Miscellaneous Flashcards
(165 cards)
1
Q
What is the age range for early-onset Vitamin K Deficiency Bleeding?
A
0-24 hours
2
Q
What are the potential sites of hemorrhage in early-onset disease?
A
Cephalohematoma, subgaleal, umbilicus, intracranial, gastrointestinal, intraabdominal
3
Q
What drugs increase the risk of early-onset disease by interfering with Vitamin K?
A
Phenobarbital, phenytoin, warfarin, rifampin, isoniazid
4
Q
How can early-onset Vitamin K deficiency bleeding be prevented?
A
Avoid high-risk medications, antenatal Vitamin K treatment to the mother, postnatal administration of Vitamin K to the infant
5
Q
What is the age range for classic Vitamin K Deficiency Bleeding?
A
2-7 days
6
Q
What are the common sites of hemorrhage in classic disease?
A
Gastrointestinal, post-circumcision, ear-nose-throat-mucosal, cutaneous, injection sites
7
Q
What are the main risk factors for classic Vitamin K Deficiency Bleeding?
A
Vitamin K deficiency, exclusive breastfeeding
8
Q
How can classic Vitamin K deficiency bleeding be prevented?
A
Parenteral Vitamin K at birth or repeated oral Vitamin K doses
9
Q
What is the age range for late-onset Vitamin K Deficiency Bleeding?
A
1-6 months
10
Q
What are the common sites of hemorrhage in late-onset disease?
A
Intracranial, gastrointestinal, cutaneous, ear-nose-throat-mucosal, injection sites, thoracic
11
Q
What are the causes of late-onset Vitamin K deficiency bleeding?
A
Cholestasis (malabsorption of Vitamin K), abetalipoprotein deficiency, idiopathic in Asian breastfed infants, warfarin ingestion
12
Q
How can late-onset Vitamin K deficiency bleeding be prevented?
A
Parenteral and high-dose oral Vitamin K during malabsorption or cholestasis
13
Q
What is the incidence of early-onset Vitamin K deficiency bleeding?
A
Very rare
14
Q
What percentage of infants develop classic disease if not given Vitamin K?
A
~2%
15
Q
What is the purpose of the BCG vaccine?
A
It protects against tuberculosis by stimulating cross-immunity to Mycobacterium tuberculosis.
16
Q
What is the type of the BCG vaccine?
A
Live attenuated vaccine.
17
Q
When is the BCG vaccine given in Sudan?
A
At birth.
18
Q
What is the dose and route for the BCG vaccine?
A
The dose is 0.1 ml given intradermally in the deltoid region.
19
Q
What is the schedule for oral polio vaccine (OPV) in Sudan?
A
OPV is given at birth, 6 weeks, 10 weeks, and 14 weeks.
20
Q
What are the two types of polio vaccines, and their differences?
A
- Salk (IPV): Inactivated, given intramuscularly, prevents viremia. 2. Sabin (OPV): Live-attenuated, given orally, induces gut immunity.
21
Q
When is the DPT vaccine administered in Sudan?
A
At 6 weeks, 10 weeks, and 14 weeks.
22
Q
What is the type of DPT vaccine?
A
Inactivated toxoid and killed antigenic components.
23
Q
What are the side effects of the DPT vaccine?
A
Local reactions, high fever, unusual crying, severe allergic reactions, prolonged seizures, and encephalopathy.
24
Q
What is the DT vaccine, and when is it used?
A
The DT vaccine is a combination of diphtheria and tetanus toxoids given to children >6 years as pertussis is contraindicated at this age.
25
What is the recommended schedule for the measles vaccine in Sudan?
A single dose is given at 9 months.
26
What is the type of the measles vaccine?
Live attenuated vaccine.
27
What is the schedule for the MMR vaccine?
The MMR vaccine is given at 15 months with a booster dose at 4-6 years.
28
What is the dosage and route for the Hepatitis B vaccine?
The Hepatitis B vaccine is given in three doses: at birth, 1 month and 6 months. Dose: 0.5 ml IM.
29
What is the type of Hepatitis B vaccine?
Recombinant DNA vaccine.
30
What is the schedule for the rotavirus vaccine in Sudan?
The rotavirus vaccine is given orally at 6 weeks, 10 weeks, and 14 weeks.
