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Flashcards in Paediatrics 1 Deck (138):
1

How much of their birth weight may a newborn lose in the first few days of life?

Up to 10% normally

2

3 signs of dehydration?

Dry mucus membranes
Decreased skin turgor
Sunken anterior fontanelle

3

Most common causative agent of bronchiolitis?

Respiratory syncitial virus RSV

4

Apart from RSV what viruses commonly cause bronchiolitis? Which has the worst outcome?

Human metapneumovirus hMPV
Adenovirus - most virulent
Parainfluenzavirus

5

How is faltering growth generally defined via growth chart?

Falling off growth curve and crossing 2 centile lines

6

Early symptoms of bronchiolitis?

Looks like viral URTI, low grade fever

7

Later symptoms of bronchiolitis?

Cough, dyspnoea, wheeze, cyanosis, vomiting, poor feeding etc.
Apnoeas

8

What exam findings are classical of bronchiolitis?

Tachypnoea and tachycardia
Increased work of breathing
Widespread bibasal inspiratory crackles and high pitched expiratory wheeze

9

Why might liver and spleen be palpable in bronchiolitis?

Hyper expanded lungs

10

What tests can be done to diagnose bronchiolitis?

NPA and RSV testing via PCR
+/- other viral cultures e.g. adenovirus, hMPV, PIV

11

Management of non-complicated bronchiolitis?

Usually self limiting after a week or 2, so supportive management with fluids, nutrition and temperature control

12

What sorts of things indicate severe bronchiolitis disease?

Increased work of breathing - nasal flaring, grunting, intercostal or sub costal recession, tachypnoea, cyanosis -> apnoeas and desaturation
Poor feeding and dehydration
Lethargy/floppy tone

13

What is the genetic mutation that most often causes CF and what protein does this damage?

Delta F508
CFTR chloride channel protein

14

Mode of inheritance of CF?

Autosomal recessive

15

Classical presentation of CF?

Recurrent LRTIs with chronic sputum production, faltering growth

16

What screening exists for CF?

Guthrie card at day 5-6 for immunoreactive trypsinogen IRT
Then do CFTR testing

17

What ENT finding in children is almost always linked to CF?

Nasal polyps

18

GI presentations of CF?

Steatorrhoea and malabsorbation
Acute or chronic pancreatitis
Faltering growth
Liver damage - portal hypertension, varices, haemorrhage

19

Signs on examination of CF?

Finger clubbing
Purulent sputum
Crackles, upper lobe wheeze

20

What spirometry picture does early CF yield? (Without bronchiectasis)

Obstructive picture

21

What is first line investigation for a child presenting with suspected CF?

Sweat testing

22

What organism has a high mortality link with CF?

Pseudomonas aeruginosa

23

What type of infertility do most male CF patients have?

Obstructive azoospermia

24

What is the trend in asthma gender prevalence with age?

Prepubescent more common in boys
Adulthood more common in women

25

Major presenting symptoms of asthma?

Wheeze
Cough - dry, non-paroxysmal, typically worse nocturnally
Chest tightness
SOB

26

When is asthma traditionally worse?

At night or early morning (diurnal variation)
Also seasonal variation in symptoms - may be worse in cold winter or polleny summer

27

What is Harrisons sulcus?

A permanent chest wall indentation along costal margins caused by chronic or severe asthma in kids

28

Over what sort of ages are PEFR and spirometry able to be reliably used on kids?

Over 5-6

29

What is the key spirometry finding which differentiates asthma from COPD?

High reversibility on administration of bronchodilator

30

What sort of long term management tools are used for childhood asthma?

Have to use an inhaler with a spacer +/- facemask if under 3
Start with inhaled SABAs PRN +/- steroid inhaler or leukotriene regular

31

3 reasons why spacers are better than no spacers?

Work better - more drug into lungs
Less risk of sore throat, oral candidiasis etc.
Better than nebuliser in an emergency

32

What is the most important early management step of acute, life threatening asthma attack in kids?

Oral prednisolone

33

Apart from early steroids, what needs to be given in management of acute asthma in kids?

High flow O2 via mask/nasal cannula aiming for sats 94-98%
B2 agonist inhalers - use spacer +/- face mask

34

What is the next step of acute asthma management in kids after inhaled B2 agonist?

