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Paediatrics Flashcards

1
Q

Risk factors for neonatal sepsis

A 
Previous baby with GBS
Current GBS colonisation
Current bacteriuria
Intrapartum temperature >38
Membrane rupture for over 18 hours
Evidence of maternal chorioamnionitis
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2
Q

Early onset neonatal sepsis usually caused by

A

Group B strep

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3
Q

Management for neonatal sepsis

A

IV benzylpenicillin with gentamycin
Measure and monitor CRP
Maintain adequate oxygen sats, fluid and electrolytes and glucose

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4
Q

Management for neonatal meningitis

A

Cefotaxime and acyclovir

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5
Q

Diagnosis of neonatal respiratory distress syndrome

A

CXR with ground glass appearance with indistinct heart border
Tachypnoea, intercostal recession, expiratory grunting and cyanosis

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6
Q

Treatment for neonatal respiratory distress syndrome

A

Maternal corticosteroids during pregnancy if possible

Post-natal oxygen, assisted ventilation, exogenous surfactant

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7
Q

When do adequate amounts of surfactant begin to be produced?

A

35 weeks

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8
Q

Treatment of neonatal seizures

A

Check glucose, turn on side to prevent aspiration risk
1st line- phenobarbital as slow injection
2nd line- phenytoin
Can use benzodiazepines

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9
Q

Features of necrotising enterocolitis

A 
Abdominal distention
Bilious vomiting
Faecal occult blood
Temperature instability 
Lethargy
Discolouration
Mucosal sloughing 
DIC
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10
Q

Diagnosis of Necrotising Enterocolitis

A

Abdo XR for pneumatosis intestinalis

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11
Q

Treatment of necrotising enterocolitis

A

NBM
NGT
IV antibiotics
Referral to surgery

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12
Q

Features of meconium aspirate syndrome

A 
Resp distress
Airway obstruction 
Pulmonary vasoconstriction 
Persistent pulmonary hypertension
Infection 
Chemical pneumonitis 
Pneumothorax
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13
Q

Transient tachypnoea of the newborn management

A

Oxygen to maintain saturations

Usually settles within 24 hours

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14
Q

Jaundice <24 hours is always

A

Pathological

Measure serum bilirubin to determine management

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15
Q

Causes of early jaundice <24 hours

A

Sepsis
Rhesus incompatibility
ABO incompatibility
Red cell anomalies- hereditary spherocytosis or G6PD

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16
Q

What is kernicterus?

A

Severe hyperbilirubinaemia and acute bilirubin encephalopathy sequalae

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17
Q

Causes of pysiological jaundice 2-14 days

A

Usually physiological- accelerated breakdown of RBC, decreased excretory capacity and low activity of UDPGT

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18
Q

Management of jaundice 2-14 days

A

Monitor unconjugated bilirubin levels and monitor for kernicterus
Phototherapy
Exchange transfusions using warmed blood via umbilical vein
IVIg if haemolytic disease

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19
Q

Causes of prolonged jaundice- >14 days

A

Unconjugated- same as early causes and UTI, Crigler-Najjar and Gilbert’s
Conjugated- hypothyroidism, biliary atresia, cystic fibrosis

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20
Q

Omphalocele vs gastroschisis

A

Omphalocele- sealed abdominal contents protruding through the umbilical ring
Gastroschisis- no covering of peritoneum

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21
Q

Features of congenital diaphragmatic herniation

A 
Difficulty resuscitating at birth
Respiratory distress
Bowel sounds in one hemithorax
Cyanosis 
Pulmonary hypoplasia
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22
Q

Hirschsprung disease clinical features

A

Delayed passage of meconium >48 hours
Abdo distension
Tight anal sphincter
Explosive discharge of stool and gas

