Paediatrics Flashcards
1
Q
What is vesico-ureteric reflux?
A
Backflow of urine from bladder to ureter and kidney
2
Q
Presentation of vesico-ureteric reflux
A
Hydronephrosis on antenatal U/S
Recurrent childhood UTI
Reflux nephropathy (chronic pyleonephritis secondary to VUR)
3
Q
Grade 1 VUR
A
Reflux to ureter only, no dilation
4
Q
Grade 2 VUR
A
Reflux to renal pelvis on micturation, no dilation
5
Q
Grade 3 VUR
A
Mild/moderate dilation of ureter, renal pelvis and calyces
6
Q
Grade 4 VUR
A
Dilation of renal pelvis and calyces, moderate ureteral tortuosity
7
Q
Grade 5 VUR
A
Gross dilation of ureter, pelvis and calyces with ureteral tortuosity
8
Q
Management of vesico-ureteric reflux
A
Mild likely to self resolve Prophylactic antibiotics Management of hypertension Gel injected into end of ureter Surgical ureteral implantation (rare)
9
Q
Investigations for vesico-ureteric reflux
A
Micturating cystourethrogram
DMSA scan to look for renal scarring
10
Q
Define enuresis
A
Involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract
11
Q
Types of noctural enuresis
A
Primary: child never had continence
Secondary: child dry for 6 months or more prior
12
Q
What conditions do you need to exclude when seeing a child with noctural enuresis?
A
Diabetes
UTI
Constipation
13
Q
Management of noctural enuresis
A
Check for underlying causes
Advise on fluids, diet, toileting behaviour
Star chart for behaviours (e.g. toilet before bed), not dry nights
Enuresis alarm under 7 years
Desmopressin over 7 years
14
Q
Inheritance of homocystinuria
A
Autosomal recessive
15
Q
What is homocystinuria?
A
Deficiency in cystathionine beta synthase
Causes increased blood and urine homocysteine
16
Q
Presentation of homocystinuria
A
In early childhood
Tall, fair hair Marfanoid appearance Kyphoscoliosis Atherosclerosis, stroke Low IQ Epilepsy Glaucoma Downwards lens dislocation Cataracts
17
Q
Management of homocysteinuria
A
Vitamin B6
Folate
Half of children won’t respond to B6 and will need a low methionine diet
18
Q
What is a low methionine diet?
A
Largely vegan
Protein from nuts, lentils
Minimise protein from meats, eggs, milk
19
Q
What is developmental dysplasia of the hip?
A
Spectrum of disease from mild acetabular dysplasia to frankly dislocated femoral head
20
Q
Risk factors for developmental dysplasia of the hip
A
Female > Male 6:1 Breech Family history First born child Oligohydramnios Birth weight >5kg Congenital calcaneovalgus foot deformity
21
Q
What percentage of children are born with developmental dysplasia of the hip?
A
1-3%
20% cases bilateral
Left hip affected more than right
22
Q
Screening for developmental dysplasia of the hip
A
Routine ultrasound if: first degree relative of hip problems at early age, breech at or after 36 weeks, multiple pregnancy
All infants screened at birth and 6 weeks with Barlow and Ortolani
23
Q
Examination for developmental dysplasia of the hip
A
Barlow - attempts to dislocate an articulated femoral head
Ortolani - attemps to relocate a dislocated femoral head
Symmetry of leg length
24
Q
Imaging for developmental dysplasia of the hip
A
Ultrasound
Xray if >4.5 months
25
Management of developmental dysplasia of the hip
Most stabilise themselves by 3-6 weeks
Pavlik harness if under 5 months
Older children may need surgery
26
Which children tend to be affected by slipped upper femoral epiphysis?
Age 10-15
Males
Obese
27
What is slipped upper femoral epiphysis?
Displacement of the femoral head epiphysis postero-inferiorly
28
Features of slipped upper femoral epiphysis
Acutely after trauma or chronic symptoms
Hip, groin, medial thigh or knee pain
Limp
Loss of internal rotation of the leg in flexion
Bilateral slip in 20%
29
Investigations of slipped upper femoral epiphysis
Xray hip - AP and lateral (frog leg)
30
Management of slipped upper femoral epiphysis
Internal fixation
31
What is Perthe's disease?
Avascular necrosis of the femoral epiphyses
32
Features of Perthe's disease
Limp
Hip pain - progressive over a few weeks
Stiffness
Reduced ROM
33
Investigations for Perthe's disease
Xray: widening of joint space, decreased femoral head size / flattening of femoral head
Bone scan or MRI if normal xray and persistent symptoms
34
Management of Perthe's disease
<6 years: observe
Older children: surgery, cast, braces
Most will resolve with conservative management
35
Who is affected by Perthe's disease?
Age 4-8
M>F 5:1
10% cases bilateral
36
What is ankyloglossia?
Tongue tie
37
Management of croup
Dexamethasone 0.15mg/kg
High flow oxygen
Nebulised adrenaline
38
Main cause of croup
Parainfluenza
39
Features prompting admission in croup
Moderate or severe
Under 6 months
Uncertainty of diagnosis
Known upper airway abnormalities (Downs, laryngomalacia)
40
What is the average age of adoption in the UK?
4 years
41
School exclusion in scarlet fever
24 hours after starting antibiotics
42
School exclusion in whooping cough
2 days after starting antibiotics
43
School exclusion in measels
4 days from onset of rash
44
School exclusion in rubella
5 days from onset of rash
45
School exclusion in chickenpox
Until all lesions have crusted over
46
School exclusion in mumps
5 days from onset of swollen glands
47
School exclusion in impetigo
Until lesions are crusted and healed, or 48 hours after antibiotic treatment
48
School exclusion in scabies
Until treated
49
School exclusion in influenza
Until recovered
50
Newborn hearing screening test
Otoacoustic emissions
51
Newborn and infant hearing test if they fail screening
Auditory brianstem response test
52
Hearing test age 6-9 months
Distraction test
53
Hearing test age 18 months-2.5 years
Recognition of familiar objects "where's the teddy?"