IV salbutamol, inhaled ipratropium neb
Eventually IV aminophylline

35

Alternative names for croup?

Laryngotrachietis or laryngotracheobronchitis

36

Febrile child with hoarseness, cough and stridor. Diagnosis?

Croup

37

What viruses typically cause croup?

Parainfluenzavirus PIV 1,2,3

38

Pathophysiology behind croup?

Infection with PIV causes subglottic laryngeal mucosal oedema, which is the narrowest part of the paediatric airway hence causing stridor

39

What does the cough typically sound like in croup?

Barking cough

40

What is spasmodic croup?

A non-infectious croup variant that occurs at night and is typically recurrent

41

Early symptoms of croup?

Coryzal symptoms
Then acute onset barking cough, stridor, hoarse voice +/- respiratory distress

42

When is viral croup normally worst? How is this different from spasmodic croup?

Viral croup is worst at night but still occurs in the day, but spasmodic croup occurs only at night

43

Medical management of croup?

Corticosteroids to reduce laryngeal mucosal oedema
Nebulised adrenaline if respiratory distress may be useful

44

What is bronchopulmonary dysplasia/chronic lung disease?

Oxygen dependence after 36 weeks corrected age (gestation + chronological)

45

What are the two biggest contributing factors to the development of BPD?

Birth weight (low)
Prematurity

46

2 major causes of BPD?

Need for artificial ventilation early in life
Infection

47

What is the typical progression in BPD baby?

Born very early (around 26 weeks), ventilated at birth then CPAP then eventually supplemental O2

48

Prophylaxis against RSV?

Palivizumab - vaccine for RSV indicated for at-risk kids e.g. BPD, heart disease, CF

49

What is Kartagener's syndrome?

Primary ciliary dyskinesia + dextrocardia with situs invertus

50

What investigation is best for bronchiectasis?

HRCT

51

Most common causative agents of pneumonia in newborns?

GBS, enterococci

52

Most common causative agents of pneumonia in infants?

Often viral pneumonia e.g. RSV
Otherwise HiB, strep pneumoniae

53

What helps to differentiate between pneumonia and bronchiolitis/other acute respiratory illnesses?

Focal chest signs - inspiratory crackles, dull percussion, reduced resonance, reduced air entry

54

What is the most important underlying pathophysiological feature in otitis media?

Eustachian tube dysfunction

55

3 reasons why kids are more predisposed to otitis media?

Developmental immaturity of Eustachian tube
Immature immune system
Frequent URTIs causing bacterial colonisation of tube

56

2 most common pathogens implicated in childhood otitis media?

Strep pneumoniae
Haemophilus influenzae

57

3 common presenting symptoms of otitis media?

Otalgia which is worse when supine
Otorrhoea
Headache

58

What features of a history are more suggestive of OME than AOM?

Tinnitus
Hearing loss
Vertigo/unsteadiness

59

What investigation is key to investigating OM?

Pneumatic otoscopy

60

4 things to comment on when observing the tympanic membrane?

Colour
Position
Mobility
Perforation

61

4 factors that contribute to urinary stasis (therefore acting as risk factors for UTIs in children)?

Renal calculi
Obstructive uropathy
Vesico-ureteric reflux
Phimosis

62

At what age do kids start to develop 'classic' symptoms of UTI?

Age of 2

63

Major underlying pathophysiological feature in recurrent UTIs in children?

Vesico-ureteric reflux VUR

64

Apart from urinary stasis, other RFs for childhood UTIs?

Previous UTIs
Constipation
Spinal lesions incl spina bifida
Renal disease
Faltering growth

65

Pattern of symptoms with increasing age for UTIs in kids?

More non-specific the younger they are
Generally fever, irritability, lethargy -> nausea vomiting abdo pain -> loin pain, typical LUT symptoms

66

What is the generally accepted standard for urine collection in kids? Alternative?

Clean catch
Otherwise plastic bag method, nappy collection pads or catheter/SPA

67

3 imaging techniques for investigating UTIs in children?

USS - stones, renal size and outline etc.
Micturating Cystography MCG - VUR
DMSA scan - renal parenchymal defects

68

What investigation is best for demonstrating VUR in kids?

MCG

69

What investigation is best for demonstrating renal parenchymal defects in kids?