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23
Q

Diagnosis of Hirschsprung disease

A

Rectal suction biopsy of aganglionic section

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24
Q

Treatment of Hirschsprung’s disease

A

Excision and colostomy

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25
Cyanotic cardiac malformations
All the Ts Tetralogy of Fallot Transposition of the great arteries Tricuspid valve abnormalities
26
Patent ductus arteriosus signs
Continuous machinery murmur, left subclavicular thrill, wide pulse pressure
27
Patent ductus arteriosus treatment
Indomethacin/ ibuprofen to inhibit prostaglandin production and close the duct
28
Tetralogy of Fallot
Large ventricular septal defect Pulmonary valve stenosis Right ventricular hypertrophy Overriding aorta 'boot shaped heart' on CXR
29
Pyloric stenosis clinical features
Projectile non-bilious vomiting Hungry after feed- alert and anxious Dehydration and electrolyte imbalance Weight loss Usually 2-8 weeks Visible gastric peristalsis after test feed Palpable olive shaped pyloric mass (from the hypertrophic pyloric sphincter muscle)
30
Pyloric stenosis electrolyte imbalance
Hypochloraemic, hypokalaemic metabolic acidosis
31
Diagnosis of pyloric stenosis
Test feed | USS abdomen
32
Management of pyloric stenosis
IV rehydration and correction of electrolyte imbalance Ramstedt pyloromyotomy once stabilised Start feeding 6 hours post operation
33
Clinical presentation of GORD
Onset usually before 8 weeks and tends to resolve by 12 months Regurgitation of feed, heartburn, epigastric pain, cough, hoarseness, distressed behaviour when feeding Failure to thrive
34
Red flags when diagnosing GORD
``` Persistent regurgitation after 12 months Onset after 6 months Faltered growth Haematemesis Bilious vomiting Projectile vomiting Abdominal mass/distension Chronic diarrhoea Melaena ```
35
Management of GORD
``` Breast feeding advice + omeprazole Smaller and more frequent feeding Gavison Enteral tube feeding Nissen Fundoplication ```
36
Markers of dehydration in the neonate
``` Increased thirst Reduced skin turgor Dry mucous membranes Sunken fontanelle and eyes Reduced urine output Tachycardia Tachypnoea Cool extremities Prolonged capillary refill ```
37
IV fluid resuscitation regimen for neonates
First 10kg 100mL/kg Second 10kg 50mL/kg subsequent kg 20mL/kg
38
IgE-mediated cow's milk protein allergy vs non IgE-mediated
IgE mediated within 20-30 mins, up to 2 hours | Non-IgE mediated 2-72 hours after exposure
39
Infant colic clinical features and management
Arching back, drawing knees up Inconsolable crying Paroxysmal, worse in the evening Excessive flatus Reassurance and treatment of any other causes- Cow's milk protein allergy or GORD
40
Age of Toddler's diarrhoea
Between 1 and 5 years old
41
Clinical features of coeliac disease
``` Profound malabsorption after introduction of wheat to the diet Failure to thrive Abdominal distension Buttock wasting Non-specific GI symptoms Irritability Anaemia with iron +/- folate deficiency ```
42
Investigations for coeliac disease
IgA tissue tranglutaminase antibodies and total IgA Consider IgG endomysial antibodies if total IgA is deficient HLA genetic test and endoscopic biopsy
43
What does a jejunal biopsy show in coeliac disease?
Lymphocytic infiltration and villous atrophy
44
Disimpaction of constipation stepwise management
1. Polyethylene glycol- Movicol and electrolytes 2. Senna- stimulant laxative 3. +/- lactulose (osmotic) 4. Sodium citrate enema Review within 1 week Continue maintenance therapy
45
Commonest serious respiratory infection of infancy
Bronchiolitis | 80% caused by respiratory syncytial virus
46
Supportive treatment for infants with bronchiolitis
Humidified oxygen via nasal cannulae if sats <92% OA If respiratory failure then CPAP Cannot tolerate oral feeding then NG or IV fluids if not able to tolerate NG