54
Hearing test >2.5 years
1) Performance testing
| 2) Speech discrimination tests
55
Hearing test >3 years
Pure tone audiometry
Done at school entry
56
What screening tests are done for hearing?
Otoacoustic emissions at newborn
Pure tone audiometry at school entry
57
How common is an undescended teste?
2-3% of term infants
Higher if preterm
25% cases bilateral
58
Complications of an undescended teste
Infertility
Torsion
Testicular cancer
Psychological
59
Management of a unilateral undescended teste
Refer at 3 months if persistent, seen by urologist by 6 months
Consider orchidoplexy around 1 year
60
Management of bilateral undescended teste
If at birth: urgent review, endocrine/genetic testing
If at 6-8 weeks: urgent 2 week referral to paediatrics
61
Conditions associated with Wilm's tumour
Beckwith-Wiedermann syndrome
WAGR syndrome
Hemihypertrophy
1/3rd cases have loss of function mutation in WT1 gene on chromosome 11
62
Features of Wilm's tumour
```
Abdominal mass
Flank pain
Painless haematuria
UTI
Systemic features - poor appetite, fever, weight loss
```
63
At what age do Wilm's tumours present?
Typically under 5
| Median age 3 years
64
Management of Wilm's tumours
Nephrectomy
Chemotherapy
Radiotherapy if advanced disease
65
Other word used for Wilm's tumour
Nephroblastoma
66
What percentage of Wilm's tumours have metastases at presentation?
20%
| Most commonly to lung
67
Features of growing pains
Never present at the start of the day after waking
No limp
No limitation on physical activity
Systemically well
Normal physical examination
Motor milestones normal
Symptoms often intermittent and worse after a day with lots of activity
68
Protective factors for sudden infant death syndrome
Breast feeding
Room sharing
Use of dummies
69
Risk factors for sudden infant death syndrome
MAJOR:
Prone sleeping, Parental smoking, Prematurity, Bed sharing, Hyperthermia or head covering
```
OTHER:
Male sex, Multiple birth, Social class IV and V, Maternal drug use, Winter
```
70
What temperature should the vaccine fridge be kept at?
+2 to +8 degrees
71
Prevalence of iron deficiency anaemia in children
10%
Higher in Asian, Afro-Caribbean, Chinese
Preterm babies at high risk
72
Causes of iron deficiency anaemia in children
Diet is primary
Malabsorption - check for coeliac
Bleeding
Outside the UK: malaria, parasites, HIV, TB
73
Management of iron deficiency anaemia in children
```
Preterm: 5mg elemental iron till weaned
Breast/formula milk till 1 year
Restrict cows milk
Iron rich weaning foods
Vit C rich weaning foods
3-6mg/kg daily iron
```
74
Causes of Hand, Foot and Mouth Disease
Coxsackie A16
Less often enterovirus 71
75
Features of hand, foot and mouth disease
Systemic upset - fever, sore throat
Oral ulcers
Vesicles on palms and soles
76
Management of hand, foot and mouth disease
Symptomatic
| No need for school exclusion
77
What is laryngomalacia?
Common benign cause of noisy breathing
Softening of the larynx, causing collapse during inspiration
78
Presentation of laryngomalacia
Noisy breathing/intermittent stridor
Around 4 weeks old
Usually self resolves by age 2 years
79
Cause of scarlet fever
Group A haemolytic streptococci
| usually strep pyogenes
80
Presentation of scarlet fever
Incubation 2-4 days
```
Fever
Malaise
Tonsilitis
Strawberry tongue
Rash - fine erythema, starts on torso, facial sparing, 'sandpaper' texture
Desquamination later
```
81
Management of scarlet fever
Oral penicillin
Azithromycin if penicillin allergic
Notifiable disease
82
Complications of scarlet fever
Otitis media
Rheumatic fever - 20 days after infection
Acute glomerulonephritis - 10 days after infection
83
Central causes of hypotonia
Down's syndrome
Prader Willi syndrome
Hypothyroidism
Cerebral palsy
84
Neurological and muscular causes of hypotonia
```
Spinal muscular atrophy
Spina bifida
Guillian-Barre syndrome
Myasthenia gravis
Muscular dystrophy
Myotonic dystrophy
```
85
Management of paediatric migraine
NSAIDS
Triptans for over 12 years - sumatriptan nasal spray
Prophylaxis:
1st line - propranolol, pizotifen
2nd line - valproate, topiramate, amitryptilline
86
Cause of roseola infantum
Human herpes virus 6
87
Features of roseola infantum
Incubation 5-15 days
High fever, lasting a few days
Maculopapular rash follows fever, starts on neck and trunk
Nagayama spots - papular enanthem on uvula and soft palate
Febrile convulsions in 10-15%
Diarrhoea
Cough
88
Management of roseola infantum
No school exclusion
| Symptomatic management
89
Treatment options for head lice
Wet combing
Malathion
Dimeticone
90
Cause of head lice
Pediculus capitis (parasite)
91
Features of chickenpox
Fever initially
Itchy rash starts on head/trunk
Rash is macular then papular then vesicular
Mild systemic upset
92
Management of chickenpox
Supportive
Keep cool, trim nails, calamine
Infective till all lesions crusted
93
Management when immunocompromised people are exposed to chicken pox?
VZIG for immunocompromised or newborns exposed
If chicken pox develops then IV aciclovir
94
Infectivity of chicken pox
4 days before rash until 5 days after rash first developed or when all lesions have crusted
Incubation is 10 to 21 days
95
Complications of chicken pox
Secondary bacterial infection (NSAIDs increase the risk)
Pneumonia
Encephalitis
Disseminated haemorrhagic chickenpox
96
Patau syndrome - what is the chromosome abnormality?
Trisomy 13
97
Patau syndrome key features
```
Microcephalic
Small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
```
98
Edward's syndrome genetics
Trisomy 18
99
Edward's syndrome key features
Micrognathia
Low set ears
Rocker bottom feet
Overlapping of fingers
100
Fragile X syndrome key features
```
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
```
101
Noonan syndrome key features
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
102
Pierre-Robin key features
Micrognathia
Posterior displacement of the tongue (may cause upper airway obustruction)
Cleft palate
103
Prada Willi key features
Hypotonia
Hypogonadism
Obesity
104
William's syndrome key features
```
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
```
105
Cri du chat syndrome genetics
Chromosome 5p deletion syndrome
106
Cri du chat key features
```
Characteristic cry due to larynx and neurological problems
Feeding difficulties, poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism
```
107
Measles infectivity
Spread by droplet
Infective from prodrone until 4 days after rash starts
Incubation period 10-14 days
108
What causes measles?