DMSA scan

70

What is Kawasaki disease and who does it affect?

Systemic vasculitis disease affecting kids from 6m to 4 years, typically around age of 1

71

What is the key symptom of Kawasaki disease that must be present to make a diagnosis?

Fever for over 5 days

72

5 'accessory' symptoms of Kawasaki disease?

Non-exudative bilateral conjunctivitis
Mucous membranes become red and dry, cracked lips, strawberry tongue
Cervical lymphadenopathy
Polymorphous non-vesicular rash
Red oedematous palms and soles -> peeling of fingers and toes

73

Complications of Kawasaki disease?

Coronary and peripheral aneurysms
Gallop heart rhythm
Myo/pericarditis

74

Over what sort of time period do the symptoms of Kawasaki disease last?

Around 4 weeks, complications arising in 2nd month

75

What disease can cause a BCG scar to become inflamed?

Kawasaki disease

76

What is characteristic about the fever in Kawasaki disease?

High and difficult to control, acute onset
Child disproportionately irritable

77

What blood abnormality occurs in Kawasaki disease that can have risk of thrombosis? Prevention of this?

Thrombocytosis
Give aspirin

78

In whom does Henloch-Schonlein Purpura HSP occur?

Young boys - 3-10 yrs old

79

What is HSP often preceded by and so when does it more commonly occur?

Viral URTI and so more common in winter months

80

What is the pathophysiology of HSP?

Exaggerated immune response to antigen exposure causing an inflammatory vasculitis and complement deposition in organs

81

4 common symptoms of HSP?

Fever
Rash
Arthralgias
Colicky abdo pain and bleeds

82

What is the rash like in HSP?

Buttocks down, on extensors of legs and ankles. Trunk sparing
Purpural palpable rash

83

What joints are typically affected in HSP?

Knees, ankles

84

What urinary abnormalities are commonly present in HSP?

Micro/macroscopic haematuria, proteinuria

85

Potential renal complications of HSP?

Nephrotic syndrome
Hypertension

86

What is a febrile seizure?

A seizure in the absence of intracranial infection accompanied by a fever (>37.8 degrees axillary)

87

In what age of kid do febrile seizures occur?

6m to 5 years, peak around 18m

88

What feature of a temperature determines how likely it is to result in febrile seizures?

The speed of the rise

89

What type of seizure is a febrile seizure?

Generalised tonic-clinic

90

When in the course of an infection is a febrile seizure most likely to occur?

Early on when temp rapidly rising

91

4 factors that make febrile seizures more likely to occur?

Younger age
Lower temperature at onset
Shorter duration of illness pre-seizure
Family history

92

What 3 things constitute 'complex' febrile seizures?

Focal, prolonged (>15mins) or more than one in same illness

93

2 options that can be given in febrile seizure if been going on for 5 mins?

Rectal diazepam or buccal midazolam

94

What important differential cause must be suspected in any young child who has a febrile seizure?

Meningitis

95

What are the majority of causative infections in febrile seizures?

Viral URTIs, tonsillitis, OM

96

What infection can cause an afebrile seizure?

Gastroenteritis

97

Important more serious causes of febrile seizures?

Meningitis
UTI
LRTI

98

Prognosis for febrile seizures?

Recurrence rate around 30-40%
Long term damage (brain damage, epilepsy) is rare
Both of the above depend on simple/complex and recurrence RFs

99

In what age is bronchiolitis found mostly?

Around 6m to 1yr, rare after 2

100

At what age is croup found?

Up to age of 6

101

At what age is necrotising enterocolitis found?

Typically within few days of 40 weeks gestation - often in first few days, rare after 3m

102

What is the age of child in which febrile seizures occur?

6m to age of 5 or 6

103

What is the management of febrile seizure duration?

5 mins call doctor or bring in
>15 mins is a complex seizure
>30 mins is status epilepticus

104

4 ways in which a febrile seizure might be called complex?

Occurring early in illness
Occurring more than once in same illness
Partial or focal in nature
Lasting >15 minutes

105

Major contraindication to all vaccines?

Previous severe allergic reaction to vaccine

106

Situation which should prompt caution when giving any vaccine?

Moderate-severe illness in child

107

2 live vaccines? What implications do these have?