31
What is the type of rotavirus vaccine?
Live attenuated oral vaccine.
32
When is the Hib vaccine administered in Sudan?
The Hib vaccine is given as part of the pentavalent vaccine at 6 weeks, 10 weeks, and 14 weeks.
33
What are the two types of pneumococcal vaccines?
1. Conjugate vaccine (<2 years, 98% efficacy). 2. Polysaccharide vaccine (>2 years, 60-70% efficacy).
34
What is the pneumococcal vaccine schedule in Sudan?
Given at 6 weeks, 10 weeks, and 14 weeks for children <2 years.
35
What is the dose and schedule for the chickenpox vaccine?
A single dose of 0.5 ml is given SC/IM at >1 year. For >12 years, two doses are given 1 month apart.
36
What is the type of chickenpox vaccine?
Live attenuated vaccine.
37
When is the influenza vaccine recommended?
The influenza vaccine is recommended annually, starting at 6 months for inactivated and 2 years for live-attenuated vaccines.
38
What is the dose and schedule for the rabies vaccine?
The rabies vaccine is given in five doses (1 ml each) at days 0, 3, 7, 14, and 30.
39
What is the type of rabies vaccine?
Inactivated virus vaccine.
40
What is the vaccination schedule for the pentavalent vaccine in Sudan?
The pentavalent vaccine is given at 6 weeks, 10 weeks, and 14 weeks.
41
What is the type of the pentavalent vaccine?
Combination of DTP, Hib, and Hepatitis B vaccines.
42
What is the hexavalent vaccine, and when is it given?
The hexavalent vaccine contains DTP, Hib, Hepatitis B, and IPV and is given at 6 weeks, 10 weeks, and 14 weeks.
43
When is the Hepatitis A vaccine given?
Hepatitis A vaccine is given as a single dose with a booster at 6-12 months.
44
What is the type of Hepatitis A vaccine?
Inactivated virus vaccine.
45
What is the dose and route for the MMR vaccine?
A single dose of 0.5 ml is given subcutaneously at 15 months with a booster at 4-6 years.
46
1. What malaria vaccines are available?
RTS,S/AS01 (Mosquirix) and R21/Matrix-M are available, targeting Plasmodium falciparum.
47
1. How is the malaria vaccine administered and What is the schedule for RTS,S/AS01?
"Reduces Tropical Sickness, Somewhat" (RTS,S)
"AS01 = Activates Strong immunity (1st malaria vaccine adjuvant)"
Intramuscular injection in the anterolateral thigh for infants and young children.
1st Dose: Around 5 months of age.
2nd Dose: 1 month after the 1st dose.
3rd Dose: 1 month after the 2nd dose.
4th Dose: 18 months after the 3rd dose.
48
When does breastfeeding failure jaundice typically occur?
In the first week of life.
49
What is the pathophysiology of breastfeeding failure jaundice?
Lactation failure leads to decreased bilirubin elimination and increased enterohepatic circulation.
50
What are the clinical features of breastfeeding failure jaundice?
Suboptimal breastfeeding and signs of dehydration.
51
When does breast milk jaundice typically begin and peak?
It starts at 3-5 days and peaks at 2 weeks.
52
What is the cause of breast milk jaundice?
High levels of β-glucuronidase in breast milk deconjugate intestinal bilirubin, increasing enterohepatic circulation.
53
What are the clinical features of breast milk jaundice?
Adequate breastfeeding with a normal examination.
54
What does the 'A' in APGAR stand for, and how is it scored?
Appearance (skin color): 0 = blue/pale, 1 = pink body with blue extremities, 2 = pink all over.
55
What does the 'P' in APGAR represent, and how is it scored?
Pulse: 0 = absent, 1 = <100 bpm, 2 = ≥100 bpm.
56
What does the 'G' in APGAR represent, and how is it scored?
Grimace (reflex irritability): 0 = no response, 1 = grimace with stimulation, 2 = active motion (sneezing, coughing, pulling away).
57
What does the 'A' (second) in APGAR measure, and how is it scored?
Activity (muscle tone): 0 = absent, 1 = arms and legs flexed, 2 = active movement.
58
What does the 'R' in APGAR measure, and how is it scored?
