Paediatrics Flashcards
Name 3 screening tools for autism spectrum disorder? (ASD)
ADOS (Autism Diagnostic Observation Schedule) - gold standard
ASQ-E2 ( Ages & Stages Questionnaires®: Social-Emotional, Second Edition)
M-Chart
About ___ % of children with Type 1 diabetes present in DKA.
Classical symptoms include ____, ____, and weight loss (usually a result of dehydration).
Other less typical presenting symptoms include _____ and recurrent _____.
25-50%
Polyuria
Polydipsia (excessive thirst)
Weight loss
Secondary enuresis (previously dry at night) Recurrent infection
Episodes of severe hypoglycaemia where there is an impairment of consciousness. seizures or coma can be treated with _____?
IV dextrose (10%)
and
IM Glucagon
Other causes of hypoglycaemia to think about include:
Hypothyroidism
Glycogen storage disorders
Fatty acid oxidation defects
Liver cirrhosis
Alcohol
Growth Hormone Deficiency
Long term complications of Hyperglycaemia (poorly controlled diabetes) include:
Macrovascular:
Coronary Artery Disease (CAD)
Stroke
Hypertension
Peripheral Ischaemia (poor healing - ulcers - diabetic foot)
Microvascular:
Peripheral Neuropathy
Retinopathy
Nephropathy (particularly glomerulosclerosis)
Infection related complications:
Pneumonia
UTI’s
Skin and soft tissue infections (particulalry in the feet)
Fungal infections (Candidiasis)
Name the different classes of insulin regimes, their duration of action, and examples of each.
Rapid-acting: 4hrs
- Novorapid
- FIASP (starts working within 2 mins)
- Humalog
- Apidra
*FAHN*
Short-acting : 8hrs
- Humulin-S
- Insuman RAPID
HI
Intermediate-acting: 16hrs
- Insuman BASAL
- Insulatard
- Humulin - I
HII
Long Acting: 24+ hrs
- Levemir (24hrs)
- Toujeo (36hrs)
- Tresiba (>42 hrs)
LTT
Delayed puberty is classed as no pubertal development by the age of ___ in boys and ___ in girls.
15
14
What are the causes of delayed puberty?
Constitutional delay:
The most common cause of delayed puberty is constitutional delay of growth and puberty, in which children are ‘late bloomers’ and enter normal puberty later than their peers. They will eventually reach full normal height and development. Constitutional delay is confirmed with a hand-wrist X-ray to confirm bone age, which is delayed in constitutional bone delay because the epiphyseal plates are late to fuse.
Low gonadotrophin secretion induces pituitary disorders:
- Craniopharyngiomas
- Kallmann syndrome
- Panhypopituitarism
- Isolated gonadotrophin deficiency)
- Hypothyroidism
- Systemic disease (e.g. cystic fibrosis or Crohn’s).
High gonadotrophin secretion causes include:
- Chromosomal disorders (Turner’s XO, Klinefelter’s XXY)
- Congenital adrenal hyperplasia
- Acquired hypogonadism (e.g. after chemotherapy)
Reasons for admission in bronchiolitis?
Aged under 3 months
Prematurity / Down Syndrome / Cystic Fibrosis
50-75% less of their normal milk intake
Clinical Dehydration
Resp Rate > 70
Oxygen sats < 92%
Signs of respiratory distress
Apnoeas
Parents not confident about managing at home or difficulty accessing medical help from home
Signs of respiratory distress in the infant?
Raised respiratory rate
Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis (due to low oxygen saturation)
Abnormal airway noises:
- Wheezing is a whistling sound caused by narrowed airways, typically heard during expiration
- Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
- Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup
Bronchiolitis is caused by which microorganism?
Respiratory Syncytial Virus (RSV)
Management of Bronchiolits?
Supportive management. This involves:
- Ensuring adequate intake. This could be orally, via NG tube or IV fluids depending on the severity. It is important to avoid overfeeding as a full stomach will restrict breathing. Start with small frequent feeds and gradually increase them as tolerated.
- Saline nasal drops and nasal suctioning can help clear nasal secretions, particularly prior to feeding
- Supplementary oxygen if the oxygen saturations remain below 92%
- Ventilatory support if required such as
- High flow humidified oxygen (Airvo or Optiflow - Increase postive end-expiratory pressure PEEP to prevent air way collapsing).
- CPAP
- Intubation
There is little evidence for treatments such as nebulised saline, bronchodilators, steroids and antibiotics.
______ is a monoclonal antibody that targets the respiratory syncytial virus. An injection is given ____ as prevention against bronchiolitis caused by RSV. It is given to high risk babies, such as ____ and those with ____.
Palivizumab
Monthly
Ex-Premature
Congenital Heart Disease.