Measles virus
RNA paramyxovirus
109
Features of measles
Prodrome - irritable, conjunctivitis, fever
Koplik spots - start before rash, white spots on buccal mucosa
Rash
110
What does the measles rash look like and where does it start?
Discrete maculopapular rash becoming blotchy and confluent
Starts behind ears
111
Management of measles
Supportive
Admit if immunosuppressed/pregnant
Notifiable disease
112
How to manage contacts of measles
Non-immunised children who come into contact with measles should be offered MMR vaccine within 72 hours
113
Complications of measles
Encephalitis - 1-2 weeks after illness onset
Subacute sclerosing panencephalitis - 5-10 years later
Febrile convulsions
Giant cell pneumonia
Keratoconjunctivitis, corneal ulcer
Diarrhoea
Myocarditis
114
What type of disease is Kawasaki's disease?
Systemic vasculitis
115
Diagnosis of Kawasaki's disease
Clinical
Highly likely if high fever + 4 other features
OR high fever + 3 other features + ECHO changes
116
Features of Kawasaki's disease
```
High grade fever for >5 days, resistant to antipyretics
Bilateral conjunctival injection
Red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles which later peel
Non-vesicular rash
Irritable child
```
117
Management of Kawasaki's disease
High dose aspirin
IV immunoglobulin
ECHO to screen for coronary artery aneurysms
118
Complication of Kawasaki's disease
Coronary artery aneurysms
119
What causes pertussis?
Bordetella pertussis
gram positive bacteria
120
Infectivity of pertussis
Incubation 10-14 days
No lifelong protection
121
Features of pertussis
```
2-3 coryzal days as prodrome
Coughing bouts - worse at night, may cause vomiting
Inspiratory whoop
Persistent cough
Apnoea in infants
Symptoms may last 10-14 days
Marked lymphocytosis
```
122
Diagnostic criteria for pertussis
Acute cough >14 days without clear cause, plus one of
Paroxysmal cough
Inspiratory whoop
Post-tussive vomit
Undiagnosed apnoea in infants
123
Management for pertussis
Antibiotics reduce spread but not clinical course, start if within 21 days of cough onset
Macrolide - clarithromycin, azithromycin, erythromycin
Prophylactic antibiotics to household contacts
School exclusion for 48 hours after starting antibiotics
124
Complications of pertussis
Subconjunctival haemorrhage
Pneumonia
Bronchiectasis
Seizures
125
Risk factors for ADHD
Maternal smoking, drinking, heroin during pregnancy
Low birth weight
Fetal hypoxia
Severe early psychosocial adversity
126
What is ADHD?
Features relating to inattention and/or hyperactivity/impulsivity that are persistent
Symptoms >6 months and in 2 or more settings (school, work, home)
Symptom onset before age 12
127
Features of ADHD
Inattention: doesn't follow direction, easily distracted, difficult to sustain tasks and organise tasks, forgetful
Hyperactivity/Impulsivity: unable to play quietly, talks excessively, doesn't wait their turn, can't sit still, interruptive
128
Management of ADHD
Parental training education programmes
Psychological therapy
Drug treatment
129
Drug management of ADHD
1st line: Methylphenidate - need to monitor height, weight, BP, heart rate, baseline ECG
2nd line: Lisdexamfetamine - need baseline ECG
130
Management of otitis media in Down's syndrome or cleft palate
Urgent referral to ENT
131
When does benign rolandic epilepsy occur?
Ages 4-12
132
Features of benign rolandic epilepsy
Seizures at night
Seizures are partial but secondary generalisation may occur
Child otherwise normal
133
EEG in benign rolandic epilepsy
Centro-temporal spikes
134
Management of benign rolandic epilepsy
Often not needed
1st line: carbamazepine
135
Prognosis in benign rolandic epilepsy
Excellent
| Majority outgrow by age 16
136
Causes of microcephaly
```
Normal variant
Familial
Congenital infection
Perinatal brain injury e.g. hypoxic ischaemic encephalopathy
Fetal alcohol syndrome
Syndromes e.g. Patau
Craniosynostosis
```
137
What is the definition of microcephaly?
Head circumference < 2nd centile
138
How would an older child with missed developmental dysplasia of the hip present?
Trendlenberg gait
| Leg length discrepency
139
Management of eczema
```
Topical emollient (250g per week)
Ratio of emollient to steroid is 10:1
Emollient applied 30 mins before steroid
Emollient can get contaminated with bacteria
Topical steroids
```
140
Contraindications to MMR vaccine
Severe immunosuppression
Allergy to neomycin
Received another live vaccine within 4 weeks
Avoid pregnancy for 1 month after
Immunoglobulin therapy within the last 3 months
141
Adverse effect of MMR vaccine
Malaise, fever rash after 1st dose
Occurs after 5-10 days
Lasts 2 days
142
Features of cow's milk protein intolerance/allergy
```
Regurgitation and vomiting
Diarrhoea
Urticaria, atopic eczema
Colic symptoms
Wheeze, chronic cough
Rarely angioedema and anaphylaxis
```
143
Diagnosing cow's milk protein intolerance/allergy
Generally clinical
Skin prick testing
Total IgE and specific IgE
144
Management of cow's milk protein intolerance/allergy if bottle fed
1st line: extensive hydrolysed formula
2nd: amino acid based formula
10% also allergy to soya milk
145
Management of cow's milk protein intolerance/allergy if breastfed
Eliminate cow's milk from maternal diet
Mum will need calcium supplement
Extensively hydrolysed formula when weaning till 1 year
146
Difference between cow's milk protein intolerance and allergy
Allergy = immediate, IgE mediated
Intolerance = delayed, milder, non-IgE mediated
147
Features of meningococcal septicaemia
```
Fever
Vomiting
Lethargy
Non-blanching rash
Prolonged cap refill
Shock
Hypotension
```
148
Management of meningococcal septicaemia in the community
Call 999
| IV or IM benzylpenicillin (unless history of anaphylaxis)
149
Chondromalacia patellae
Softening of the patella cartilage
Teenage girls
Anterior knee pain walking up/down stairs, rising from sitting
Responds to physio
150
Osteochondritis dissecans
Pain after exercise
| Intermittent swelling and locking
151
Osgood schlatter
Sporty teenagers
| Pain, swelling, tenderness over the tibial tubercle
152
Patellar tendonitis
Athletic teenage boys
Chronic anterior knee pain that's worse after running
Tender below the patella on examination
153
Patellar subluxation
Medial knee pain due to lateral subluxation of patella
| Knee may give way
154
First sign of puberty in males and age of onset
Testicular growth
Around age 12
Testicular volume >4ml indicates puberty onset
155
First sign of puberty in females
Breast development
| Around age 11.5
156
Management of threadworms
Mebendazole
157
Management of labial adhesions
Generally self-resolves by puberty
If problems e.g. recurrent UTI may need topical oestrogens
Severe may be require surgery
158
What are labial adhesions?