Respiration: 0 = absent, 1 = slow/irregular, 2 = vigorous cry.
59
What APGAR score indicates an excellent condition?
A score of 7-10.
60
What APGAR score suggests moderate depression?
A score of 4-6.
61
What APGAR score indicates severe depression?
A score of 0-3.
62
What is the onset of conjunctivitis due to silver nitrate?
Within 24 hours.
63
What are the findings on conjunctival scraping in silver nitrate conjunctivitis?
None to few polymorphonuclear leukocytes.
64
What is the typical onset of Neisseria gonorrhea conjunctivitis?
2-4 days.
65
What are the clinical features of Neisseria gonorrhea conjunctivitis?
Severe, purulent discharge with lid edema.
66
What are the findings on conjunctival scraping in Neisseria gonorrhea conjunctivitis?
Gram-negative intracellular diplococci.
67
What is the onset of Chlamydia trachomatis conjunctivitis?
4-10 days.
68
What are the findings on conjunctival scraping in Chlamydia trachomatis conjunctivitis?
Giemsa stain showing basophilic cytoplasmic inclusion bodies.
69
What is the onset of herpes simplex conjunctivitis?
7-14 days.
70
What are the findings on conjunctival scraping in herpes simplex conjunctivitis?
Gram stain shows multinucleated giant cells.
71
Describe the maximal vertical pocket (MVP) criteria for Stage I of TTTS.
MVP <2 cm in the donor twin's sac or >8 cm in the recipient twin's sac.
72
What is the clinical significance of the fetal bladder in diagnosing Stage II TTTS?
Nonvisualization of the fetal bladder in the donor twin for over 60 minutes.
73
What Doppler abnormalities are seen in Stage III TTTS?
Absent/reversed umbilical artery diastolic flow, reversed ductus venosus a-wave flow, pulsatile umbilical vein flow.
74
What defines Stage IV of TTTS?
Hydrops fetalis in one or both twins.
75
What is the outcome in Stage V TTTS?
Fetal demise in one or both twins.
76
What is the typical period of growth restriction onset in symmetrical IUGR?
First or second trimester.
77
How does the physical presentation of asymmetrical IUGR differ from symmetrical IUGR?
Asymmetrical IUGR shows a relatively large head compared to a small abdomen.
78
What is the pathophysiological basis of symmetrical IUGR?
Impaired cellular embryonic division, often due to chromosomal abnormalities or infections.
79
What are common extrinsic causes of asymmetrical IUGR?
Placental insufficiency, maternal hypertension, and anemia.
80
What are the outcomes and prognoses for symmetrical vs. asymmetrical IUGR?
Symmetrical: greater morbidity/mortality; Asymmetrical: better preserved brain growth.
81
What is the recommended management for a newborn whose mother is HBsAg positive?
Administer the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG).
82
Within how many hours of birth should the hepatitis B vaccine and HBIG be given to a newborn of an HBsAg-positive mother?
Within 12 hours of birth (or as soon as possible thereafter).
83
What clinical sign is common in neonatal DDH screening?
Clunk on hip movement and asymmetrical upper leg skin folds.
84
What are the key signs of septic arthritis in infants?
Fever, irritability, restricted joint movement, and toxic appearance.
85
Which demographic is most affected by SCFE?
Obese adolescent boys.
86
Why is Kawasaki Disease significant?
It is the most common cause of acquired heart disease in children in the UK.
87
Which population is most at risk?
More common in males and Asian populations, particularly Japanese children.
88
What is the treatment for refractory KD?
Steroids, infliximab, cyclosporine.
89
What is the prognosis of KD?
Without coronary abnormalities: complete recovery; With coronary abnormalities: 50% resolve within 1–2 years; giant aneurysms may require warfarin or low-dose aspirin.
90
Who is most commonly affected by SLE?
Females > males (9:1), typically after age 5.
91
What lab abnormalities are seen in SLE?
High ESR, low complement (C3, C4).
92
What is the inheritance pattern of osteogenesis imperfecta?
Autosomal Dominant (AD).
93
Which type of osteogenesis imperfecta is most severe?
Type II (fatal, multiple fractures before birth).
94
What mutation causes achondroplasia?
Mutation in the FGFR3 gene.