Management of ADHD?
Conservative:
- Parental and child education
- Diet and Exercise (food diary can be helpful to keep track of certain foods that trigger symptoms such as food colourings etc).
Medication: (CNS stimulants)
- Methylphenidate (Ritalin)
- Dexamfetamine
- Atomoxetine
Slapped Cheek Syndrome or “fifth disease” “Erythema infectiosum” is a self-resolving condition that is caused by which microorganism?
Parvovirus B19
Hand dominance normally develops by ___ years and children with a preference before 18 months may indicate _____ or _____
2 yrs
18 months
Cerebral palsy or Spastic hemiplegia
Major complicaiton of slapped cheek syndrome or parvovirus B19 infection?
Aplastic Anaemia
_____ is the most common cardiac defect in infants of diabetic mothers. This applies to mothers with type 1 and 2 diabetes, rather than gestational diabetes.
Transposition of the great arteries
The 2nd most common cardiac defect associated with people with trisomy 21 or Down’s syndrome is an ______ , which will have a ____ murmur.
Atrio-ventricular septal defect (AVSD)
Pan-systolic
*Pan systolic due to the ventricular septal defect (VSD).
HSP presents with purpura or petechiae on the lower limbs and ____ pain, _____ , and ____ (haematuria +/- proteinuria), due to immunoglobulin deposition in the gut, joints and kidneys respectively.
Abdominal
Arthralgia
Nephritis
The most common congenital heart defect in a patient with Turner’s syndrome is ___
5% of babies with Turner syndrome are born with _____.
Frequent bouts of ____ are also more common in children with Turner’s syndrome
Bicuspid aortic valve
coarctation of the aorta
otitis media (i.e glue ear if recurrent)
Tet spells can be managed with analgesia and supplemental oxygen. A last line medication is a ____ agent (e.g. ____ ).
Vasoconstrictive
Phenylephrine
Duodenal atresia is diagnosed with a characteristic finding of a ‘____’ on abdominal x-ray
double bubble
Ewing’s sarcoma typically presented with the ____ (____) periosteal reaction which is visible on x-ray. MRI typically shows a large mass with evidence of necrosis and on histology small ____ cells are visible with clear cytoplasms on haematoxylin and eosin staining.
lamellated
onion skinning
blue round
An episode of a generalised tonic-clonic seizure after head trauma with rapid recovery and no post-ictal confusion is consistent with a ___ seizure. This is caused by overactivity of the ___ nerve, causing vasodilation and a collapse from a temporary reduction in cerebral perfusion.
reflex anoxic
vagus
____ is the most common cause of nephrotic syndrome in children and typically presents with ____ in the ages ___.
Minimal change disease
Facial swelling
1-8 yrs old
_____ is diagnosed by a MCUG (micturating cystourethrogram) scan. MCUG is a diagnostic test to visualise the radioactive dye refluxing up into the ureters and/or kidneys.
Scarring of the kidneys is investigated using a ____ test.
Vesicouretric reflux
DMSA (radionuclide scan)
_____ is a common disease in children characterised by an initial high fever followed by a maculopapular rash. It is caused by human herpes virus 6. _____ occur in up to 15% of children with the disease.
Roseola infantum
Febrile Convulsions
Perianal/vulval itching in a child worse at night with no abnormalities on examination is characteristic of ____ . First line treatment is with oral ____ and hygiene measures for all members of the household.
Threadworm (type of parasitic worm)
Mebendazole
Mebendazole is in a class of medications called anthelmintics.
The underlying trigger for the inflammation of the synovial membrane in transient synovitis is a ____ .
Preceding viral infection.
Mesenteric adenitis often presents with a history of pain in the ____., usually following an ______ . It does not give a septic picture.
right iliac fossa (not similarity to appendicitis)
acute viral illness (usually upper respiratory tract infection)
_____ is a collection of fluid that collects due to pressure on the head during vaginal delivery.
Caput succedaneum
(C)aput (s)uccedaneum (c)rosses (s)uture lines. This will usually spontaneously resolve within days.
_____ is a condition caused by sustained and severely elevated levels of _____ bilirubin within the central nervous system.
Acute bilirubin encephalopathy
Unconjugated (lipid soluble and so in high doses can cross BBB and cause neurotoxicity)
Conjugated bilirubin is water soluble and thus cannot cross BBB and induce neurotoxicity.
Risk Factors for Sepsis in Paeds:
- Age (<1 year)
- Impaired immune function (e.g. diabetes, splenectomy, immunosuppressant medication, cancer treatment)
- Recent surgery in the last six weeks
- Breach of skin integrity (burns/cuts/skin infections)
- An indwelling catheter or line.
