1. SABA 2. SABA + paeds low dose ICS 3. SABA + paeds low dose ICS + LTRA 4. SABA + paeds low dise ICS + LABA 5. SABA + MART (combined low dose ICS + LABA) 6. SABA + MART (mod dose ICS)/ SABA + mod dose ICS + LABA 7. SABA + MART (high dose ICS) / SABA + high dose ICS + LABA/ SABA + theophylline/ SABA + seeking advice from expert

Paediatrics 1 Flashcards by H JP

Top two common organisms causing infection of the newborn eye (ophthalmia neonatorum)

Chlamydia trachomatis
Neisseria gonorrhoea

How well did you know this?

Not at all

Perfectly

short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis
=
Gene
RF
AD/AR

Achondroplasia
FGFR 3 gene
Advancing maternal age
AD

How well did you know this?

Not at all

Perfectly

Acute epiglottitis is caused by which organism

Sx (4)
What is the tripod position?

Mx (3)

Haemophilus influenzae

Generally unwell
High temp
Stridor
Drooling

Sitting, leaning forward, neck extended - helps them breathe

Mx anaesthetics, oxygen, IV abx

How well did you know this?

Not at all

Perfectly

XR may show what in acute epiglottitis?

Thumb sign

How well did you know this?

Not at all

Perfectly

XR in croup can show what?

Steeple sign

How well did you know this?

Not at all

Perfectly

Which leukemia is the most common affecting children?
Peak incidence age

ALL
2-5yo

How well did you know this?

Not at all

Perfectly

Name five poor prognostic factors with children with ALL

Age <2 or >10
WCC >20 at time of diagnosis
Non-caucasian
Male
T or B cell surface markers

How well did you know this?

Not at all

Perfectly

Name seven features of ALL

Anaemia
Neutropenia
Thrombocytopenia
Testicular swelling
Bone pain
Hepatosplenomegaly
Fever

How well did you know this?

Not at all

Perfectly

What is HbH disease?
Type of anaemia
Number of alpha globulin alleles affected

Alpha thalassemia
3 alpha globulin alleles are affected leading to a
Hypochromic microcytic anaemia with splenomegaly

How well did you know this?

Not at all

Perfectly

Life threatening asthma attack
Sats
PEF
Chest signs (2)

<92%
<33%
Silent chest
No respiratory effort

How well did you know this?

Not at all

Perfectly

Severe asthma attack
Sats
PEF
Chest signs (2)
HR >5yo and 1-5yo
RR

<92%
33-50%
HR > 125 (>5yo), >140 (1-5yo)
RR >30 if >5yo >40 if 1-5yo
Too breathless to talk or feed
Accessory muscle use

How well did you know this?

Not at all

Perfectly

Moderate asthma attack aged 2-5yo
Sats

Moderate asthma attack >5yo
sats
PEF

> 92%

> 92%
50% PEF

How well did you know this?

Not at all

Perfectly

Mild - mod asthma Mx
How often
Max number of puffs
How many times to repeat before referring to hospital?

SABA with spacer
1 puff every 30-60 seconds
Max 10 puffs

Can repeat and then refer to hospital

Prednisolone 3-5 days

How well did you know this?

Not at all

Perfectly

Pred dosing
2-5yo
>5yo

mg/kg

20mg OD
30-40mg OD

1-2mg/kg

How well did you know this?

Not at all

Perfectly

5-16yo asthma mx (7)

SABA
SABA + paeds low dose ICS
SABA + paeds low dose ICS + LTRA
SABA + paeds low dise ICS + LABA
SABA + MART (combined low dose ICS + LABA)
SABA + MART (mod dose ICS)/ SABA + mod dose ICS + LABA
SABA + MART (high dose ICS) / SABA + high dose ICS + LABA/ SABA + theophylline/ SABA + seeking advice from expert

How well did you know this?

Not at all

Perfectly

Low
Mod
High dose ICS doses

200
200-400mcg
>400mcg

How well did you know this?

Not at all

Perfectly

Mx asthma <5yo
(4)

SABA
SABA + 8 week trial of paeds mod ICS
Then stop and monitor sx

If sx didn’t resolve during 8 week trial then ?alternative diagnosis
If sx resolved and then reoccured within 4 weeks of stopping ICS rx then restart ICS at paediatric low dose ICS
If sx resolved and then reoccurred >4 weeks after stopping then repeat 8 week trial of paeds mod dose ICS

SABA + paeds low dose ICS + LTRA
Stop LTRA and refer

How well did you know this?