95
What is the inheritance pattern of achondroplasia?
Autosomal Dominant (AD), with 50% cases due to new mutations.
96
What complications are associated with achondroplasia?
Hydrocephalus and recurrent otitis media.
97
What is the inheritance pattern of severe osteopetrosis?
Autosomal Recessive (AR).
98
What is the normal age range for bow legs in children?
1-3 years
99
What are the differential diagnoses for bow legs?
Rickets; Osteogenesis imperfecta; Blount's disease
100
What is a possible differential diagnosis for knock knees?
Juvenile idiopathic arthritis
101
What are the differential diagnoses for flat feet?
Hypermobility; Congenital tarsal fusion
102
What are the differential diagnoses for in-toeing?
Tibial torsion; Femoral anteversion
103
What are the differential diagnoses for toe-walking?
Spastic diplegia; Muscular dystrophy
104
What is the most common cause of acute hip pain in children?
Transient synovitis (irritable hip)
105
What is the typical clinical presentation of transient synovitis?
Sudden onset of hip pain or limp, sometimes referred to the knee; No pain at rest; No fever, and the child does not appear ill
106
What is the treatment for transient synovitis?
Bed rest; Analgesia
107
What is the typical age group and gender ratio for Perthes disease?
Age: 5-10 years; Gender ratio: Boys are more affected (5:1)
108
What is the clinical presentation of Perthes disease?
Gradual onset of limp or hip pain; Bilateral in 10-20% of cases
109
What is the treatment for Perthes disease?
Bed rest; Skin traction
110
What is the prognosis for Perthes disease?
Prognosis is good if treated before 6 years of age and if less than 50% of the femoral head is affected
111
What is a slipped upper femoral epiphysis (SUFE)?
Displacement of the femoral head epiphysis posteriorly and inferiorly
112
What is the common age group affected by SUFE?
10-15 years
113
What conditions increase the risk of SUFE?
Obesity; Hypothyroidism; Hypopituitarism
114
What is osteomyelitis?
Infection of the metaphysis of long bones
115
What are the most common sites for osteomyelitis?
Distal femur; Proximal tibia
116
What are the clinical features of septic arthritis?
Acute erythematous, warm, swollen joint; Decreased range of motion (pseudo paresis); High-grade fever and irritability
117
What investigations are needed for septic arthritis?
CBC: High WBC (PMNs); CRP: Elevated; Ultrasound: Shows joint effusion; X-ray: To exclude trauma; Bone scan or MRI: Diagnostic; Joint aspiration with culture and sensitivity: Confirmatory
118
When is in-toeing considered normal?
1-2 years
119
What are the differential diagnoses for out-toeing?
Hypermobility; Ehlers-Danlos syndrome; Marfan syndrome
120
When is toe-walking considered normal?
1-3 years
121
What is the age group commonly affected by transient synovitis?
2-12 years
122
What investigations are required to diagnose transient synovitis?
CBC and CRP: Normal; X-ray of the hip: Normal; Blood culture and sensitivity: Normal
123
What is the clinical presentation of SUFE?
Limping or hip pain, often following trauma; Restriction of abduction and internal rotation
124
What percentage of SUFE cases are bilateral?
0.2
125
What is the treatment for SUFE?
Surgical pin fixation
126
What are the most common pathogens causing osteomyelitis?
Staphylococcus aureus (most common); Streptococcus; Haemophilus influenzae B (Hib); Salmonella (in sickle cell anemia)
127
What investigations are required for osteomyelitis?
CBC: High WBC (PMNs); CRP: Elevated; Blood culture and sensitivity: Positive (usually); X-ray: Normal in early stages (1st 7-10 days); Radionuclide bone scan or MRI: Diagnostic
128
What is septic arthritis?
A serious infection of the joint space that can lead to bone destruction
129
What is the typical age group for septic arthritis?
Most common in children <2 years but can occur at any age
130
What are the common pathogens in septic arthritis?
Staphylococcus aureus (most common); Haemophilus influenzae B (Hib)
131
What is the most commonly affected joint in septic arthritis?
The hip
132
What is reactive arthritis?
The most common form of arthritis in childhood, characterized by transient joint swelling (<6 weeks) following an extra-articular infection.
133
What infections can trigger reactive arthritis?