Fusion of the labial minora in the mid-line
Age 3 months to 3 years
Generally self-resolve by puberty
159
What conditions are tested for with the heel prick?
```
Cystic fibrosis
Hypothyroidism
Phenylketonuria
Maple syrup urine disease
Medium chain acteyl co-A dehydrogenase deficiency
Homocystinuria
Isovaleric acidaemia
Glutaric aciduria type 1
```
160
In a child with frank haematuria what should you consider?
Wilm's tumour
| Very urgent paediatric referral
161
Features of pyloric stenosis
```
Presents at 3-6 weeks
Projectile vomiting
Palpable mass in upper quadrant
Dehydration
Constipation
```
162
Investigations for pyloric stenosis
Hypochloraemic, hypokalaemic acidosis
Diagnosed via ultrasound
163
Who is most likely to get pyloric stenosis?
M>F 4:1
10-15% have family history
First born more commonly affected
164
Management of pyloric stenosis
Ramstedt pyloromyotomy
165
Average age of diagnosis of retinoblastoma
18 months
166
Inheritance and genetics of retinoblastoma
Autosomal dominant
Loss of function of retinoblastoma tumour suppressor gene on chromosome 13
10% cases hereditary
167
Features of retinoblastoma
Absent red-reflex, replaced by white pupil (Leukocoria)
Strabismus
Visual problems
168
Management of retinoblastoma
Enucleation
Other options if not advanced: external beam radiation, chemotherapy, Photocoagulation
169
What should you think of in a baby with lack of red reflex?
Retinoblastoma
170
What vitamins would someone on orlistat be at risk of becoming deficient in?
Fat soluble
A, D, E, K
171
What should you do if there are weak or absent femoral pulses at the 6 week baby check?
Discuss with the paediatric consultant on call
172
Management of umbilical granulomas
Salt application
| Silver nitrate cautery
173
What is glue ear?
Otitis media with effusion
174
Features of glue ear
Peaks at 2 years
Conductive hearing loss - may present with speech/language delay, behavioural problems
175
Presentation of acute otitis media
```
Sudden onset
Otalgia
Rubbing ear
Fever
URTI symptoms
Hearing loss
Ear discharge
```
176
Findings of acute otitis media on examination
Bulging TM
Loss of light reflex
Erythema of TM
Otorrhoea
177
Management of acute otitis media
Generally self limiting
5-7 days amoxicillin
Erythromycin/clarithromycin if pen allergic
178
When do you give antibiotic therapy in acute otitis media?
```
If not improving by day 3
Systemically unwell
Immunocompromised
Significant co-morbidity
<2 years and bilateral
Perforation/discharge
```
179
Features of Down's Syndrome
```
Upslanting palpebral fissures, Epicanthic folds, Brushfield Spots, Single palmar crease
Hypotonia
Duodenal atresia
Hirschsprung's disease
Congenital heart disease
Visual problems
Otitis media
```
180
Genetic abnormalities in Down's Syndrome
94% Non-disjunction
5% Robertson translocation
1% Mosaicism
181
Risk of recurrence of Down's Syndrome if it is a Robertson translocation
10-15% if mother is the carrier
| 2.5% if father is the carrier
182
Risk of Down's Syndrome if maternal age is 20
1 in 1,500
183
Risk of Down's Syndrome if maternal age is 30
1 in 800
184
Risk of Down's Syndrome if maternal age is 35
1 in 270
185
Risk of Down's Syndrome if maternal age is 40
1 in 100
186
Risk of Down's Syndrome if maternal age is 45
1 in 50 or more
187
Gold standard for antenatal Down's Syndrome testing
Combined test, between weeks 11 and 13+6
Nuchal transluency (thickened in DS)
Serum beta HCG (increased)
Pregnancy associated plasma protein A (decreased)
188
Antenatal Down's Syndrome testing for late bookers
Weeks 15-20 triple or quadruple tes
Alpho-feto protein
Unconjugated oestriol
Human chorionic gonadotrophin
+ Inhibin A for quadruple
189
Cause of rubella
Togavirus
190
Features of rubella
Low grade fever, headache
Maculopapular rash - starts on face then spreads to body, gone by day 3-5
Lymphadenopathy
Forchheimer spots - red spots seen on soft palate
191
Management of rubella
Supportive
| School exclusion for 4 days after rash starts
192
Features of congenital rubella syndrome
```
Sensorineural deafness
Congenital cataracts
Congenital heart disease
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
'Salt and pepper' chorioretinitis
Cerebral palsy
```
193
Risk of congenital rubella syndrome
90% in weeks 8-10
Low risk after 16 weeks
194
What is erythema infectiosum also called?
