suspicion of open or depressed skull injury or tense fontanelle * Any sign of basal skull fracture (haemotympanum, panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign) * Focal neurological deficit * If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head * Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 m, high-speed injury from a projectile or an object)
164
Most common viral cause of bronchiolitis
Respiratory syncytial virus
165
Risk factors for bronchiolitis
<1 y/o | Ex-preterm with chronic lung disease
166
Clinical features of bronchiolitis
``` Coryzal symptoms Cough Harsh breath sounds Wheeze Increased respiratory rate Decreased feeding Hyperinflation Crepitations Apnoea Mild fever Grunting ```
167
Prevention for RSV
Palivizumab | Given to young children with severe chronic diagnoses such as congenital cardiac disease or chronic lung disease
168
Reasons for admission in bronchiolitis
``` Aged < 3 months Pre- existing condition- prematurity, Down’s syndrome, cystic fibrosis < 75% of milk intake Clinical dehydration Resp rate <70 Oxygen sats <92% Apnoeas Moderate/ severe respiratory distress ```
169
What is cerebral palsy?
Non- progressive disease of the brain originally from the antenatal, neonatal or postnatal period
170
Risk factors for CP?
``` Prematurity Multiple births Maternal illness Thyroid disease Birth asphyxia Brain malformation Antenatal infection Metabolic/ genetic ```
171
Clinical features of febrile convulsions
Usually occur early in a viral infection as the temperature rises rapidly Seizures last <5 minutes Most commonly tonic clonic

5TH YEAR (10 decks)

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