Not at all

Perfectly

DSM-V definition of ADHD
(Three main symptoms)
How many features in children up to 16 and >=17yo

Common age range of diagnosis

Inattention
Hyperactivity
Impulsivity

Children up to 16yo have to have six features
17yo and over have to have five features

3-7yo

How well did you know this?

Not at all

Perfectly

Non pharmacological Mx ADHD (2)

Drug therapy is offered to which age group

10 week watch and wait period to see if symptoms are persistent
Refer to CAMHS or paeds with special interest in behavioural disorders

5 or more yo

How well did you know this?

Not at all

Perfectly

Drug treatment in ADHD
1st line
2nd line
If you benefit from 2nd line but can’t tolerate SE

1st line methylphenidate (six week trial)
If inadequate reponse
2nd line lisdexamfetamine
3rd line dexamfetamine (if you benefit from lisdexam but can’t tolerate SE)

How well did you know this?

Not at all

Perfectly

SE methylphenidate (3)

Monitoring (2)

AP
Nausea
Dyspepsia

Height and weight every 6 months
Baseline ECG

How well did you know this?

Not at all

Perfectly

ADHD adults mx (2)

Methyl or lisdexam

How well did you know this?

Not at all

Perfectly

Autism
Features (3)

Impaired social communication
Repetitive behaviours
Intellectual/ language impairment

How well did you know this?

Not at all

Perfectly

AD conditions
Disease is passed on to what percentage of children?

50%

How well did you know this?

Not at all

Perfectly

AR conditions Two heterozygote parents What percentage will have the condition? Will be a carrier? Will be unaffected

25% 50% 25%

Age range for benign rolandic epilepsy? What is it? (when and type of seizure) (2) EEG shows Seizures stop by

4-12yo Seizures typically at night, partial +/- secondary generalisation EEG shows centro-temperoral spikes Seizures stop by adolescence

Bronchiolitis Age range Organism Worse when?

<1yo (peak 1-9 months) RSV Worse in winter

Bronchiolitis Ix (1) Mx (3)

Immunofluorescence of nasopharyngeal secretions Humidified O2 if O2 <92% NG feeding Suction

What is Sever disease?

Calcaneal apophysitis Overuse injury in sporty kids

What is the differences between cephalohaematoma and caput succedaneum

Cephalohaematome Develops hours after birth Parietal region Takes months to resolve Caput succedanaeum Present at birth Forms over vertex and crosses suture line Resolves within days

Complication of cephalohaematoma

Jaundice

Chickenpox Infectivity period

4 days prior to rash until 5 days after rash

Chickenpox features

Fever initially Itchy rash on head and trunk and then spreads Macular then papular then vesicular

Mx chickenpox (3) What may increase risk of secondary bacterial infection?

Keep cool Calamine lotion School exclusion NSAIDs

Heel prick test tests for which four conditions

1. Hypothyroidism 2. PKU 3. CF 4. MCADD

Prodrome: irritable, conjunctivitis, fever Koplik spots: white spots ('grain of salt') on buccal mucosa Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent =

Measles

Fever, malaise, muscular pain Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70% =

Mumps

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day Lymphadenopathy: suboccipital and postauricular =

Rubella

Also known as fifth disease or 'slapped-cheek syndrome' Caused by parvovirus B19 Lethargy, fever, headache 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces =

Erythema infectiosum

Caused by the coxsackie A16 virus Mild systemic upset: sore throat, fever Vesicles in the mouth and on the palms and soles of the feet =

Hand, foot and mouth disease

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci Fever, malaise, tonsillitis 'Strawberry' tongue Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor) =

Scarlet fever

Codeine use in children rule Breastfeeding yes or no

>12yo for pain that is not controlled by paracetamol or ibuprofen No

Name five acyanotic congenital heart coditions

VSD (most common) ASD PDA Coarctation Aortic valve stenosis

Name three cyanotic congenital heart conditions

ToF (presents 1-2months old) most common Transposition of the great arteries (presents at birth) Tricuspid atresia

Red flags for constipation in children (7)

From birth Passage of meconium >48 hours Ribbon stools Faltering growth (amber) Weakness in legs Locomotor delay Distension

Mx constipation

1. Movicol 2. add Senna (stimulant) 3. Substitute stimulant for osmotic e.g lactulose

Cow's milk protein intolerance Age of onset Features (5)

Present usually in the first 3 months of life Regurgitation Vomiting Diarrhoea Urticaria Colic symptoms