Fifth's disease
| Slapped cheek syndrome
195
Cause of erythema infectiosum
Parvovirus B19 or erythrovirus B19
196
Features of erythema infectiosum
Low grade fever
Bright red rash on cheeks
Lace-like rash on body
URTI
197
Management of erythema infectiosum
Supportive
| No school exclusion as not infectious after gets rash
198
Erythema infectiosum during pregnancy
if <20 weeks need to check maternal IgG and IgM
Risk of hydrops fetalis, intrauterine death, spontaneous abortion
199
Cause of mumps
Paramyxovirus
200
Features of mumps
```
May be asymptomatic
Systemic - fever, malaise
Parotitis
Headache
Facial pain
```
201
Management of mumps
Supportive
Notifiable
Infectious for 9 days after swelling starts
202
Complications of mumps
Orchitis - 25% of postpubertal males
Hearing loss - transient, unilateral
Meningoencephalitis
Pancreatitis
203
Definition of obesity in children
BMI > 98th centile
204
Definition of overweight in children
BMI > 91st centile
205
Paraumbilical hernia
Defects in linea alba
Edges well defined
Less likely to spontaneously close
206
Omphalitis
Infection of umbilicus
Staph aureus most common
Topical and systemic antibiotics
Can spread rapidly
207
Persistent urachus
Persistent urachus which attaches to bladder
Discharges urine
Associated with other urogenital abnormalities
208
Umbilical granuloma
Cherry red lesion around umbilicus
May bleed on contact
Purulent discharge
209
Persistent vitello-intestinal duct
Discharges small bowel content
Rare
Requires surgical closure
210
What type of vaccine is the rotavirus vaccine?
What is the theoretical risk of rotavirus vaccine?
Live attenuated vaccine
Theoretical risk of intussusception
211
Constipation red flags in children
```
From birth or first few weeks
Breastfed
Meconium >48 hours
Ribbon stools
Faltering growth
Weakness in legs
Abdo distension
```
212
Management of constipation
Disimpaction if needed: movicol, then stimulant, then osmotic
Maintenance: movicol, then stimulant, then osmotic
Ensure enough fluids and fibre
213
Management of constipation in bottle fed infants
Extra water between feeds
Abdominal massage
Bicycle legs
214
Management of constipation in breast fed infants
Unusual
| Consider organic cause
215
Management of constipation in a weaning infant
Extra water, dilated fruit juice, fruit
| Lactulose
216
Signs of faecal impaction
Severe constipation
Overflow soiling
Faecal mass palpable in abdomen
217
How many children will have a febrile convulsion?
3%
218
Risk of further febrile convulsions
1 in 3
Apyretics do not lower risk
219
Types of febrile convulsions
Simple
Complex
Status
220
Simple febrile convulsion
<15 minutes
Generalised
No recurrence in 24 hours
Complete recovery in 1 hour
221
Complex febrile convulsion
15-30 mins
Focal seizure
Repeat seizure within 24 hours
222
Febrile status epilepticus
>30 mins
223
Which febrile convulsions should be admitted?
First seizure
| Any features of complex seizure
224
What is a cephalohaematoma?
Swelling on newborns head a few hours after birth
Bleeding between periosteum and skull
May cause jaundice
Up to 3 months to resolve
225
What is ophthalmia neonatorum?
Infection of newborn eye
226
What causes ophthalmia neonatorum?
Chlamydia trachomatis
| Neisseria gonorrhoeae
227
Management of ophthalmia neonatorum
Same day paediatric assessment
228
Features of acute lymphoblastic leukaemia
```
Lethargy, pallor
Frequent severe infections
Easy bruising, petechiae
Bone pain
Spleno/hepatomegaly
Fever in 50%
Testicular swelling
```
229
Poor prognostic factors in acute lymphoblastic leukaemia
```
Age <2 or >10
WBC >20 at diagnosis
T or B cell surface markers
Non-caucasian
Male sex
```
230
Features of eczema in infants
Affects face and trunk
231
Features of eczema in young children
Affects extensor surfaces
232
Features of eczema in older children
Typical distribution
Flexor surfaces
Creases of face and neck
233
School exclusion in conjunctivitis
No exclusion
234
Treatment of croup
Oral dexamethasone 0.15mg/kg
235
Benzylpenicillin for menginococcal dose if 1-11 months old
300mg IM or IV
236
Benzylpenicillin for meningococcal dose if 1-9 years
600mg IM or IV
237
Benzylpenicillin for meningococcal dose if 10-17 years
1.2 grams IM or IV
238
Benzylpenicillin for meningococcal dose if an adult
1.2 grams IM or IV
239
Prophylactic treatment of meningitis in close contacts
Ciprofloxacin
240
Antibiotics for meningitis <3 months
IV amoxicillin + IV cefotaxime
| No steroids
241
Antibiotics for meningitis >3 months
IV cefotaxime or ceftriaxone
242
Who is affected by infantile spasms?
Age 4-8 months
| M>F
243
Features of infantile spasms
Characteristic 'salaam' attacks
Last 1-2 seconds but may repeat 50 times
Progressive mental handicap
244
EEG in infantile spasms
Hypsarrhythmia
245
CT in infantile spasms
Diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)
246
What is Freiberg disease?
Metatarsal avascular necrosis
| usually second metatarsal
247
Who is mainly affected by Freiberg disease?
Tall, athletic females
| Usually adolescents
248
Features of Freiberg disease
Pain
Swelling
Stiffness
Of the affected metatarsal (usually 2nd)
249
Management of Freiberg disease
Limit activity, analgesia, orthotic devices
Refer if no improvement at 6 weeks
Surgery rarely needed
Recovery may be gradual and take up to 1 year
250
What is calcaneal apophysitis?
Swelling and irritation of growth plate in the heel
Heel pain in sporty children
Pain on squeezing heel
Also called Sever disease
251
What does hand dominance prior to 18 months suggest?