47
Treatment for high risk infants with bronchiolitis
Palivizumab
48
Antibiotic treatment of pneumonia
Amoxicillin first line, macrolide added if no response If mycoplasma or chlamydia is suspected then macrolide Influenza then use co-amoxiclav
49
Most likely cause of a bacterial pneumonia in children?
Strep pneumoniae
50
What is an abnormal fractional exhaled nitric oxide
Above 35ppb
51
CENTOR criteria
Tonsillar exudate Tender anterior cervical lymphadenopathy Absence of cough Fever >38 degrees
52
Infectious mononucleosis maculopapular rash exacerbated by
Antibiotics particularly penicillin
53
Scarlet fever caused by
Group A streptococcus = | Strep pyogenes
54
Clinical presentation of scarlet fever
``` Fever lasting 24-48 hours Punctuate erythematous rash- sandpaper texture Desquamation Strawberry tongue Tender adenopathy ```
55
Clinical presentation of Kawasaki disease
``` Mucocutaneous lymphadenopathy High grade fever for >5 days, resistant to antipyretics Widespread maculopapular rash Strawberry tongue, red or cracked lips Desquamation Painless lymphadenopathy ```
56
Management of Kawasaki disease
High dose aspirin | Echocardiogram screening for coronary artery aneurysms
57
Clinical features of measles
Conjunctivitis Fever Koplik spots on the buccal membrane Rash- starting behind the ears and spreading to the whole body- discrete maculopapular rash that becomes blotchy and confluent
58
Complications of measles
``` Otitis media- most common Pneumonia- most common cause of death Encephalitis Sub-acute sclerosing panencephalitis- 10 years later Febrile convulsions ```
59
Mumps clinical features
Fever Malaise Myalgia Unilateral progressing to bilateral parotitis
60
Complications of mumps
Orchitis Hearing loss Meningoencephalitis Pancreatitis
61
Erythema infectiosum clinical features
Lethargy Fever Headache 'Slapped cheek' rash
62
Cause of erythema infectiosum | Synonyms
Parvovirus B19 | Slapped cheek or 5th disease
63
6 in 1
``` Diphtheria Tetanus Pertussis Polio Hib Hep B ```
64
Childhood vaccination schedule
``` 6 in 1 at 2,3,4 Then at 1 give HiB once more (4 in 1) Rotavirus at 2 and 3 If it divides by 2 give Men B If it divides by 3 give PCV ``` MMR at 1 and 40 months (with HiB, Men C, Men B, PCV at 1) HPV at 12-13 y/o Men ACWY at 14 y/o
65
Management of laryngotracheobronchitis (croup)
Stat dose of oral dexamethasone 0.15mg/kg +/- nebulised adrenaline Supportive treatment
66
Causative agent of epiglottitis
H. influenzae type B
67
What is the combined test for Down's screening?
nuchal translucency measurement + serum beta HCG + PAPP-A High HCG Low PAPP-A Thickened nuchal measurement
68
Most common cardiac abnormalities in Down's syndrome
ASD 40% | VSD 30%
69
Patau syndrome
Trisomy 13 Features of microcephaly, small eyes, cleft palate, polydactyly IUGR, neural tube defects Median survival <3 days
70
Edward's syndrome
Trisomy 18 Features micrognathia, rockerbottom feet, overlapping of fingers, low set ears
71
Turner syndrome
``` 45 XO Widely spaced nipples, broad shield chest, webbed neck short statue, may be normal intellect, wide carrying angle Subfertility Sexual developmental issues Coarctation of the aorta ```
72
Fragile X syndrome
Most commonly inherited caused of intellectual disability in males Macrocephaly, long face, large ears, macro-orchidism
73
What is secondary nocturnal enuresis?
Involuntary discharge of urine in a child older than 4 when they have been dry for a period of at least 6 months previously
74
Management of enuresis
Conservative- look for trigger, advise on fluid intake, diet and toileting behaviour, reward systems for dry nights/ using the toilet before bed Medical- Enuresis alarm 1st line for children <7 Desmopressin 1st line for children >7, particularly if enuresis alarm has been ineffective or for short term control

ISCE prep (6 decks)

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