Cow's milk protein intolerance Ix (3)

Skin prick Patch testing RAST IgE for cow's milk protein

Cow's milk protein intolerance Mx Formula fed (2) Breastfed (3)

1. Extensive hydrolysed formula 2. Amino acid based formula 1. Continue breastfeeding 2. Eliminate cow's milk protein from maternal diet 3. eHF milk when breastfeeding stops until 12 months of age

Croup Age range Organism Season

6 months - 3 years Parainfluenza Autumn

Croup features (4)

Stridor Barking cough - worse at night Fever Coryzal sx

Who should be admitted with croup? (4)

Moderate or severe <6 months Known upper airway abnormalities Uncertainty about diagnosis

Mx croup (2) Emergency treatment (2)

Single dose dexamethasone 0.15mg/kg OR Prednisolone Oxygen Nebs adrenaline

CF AD/AR Common organisms that colonise (2)

AR Staph Aur Pseudomonas aeruginosa

Name four presenting features of CF

Recurrent chest infections Meconium ileus Steatorrhoea/ FTT Liver disease

Name six non presenting features of CF

Short stature Rectal prolapse Nasal polyps DM Delayed puberty Infertility/ subfertility

CF mx (6) Pharmaclogical therapy (2)

1. BD chest physio + postural drainage 2. High calorie diet with high fat intake 3. Minimise contact with other CF patients 4. Vitamin supplementation 5. Pancreatic enzyme supplements 6. Lung transplant Lumacaftor/lvacaftor

Referral for developmental delay Not smiling by No sitting by Cannot walk by

10 weeks 12 months 18 months

Hand preference before what age is abnormal? Could indicate?

12 months Cerebral palsy

Name seven risk factors for developmental dysplasia of the hip

1. First born 2. Oligohydramnios 3. Positive FH 4. Female 5. Breech presentation 6. Congenital foot deformity 7. Birth weight >5kg

Developmental dysplasia of the hip Most common in which hip? Who requires screening with an US? (3)

Left 1st degree FH, breech presentation K36 and above, multip

What test is done at the six week check to check for developmental dysplasia of the hip?

Barlow - dislocate Ortolani - relocate

Ix of choice for DDH Unless what age, in which case which scan?

US Unless >4.5months - XR

Most common cause of gastroenteritis in children (organism)

Rotavirus

Gastroenteritis Diarrhoea usually lasts for ? and stops within ? Vomiting usually lasts for ? and stops within ?

5-7 days 2 weeks 1-2 days 3 days

Who is a stool culture done on in gastroenteritis? (3)

Suspected septicaemia Immunocompromised Blood/mucous in stool

High LH, low testosterone =

Klinefelters Primary hypogonadism XXY

Low LH and low testosterone

Hypogonadotrophic hypogonadism Kallman's

High LH normal/ high testosterone

Androgen insensitivity syndrome

Low LH and high testosterone

Testosterone secreting tumour

often taller than average lack of secondary sexual characteristics small, firm testes infertile gynaecomastia - increased incidence of breast cancer elevated gonadotrophin levels =

Klinefelter's XXY

'delayed puberty' hypogonadism, cryptorchidism anosmia sex hormone levels are low LH, FSH levels are inappropriately low/normal patients are typically of normal or above average height = Inherited?

Kallman's X linked recessive

'primary amenorrhoea' undescended testes causing groin swellings breast development may occur as a result of conversion of testosterone to oestradiol = Mx (3)

Androgen insensitvity syndrome 46XY Raise child female Orchidectomy (increased risk of testicular cancer with undescended testes) Oestrogen therapy

Congenital abnormality of the layrnx Infants typical present at 4 weeks of age with: stridor =

Laryngomalacia

Which vaccination should be deferred in children with an evolving or unstable neurological condition

DTP

precocious puberty cafe-au-lait spots polyostotic fibrous dysplasia short stature =

McCune-Albright syndrome

X linked recessive inheritance affects which gender? Males sons are Males daughters are Each male child of a heterozygous female carrier has what chance of being affected Each female child of a heterozygous female carrier has what chance of being carrier

Males only Males sons are unaffected Males daughters are carriers Each male child of a heterozygous female carrier has a 50% chance of being affected Each female child of a heterozygous female carrier has a 50% chance of being a carier

Wilm's tumour Age Features (3) Mx

Under age of 5 Abdominal mass Painless haematuria Flank pain Paediatric review within 48 hours