Cerebral palsy
| Hemiparesis
252
Management of fever in a baby under 3 months
Refer to hospital
Full septic screen
IV antibiotics
253
Causes of early jaundice
```
Rh incompatibility
ABO incompatibility
G-6-P dehydrogenase deficiency
Spherocytosis
Infection
Autoimmune haemolytic anaemia
Crigler Najjar syndrome
Gilbert's syndrome
```
254
Causes of jaundice 24 hours - 3 weeks
```
Physiological jaundice
Breast milk jaundice
Infection
Haemolysis
Bruising
Polycythaemia
Crigler Najjar syndrome
```
255
Causes of prolonged jaundice >3 weeks
```
Physiological jaundice
Breast milk jaundice
UTI
Congenital infection e.g. CMV, toxoplasmosis
Hypothyroidism
Haemolytic anaemia
Obstruction
Biliary atresia
Neonatal hepatitis
```
256
Main causes of neonatal sepsis
Group B streptococcus
| Escheria coli
257
Risk factors for neonatal sepsis
```
Maternal - previous baby with GBS, GBS colonisation, bacteruria
Intrapartum temp > 38
Membrane rupture > 18 hours
Premature < 37 weeks
Low birth weight < 2.5kg
Maternal chorioamnionitis
```
258
Management of neonatal sepsis
IV benzylpenicillin + IV gentamicin
259
What is Epstein's pearl?
Congenital cyst in the mouth
| Spontaneously resolve over a few weeks
260
Inheritence of Freidrich's ataxia
Autosomal recessive
| Trinucleotide repeat
261
Management of threadworms in pregnant women
1st trimester - 2 weeks strict personal hygeine
2nd/3rd trimester - can use mebendazole if necessary
262
Inheritance of haemophilia A
X linked recessive
263
Inheritance of Alport's syndrome
X linked dominant
| 10% cases are autosomal recessive
264
Inheritance of Rett's syndrome
X linked dominant
265
Inheritance of vitamin D resistant rickets
X linked dominant
266
Inheritance of Fragile X
X linked dominant
| Trinucleotide repeat
267
Inheritance of Huntington's disease
Autosomal dominant
| Trinucleotide repeat
268
Inheritance of myotonic dystrophy
Autosomal dominant
| Trinucleotide repeat
269
Should a premature baby have their immunisation schedule adjusted for gestational age?
No, give according to chronological age
270
What is genu varum?
Bow legs
271
What is genu valgum?
Knock knees
272
What is the main cause of hypertension in children?
Renal parenchymal disease
273
Causes of hypertension in children
```
Renal parenchymal disease
Renal vascular disease
Coarctation of the aorta
Phaeochromocytoma
Congenital adrenal hyperplasia
Essential hypertension
```
274
Which condition is associated with supravalvular aortic stenosis?
William's syndrome
275
Vaccinations at birth
BCG if has risk factors
276
Vaccinations at 2 months
'6-1 vaccine' - diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
Oral rotavirus
Men B
277
When do children receive the Men C vaccine?
Used to be given at 3 months but has been discontinued
278
Vaccinations at 3 months
'6-1' vaccine - diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
Oral rotavirus
Pneumococcal vaccine
279
Vaccinations at 4 months
'6-1 vaccine' - diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
Men B
280
Vaccinations at 12-13 months
Hib/Men C
MMR
Pneumococcal vaccine
Men B
281
Vaccinations at 2-8 years
Annual flu vaccine
282
Vaccinations at 3-4 years
'4 in 1 preschool booster' - diphtheria, tetanus, whooping cough, polio
MMR
283
Vaccinations at 12-13 years
Human papilloma vaccine
284
Vaccination at 13-18 years
'3 in 1 teenage booster' - tetanus, diphtheria, polio
Men ACWY
285
At what ages can the rotavirus vaccine be safely given?
First dose not after 15 weeks
Second dose not after 24 weeks
Due to theoretical risk of intussusception
286
What type of vaccine is rotavirus?
Oral live attenuated
287
What age is the rotavirus vaccine given?
2 months
| 3 months
288
When is genu varum a normal variant?
Bow legs
| Birth to 2 years is normal
289
When is genus valgus a normal variant?
Knock knees
| 3-6 years is normal
290
When is flat feet a normal variant?
Until age 3
| most will resolve by age 8
291
What vaccines are in the 6-1 vaccine?
diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
292
Inheritance of sickle cell anaemia
Autosomal recessive
293
Epistaxis under 2 years
Uncommon - urgent referral for possible bleeding disorder
294
Normal observations under 1
HR 110-160
SBP 70-90
RR 30-40
295
Normal observations 1-2
HR 100-140
SBP 80-95
RR 25-35
296
Normal observations 2-5
HR 95-130
SBP 80-100
RR 25-30
297
Normal observations 5-12
HR 80-120
SBP 90-110
RR 20-25
298
Normal observations >12
HR 80-100
SBP 100-120
RR 15-20
299
When is Men C vaccine given?
1 year and 14 years
300
When is Men B vaccine given?
2 months, 4 months, 1 year
301
When is pneumococcal vaccine given?
3 months and 1 year
302
When is MMR vaccine given?
1 year and 3-4 years
303
When is rotavirus vaccine given?
2 months and 3 months
304
When is '6-1' vaccine given?
2 months, 3 months and 4 months
'4 in 1 booster' at age 4
'3 in 1 booster' as a teenager
305
Visual problems in Down's syndrome
```
Refractive errors
Strabismus
Cataracts
Recurrent blepharitis
Glaucoma
```
306
Commonest cause of hypothyroidism in children
Autoimmune thyroiditis
307
Causes of hypothyroidism in children
Autoimmune thyroiditis
Post total-body irradiation
Iodine deficiency
308
Inheritance of sick cell anaemia
Autosomal recessive
309
Side effect of montelukast
Nightmares
310
Investigations for atypical or repeat UTI in infant <6 months
Ultrasound during infection
DMSA 4-6 months later
MCUG
311
Cause of cystic fibrosis
defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which codes a cAMP-regulated chloride channel
80% of CF cases are due to delta F508 on the long arm of chromosome 7
312
Organisms which may colonise CF patients
Staph aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergillus
313
Most common cause of inherited learning disability
Fragile X syndrome
314
Specific exclusion for the DTP vaccine
Unstable or evolving neurological condition
315
Features of pityriasis rosea
Herald patch
1-2 weeks later salmon-pink oval scaly patches in christmas tree distribution on the back
316
Management of pityriasis rosea
Self limiting
| Resolves in 6 weeks
317
What is pityriasis verisocolor?