MMR
Varicella
Can't give if child immunocompromised

108

What vaccination can't be given if child has SCID or other severe immunodeficiency (besides the lives)?

Rotavirus

109

2 major RFs for Down's syndrome?

FH
Maternal age

110

What is often the first thing noticed in a baby with Down's syndrome?

Hypotonia

111

What haematological abnormality can occur in Down's syndrome?

Transient myelodysplasia of newborn (like transient leukaemia and polycythaemia)
Also increased risk of AML, ALL

112

Head and face features suggestive of Down's syndrome?

Brachycephaly
Slanted palpebral fissures
Epicanthic folds
Low, flat nasal bridge and upturned nose
Ears - low set or other abnormalities
No philtrum, small upper lip, protruding tongue

113

Hand and feet features of Down's syndrome?

Single palmar crease
Short, curved little finder
Short broad hands
Gap between hallux and second toe

114

What things should be screened for in Down's syndrome?

Congenital heart defects
GI defects - oesophageal, duodenal, anal atresia, coeliacs etc.
Hearing loss
Cataracts and glaucoma
Hypothyroidism

115

What common endocrine abnormality is associated with Down's syndrome?

Hypothyroidism

116

When does infantile colic tend to resolve? What typifies it?

By about 4m
Inconsolable crying and indrawing of knees (particularly evening) but is a diagnosis of exclusion

117

What must be excluded to suggest diagnosis of infant colic?

Cows milk protein intolerance
GORD

118

Differentials for childhood wheeze?

Viral induced
Asthma
Bronchiolitis
GORD
BPD
CF
Pneumonia - esp atypical
Cardiac wheeze (heart failure)

119

2 areas of Sx of hypoglycaemia?

Neuroglycopenic
Adrenergic

120

Neuroglycopenic Sx of hypoglycaemia?

Headache, irritability, drowsiness, LoC, coma, seizures

121

Adrenergic Sx of hypoglycaemia?

Sweating, tremor, pallor, hunger, tachycardia/tachypnoea, visual disturbance

122

Rash classical of rubella?

Maculopapular, distinctly rose-like

123

What eye signs are suggestive of rubella?

Pain on upwards and lateral eye movement
Conjunctivitis

124

When is MMR given?

12-13 months and then 3-5 years

125

5 contraindications to MMR?

Acute illness
Immunocompromise
Another live vaccine given in prev 3 weeks
Malignancy
Allergy

126

Risk of MMR vaccine?

Fever +/- rash for couple of days around 1 week after vaccine
NO autism or IBD link

127

Why MMR as opposed to single jabs?

Single jabs require private healthcare - not on NHS (MMR recommended by WHO and RCPCH)
More injections
No evidence to say they are as effective or safer than combined
Poor compliance likely
Wouldn't be fully immunised until age 7; more vulnerable to disease

128

Important things to remember regarding inhaler advice for kids?

Check expiry date
Can use more than one puff, 30s apart
If need to use more than 3 times per week see GP

129

Advice regarding spacer use in kids?

5 tidal breaths or 10s in babies (with mask)
Wash once per week - hot soapy water, drip dry
Replace every 3-6 months

130

What must have happened for coeliac to present?

Weaning

131

What can occur transiently post-gastroenteritis, causing flatus diarrhoea bloating and abdominal cramps with certain foods?

Carbohydrate e.g. Lactose intolerance

132

What does weight gain, delayed puberty, TATT and dry skin/coarse hair suggest in a teenager?

Hypothyroidism

133

When does DMD or BMD present? How?

Around 2-3 years, starting with proximal muscle weakness

134

5 causes of language delay in kids?

Deafness e.g. OME
Articulation problem e.g. Cleft palate
Familial
Lack of stimulus (?neglect)
Autism

135

Describe oppositional defiant disorder?

Loses temper easily, argues with adults and defies requests
Deliberately annoys others

136

Describe conduct disorder?

Bullying, threatening, intimidation
Fighting
Cruelty to animals

137

Differentials for a febrile convulsion?

Seizure or paediatric epileptic syndrome
Reflex anoxic seizure
Pseudoseizure
Vasovagal
Breath holding spell
Cardiac cause

138

Describe reflex anoxic seizures?

Pallor followed by fall to floor, in response to e.g. Bump to head, emotion, crying, fever