Salmonella; Campylobacter; Mycoplasma; Lyme disease; Viral infections (e.g., rubella, mumps, adenovirus, hepatitis)
134
What are the investigation findings in reactive arthritis?
CBC and X-ray: Normal
135
What is the treatment for reactive arthritis?
No specific treatment; NSAIDs for symptom relief
136
What is chondromalacia patellae?
Softening of the articular cartilage of the patella
137
Who is most commonly affected by chondromalacia patellae?
Adolescent females
138
What are the red flag features of back pain in children?
Young age; High fever (infection); Night waking or persistent pain (e.g., osteoid osteoma); Painful scoliosis (infection or malignancy); Focal neurological signs (e.g., loss of power or bladder control indicating spinal compression); Associated weight loss or systemic malaise (e.g., malignancy)
139
What are the diagnostic criteria for growing pains?
Occurs between ages 3–12 years; Symmetrical pain in lower limbs, not limited to joints; Pain never present at the start of the day or after walking; No limitation of physical activity; Normal physical examination except for possible joint hypermobility
140
What are the features of hypermobility in children?
Pain in lower limbs, worse after exercise; No joint swelling or transient; Can be generalized or limited to peripheral joints (e.g., hands, feet)
141
What are the diagnostic criteria for JIA?
Age at onset <16 years; Arthritis in ≥1 joint; Duration ≥6 weeks; Exclusion of other causes of arthritis (e.g., infection)
142
What is the prognosis for oligoarthritis?
Excellent in most cases
143
What is the prognosis for systemic arthritis?
Variable to poor
144
What is psoriatic arthritis?
Arthritis, psoriasis, nail pitting, chronic uveitis
145
What is enthesitis-related arthritis?
Large joint arthritis (e.g., sacroiliac, lumbar); HLA-B27 positive; Inflammation of tendons and ligaments
146
What is the prognosis for JIA?
Early aggressive treatment improves outcomes; Despite treatment, over half of patients may have active disease into adulthood
147
What does a sunken anterior fontanelle indicate?
Dehydration.
148
What type of vaccine is the Hepatitis A vaccine?
Inactivated (killed) whole-virus vaccine.
149
What is the standard dosing schedule for the Hepatitis A vaccine?
2 doses: 0 and 6–12 months apart.
150
Which groups are recommended to receive the Hepatitis A vaccine?
Children, travelers to endemic areas, , chronic liver disease patients.
151
How is the Hepatitis A vaccine administered?
Intramuscular (IM), usually in the deltoid muscle.
152
How long does immunity last after the Hepatitis A vaccine?
At least 20 years, possibly lifelong.
153
What type of vaccine is the Hepatitis B vaccine?
Recombinant subunit vaccine containing HBsAg.
154
What is the standard dosing schedule for the Hepatitis B vaccine?
3 doses: 0, 1, and 6 months.
155
Which groups are recommended to receive the Hepatitis B vaccine?
All infants, healthcare workers, MSM, IV drug users, dialysis patients, immunocompromised individuals.
156
How is the Hepatitis B vaccine administered?
Intramuscular (IM), usually in the deltoid muscle.
157
What is the post-exposure prophylaxis for Hepatitis B?
Hepatitis B vaccine within 24 hours, plus Hepatitis B immune globulin (HBIG) for neonates born to infected mothers.
158
Does the Hepatitis B vaccine prevent chronic infection?
Yes, it prevents chronic Hepatitis B and hepatocellular carcinoma.
159
What is Twinrix?
A combination vaccine containing inactivated Hepatitis A and recombinant Hepatitis B.
160
What is the standard dosing schedule for Twinrix?
3 doses: 0, 1, and 6 months.
161
Who should receive Twinrix?
People at risk for both Hepatitis A and B, including travelers and healthcare workers.
162
Is there a vaccine for Hepatitis C?
No, currently there is no available vaccine for Hepatitis C.
163
How is Hepatitis C prevented?
Avoiding blood exposure, using safe injection practices, and screening blood products.
164
What is the most serious complication of Kawasaki disease?
Coronary artery aneurysm (CAA).
165
Why is aspirin given in Kawasaki disease?
Initially high-dose for inflammation, then low-dose for thrombosis prevention.