Superficial cutaneous fungal infection
| Caused by malassezia furfur
318
Predisposing factors for pityriasis versicolor
Immunosuppression
Malnutrition
Crohn's
319
Features of pityriasis versicolor
```
On trunk
Patches may be hypopigmented, pink or brown
More noticeable after sun exposure
Scale common
Mild pruritis
```
320
Management of pityriasis versicolor
Topical antifungal with ketaconazole shampoo
If doesn't respond: skin scrapings, oral itraconazole
321
Genetics of fragile X syndrome
Trinucleotide repeat disorder
| X linked dominant
322
Features of fragile X syndrome in males
```
Learning difficulty
Large, low set ears
Long thin face
High arched palate
Macro-orchidism
Hypotonia
Autisim
Mitral valve prolapse
```
323
Features of fragile X syndrome in females
Ranges from mild to normal
324
How many babies are affected by cleft lip and palate?
1 in 1000
325
Types of cleft lip and palate
15% isolated cleft lip
40% isolated cleft palate
45% combined cleft lip and palate
326
Problems caused by cleft lip and palate
Feeding
Speech - 75% have normal speech with therapy
Increased risk of otitis media
327
Management of cleft lip and palate
Cleft lip repaired 1 week to 3 months
| Cleft palate repaired 6 to 12 months
328
Main types of bacteria causing UTI in children
E. Coli (85%)
Klebsiella
Staphylococcus saprophyticus
329
Presentation of UTI in infants
```
Poor feeding
Fever
Irritable
FTT
Vomiting
```
330
Management of UTI in children
<3 months = admit
Upper UTI = admit
>3 months and lower UTI = oral antibiotics
331
Specialist investigations for UTI in children
If <6 months will need renal ultrasound, plus DSMA and MCUG if recurrent or atypical infection
332
Androgen insensitivity syndrome inheritance
X linked recessive
333
Androgen insensitivity syndrome karyotype
46 XY
334
What is androgen insensitivity syndrome?
End organ resistance to testosterone causes genetically male children to have female phenotype
335
What is congenital adrenal hyperplasia?
A group of autosomal recessive conditions causing abnormal cortisol synthesis
336
Most common enzyme deficiency in congenital adrenal hyperplasia
21-hydroxylase deficiency (90%)
337
Classical congential adrenal hyperplasia features
Severe
Non-salt losing presents in childhood with low glucocorticoids and high androgens, males present with virilisation at age 2-4
Salt losing presents in adrenal crisis in first few weeks due to aldosterone deficiency
Females have ambiguous genitalia
338
Non-classical congenital adrenal hyperplasia features
Milder
Later onset
Hyperandrogenism in childhood or teenage years
Females have early pubarche, infertility, hirsutism, menstrual disturbance
339
5-alpha reductase deficiency genotype
46 XY
340
5-alpha reductase deficiency interitance
Autosomal recessive
341
What is 5-alpha reductase deficiency?
Inability of males to convert testosterone to dihydrotesosterone
342
Presentation of 5-alpha reductase deficiency
Ambigous genitalia at birth
Hypospadias
Virilisation at puberty
343
Male pseudohermaphroditism
46 XY
| Testes but external genitalia is female or ambiguous
344
Female pseudohermaphroditism
46 XX
Ovaries but external genitalia is male or ambiguous
345
True hermaphroditism
46 XX or 46 XXY
Very rare
Both ovarian and testicular tissue
346
Features of androgen insensitivity syndrome
Primary amenorrhoea
Undescended tests cause groin swelling
May have breast development
347
What is the other term for primary hypogonadism?
Klinefelter's syndrome
348
Features of Klinefelter's syndrome
```
Tall
Lack secondary sexual characteristics
Small, firm testes
Infertile
Gynaecomastia
Learning difficulties
Truncal obesity
```
349
Genotype in Klinefelter's syndrome
47 XXY
350
Hormone levels in Klinefelter's syndrome
High LH
| Low testosterone
351
Treatment for Klinefelter's syndrome
Testosterone replacement
| Fertility treatment
352
What is the other name for hypogonadotrophic hypogonadism?
Kallman's syndrome
353
Inheritance of Kallman's syndrome
X linked recessive
354
Features of Kallman's syndrome
```
Anosmia
Delayed puberty
Hypogonadism
Cryptoorchidism
Normal or above average height
```
355
Hormone levels in Kallman's syndrome
Low LH
| Low testosterone
356
Most common cause of diarrhoea and vomiting in children?
Rotavirus
357
Cystic fibrosis inheritance
Autosomal recessive
358
Genetics of cystic fibrosis
CFTR gene on chromosome 7
Most commonly delta F508 variant
359
Features of cystic fibrosis
```
Meconium ileus, rectal prolapse
Recurrent chest infections
Malabsorption = steatorrhea, FTT
Liver disease
Diabetes
Nasal polyps
Pubertal delay, short stature
Subfertility
```
360
Diagnosis of cystic fibrosis
Newborn heel prick
Sweat test
Genetic testing
361
Colonising organisms in cystic fibrosis
Staph aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergillus
362
Management of cystic fibrosis
chest PT, postural drainage
Multivitamin, pancreatic supplement
High calorie high fat diet
Orkambi if delta 508
363
Features of rickets
```
Genu varum (bow legs) in toddlers
Genu valgum (knock knees) in chidren
'Rickety rosary' - swelling at costochondral junction
Kyphoscoliosis
Craniotabes (soft skull)
Increased infections
Impaired growth
```
364
Blood tests in rickets
Low Vit D, Low calcium
| High Alk phos
365
Wrist xray in rickets
Cupping, splaying and fraying of metaphysis
366
Presdisposing factors for rickets
Dietary deficiency of calcium
Prolonged breast feeding
Unsupplemented cows milk formula
Lack of sunlight
367
Management of rickets
Oral vitamin D replacement
368
When do flat feet resolve?
4-8 years
369
In-toeing in children
Present by 1 year
Majority will self resolve
If not may need casting or surgery depending on cause
370
What is genu varum?
bow legs
371
When does genu varum resolve?
Presents 1-2 years
| Resolves by 4-5 years
372
What is genu valgum?
knock nees
373
Out-toeing - when does it resolve?
Resolves by age 2
| Intervene if doesn't resolve
374
Cause of acute epiglottitis
Haemophilus influenzae type B
375
Features of acute epiglottitis
```
Rapid onset
High temperature
Stridor
Drooling of saliva
'Tripod' position
```
376
Diagnosis of acute epiglottitis
Direct visualisation by anaesthestics
| Lateral view xray - 'thumb sign'
377
Management of acute epiglottitis
May need intubation
Oxygen
IV antibiotics
378
What is Bartter's syndrome?
Inherited cause of severe hypokalaemia due to defective chloride absorption in the loop of henle
379
Inheritance of Bartter's syndrome
Autosomal recessive
380
Features of Bartter's syndrome
```
FTT
Polyuria, polydipsia
Weakness
Sensorineural deafness
Normotension
Hypokalaemia
```
381
Blood pressure in Bartter's syndrome
Normotensive
382
Management of Bartter's syndrome
Oral potassium
| Potassium sparing diuretics
383
Triad of nephrotic syndrome
Proteinuria (>1g/m2 in 24 hours)
Hypoalbuminaemia
Oedema
384
Causes of nephrotic syndrome
80% due to primary glomerulonephritis
| 20% due to systemic disease - diabetes, SLE, amyloidosis
385
Main cause of nephrotic syndrome in children
Minimal change glomerulonephritis
386
Treatment of minimal change glomerulonephritis
High dose steroids
| 90% children respond
387
Genetics of Turner's syndrome
45XO or 45X
Presence of just one sex chromosome OR deletion of short arm of one of the chromosomes
388
Features of Turner's syndrome
```
Short stature
Shield chest, widely spaced nipples
Webbed neck
Primary amenorrhoea
Cystic hygroma
Multiple pigmented naevi
Lymphoedema in neonates (in feet)
Horseshoe kidney
Short 4th metacarpal
```
389
Congenital heart disease in Turner's syndrome
15% bicuspid aortic valve
| 10% coarctation of the aorta
390
Congenital renal disease in Turner's syndrome
Horseshoe kidney
391
What diseases are females with Turner's syndrome at increased risk of?
Autoimmune thyroiditis
| Crohn's
392
Causes of macrocephaly
```
Chronic hydrocephalus
Chronic subdural effusion
Neurofibromatosis
Gigantism (e.g. Soto's syndrome)
Metabolic storage diseases
Bone problems e.g. thalassaemia
```
393
Congenital toxoplasmosis
```
Cerebral calcifications
Chorioretinitis
Hydrocephalus
Cerebral palsy
Hepatosplenomegaly
Anaemia
```
394
Congenital cytomegalovirus
```
Growth retardation
Purpuric skin lesions
Pneumonitis
Sensorineural deafness
Hepatosplenomegaly
Anaemia
Cerebral palsy
```
395
McCune Albright Syndrome
Precocious puberty
Cafe-au-lait spots
Polyostotic fibrous dysplasia
Short stature
396
Define precocious puberty
Development of secondary sexual characteristics before 8 years in females and 9 years in males
397
Classification of precocious puberty
Gonadotrophin dependent - LH and FSH raised
Gondadotrophin independent (pseudo) - LH and FSH low, excess sex hormones
398
Causes of precocious puberty in males
Bilateral enlarged testes = gonadotrophin release from intracranial lesion
Unilateral enlarged teste = gonadal tumour
Small testes = adrenal cause (tumour or adrenal hyperplasia)
399
Causes of precocious puberty in females
Usually idiopathic/familial and follows normal puberty
Organic is rare e.g. McCune Albright Syndrome
400
Asthma management age 5-16 STEP ONE
SABA
| Salbutamol
401
Asthma management age 5-16 STEP TWO
SABA + low dose ICS
| Salbutamol + clenil 100mcg 2 puffs BD
402
Asthma management age 5-16 STEP THREE
SABA + low dose ICS + LRTA
| Salbutamol + clenil 100mcg 2 puffs BD + montelukast
403
Asthma management age 5-16 STEP FOUR
SABA + low dose ICS + LABA
| stop LRTA
404
Asthma management age 5-16 STEP FIVE
SABA + maintenance and reliever therapy (MART) that includes low dose ICS
Salbutamol + fostair
405
Asthma management age 5-16 STEP SIX
SABA + MART that includes moderate dose ICS
406
Example of low dose ICS
Clenil 100mcg 2 puffs BD
407
Example of moderate dose ICS
Clenil 200mcg 2 puff BD
408
Example of LRTA
Montelukast
409
Example of MART
Fostair
410
Asthma management age <5 STEP ONE
SABA
411
Asthma management age <5 STEP TWO
SABA+ 8 week trial of moderate dose ICS
If improves and symptoms return within 4 weeks = continue low dose ICS
If improves and symptoms return outwith 4 weeks = repeat trial
412
Asthma management age <5 STEP THREE
SABA + low dose ICS + LTRA
413
Asthma management age <5 STEP FOUR
Stop LRTA
Continue SABA + low dose ICS
Refer specialist clinic
414
Example of LABA
Salmeterol
415
Features of asthma
```
Cough, worse at night
Dyspnoea
Wheeze
Reduced PEFR
Atopy
```
416
Spirometry findings in asthma
Reduced FEV1
Normal FVC
FEV1/FVC ratio <70%
417
Moderate acute asthma
PEFR >50%
| Normal speech
418
Acute severe asthma
PEFR 33-50%
Can't finish sentences
HR over threshold
RR over threshold
419
Acute severe asthma - HR criteria
>110 if over 12
>125 if over 5
>140 if 1-5
420
Acute severe asthma - RR criteria
>25 if over 12
>30 if over 5
>40 if 1-5
421
Life threatening asthma
```
Oxygen <92%
PEFR <33%
PaO2 <8
Normal PaCO
Confusion
Exhaustion
Silent chest
Cyanosis
Hypotension, bradycardia
```
422
Steroids in acute asthma in children
Given to all children for 3-5 days
20mg OD if age 2-5
40mg OD if >5