A child with > 5 days of fever, conjunctivitis, truncal rash, adenopathy, oedema and desquamation of the hands most likely has a diagnosis of ____ .
This is treated with ____ and ______ within 10 days of symptom onset. It is important to start treatment promptly to optimise patient outcomes.
Kawasaki disease
High dose aspirin
Intravenous Immunoglobulin
Perthes disease is the idiopathic _____ . It typically presents in boys aged ____ years. There is atraumatic hip pain and a limp. Treatment depends on the degree of joint destruction, and ranges from symptom control and bracing to surgical correction.
Avascular necrosis of the femoral epiphysis
5-6
____ is a rare but dangerous condition that is similar to viral croup but the child has a high fever and has rapidly progressive airway obstruction with copious thick airway secretions.
It is caused by ______.
It will not respond to steroid and supportive treatment like croup. Treatment is thus with ____ . In some cases intubation may also be required.
Bacterial tracheitis
Staphylococcus aureus
IV antibiotics
Gold standard for a definitive diagnosis of coeliac disease is ____ .
Small bowel biopsy
(not Anti-TTG although helpful)
Hand, foot and mouth disease presents with ___ on the hands and feet and ____ on the tongue, as well as a fever
blisters
ulcerations
____ is the most common finding at paediatric cardiac arrests. ____ is the second most common
Asystole
Pulseless electrical activity
Diagnosis of neonatal respiratory distress syndrome is through clinical evaluation and a ____ appearance on chest x-ray.
‘ground glass’
Paroxysmal cough to the point of vomiting is a red flag suggestive of ____. It is caused by _____ infection, and is diagnosed with a pernasal swab.
Whooping cough
Bordetella pertussis
The three core signs of Acute Lymphocytic Leukaemia are:
- neutropaenia (recurrent infections)
- anaemia (pallor, fatigue)
- thrombocytopaenia (purpuric rash)
Reye’s syndrome presents with:
- Hepatitis/Hepatomegaly - Abnormal LFTs
- Vomiting
- Encephalopathy (slurred speech, lethargy, coma and potentially death).
Can cause hepatomegaly and liver failure (liver swelling)
Primarily occurs in children (although can occur at any age) taking aspirin in response to a viral infection such as chickenpox (VZV)
The rash is a malar rash with eyelid involvement, characteristic of _____ . ~50% of patients are positive for auto-antibodies but they are myositis specific ones. Even with the the antibody profile, ESR is still most likely to be raised in an untreated patient.
Juvenile dermatomyositis (JDM)
Fragile X syndrome presents with features including:
A long face
Extra large testicles
Jaw and ears
Social anxiety
Autistic spectrum features
What are the characteristic skin changes seen in dermatomyositis?
- Heliotrope rash: a purple rash on the eyelids
- Gottron’s papules: red papules on the dorsal aspect of the finger joints.
- Shawl rash: erythema across the upper back and shoulders
- Nailfold erythema
Potter’s syndrome describes the typical physical appearance caused by pressure in utero due to ____ , classically due to _____
oligohydramnios
bilateral renal agenesis
Components of the APGAR score
There are 5 components to the APGAR score: _____, _____, _____, _____ and ____.
The Apgar score is a test given to newborns soon after birth. This test checks a baby’s heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they’re born.
Appearance
Appearance relates to the colour of the child. A score of 2 is for a pink baby, 1 if the baby is blue peripherally but pink centrally, and 0 if the baby is blue all over.
Pulse
Pulse: a heart rate of >100 beats per minute scores 2, <100 scores 1, and a non-detectable heart rate scores 0.
Grimace
Grimace relates to the response to stimulation: crying on stimulation scores 2, a grimace scores 1, and no response scores 0.
Activity
Activity: Flexed limbs that resists extension score 2, some flexion scores 1, and a floppy baby scores 0.
Respiration
Respiration: a strong cry scores 2, a weak cry scores 1, and no respiratory effort scores 0.
Patients are infectious up to ____ days before lesions appear and up until the last lesion dries (i.e crusts over) . The incubation period for chicken pox is up to ____
3 days
3 weeks
One of the physically demonstrable symptoms of meningitis is ______ sign. Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
Brudzinski’s
Whilst bronchiolitis obliterans (aka ____) is a relatively rare complication of bronchiolitis it is most commonly associated with _____ infection.
popcorn lung
adenovirus
Bronchiolitis obliterans (BO), also known as obliterative bronchiolitis, constrictive bronchiolitis and popcorn lung, is a disease that results in obstruction of the smallest airways of the lungs (bronchioles) due to inflammation
The MHRA advises that codeine should be contrainidcated in ____ and also children who have undergone adeno/tonsillectomy surgery who have Obstructive Sleep Apnoea.
This is because a % of the child population (6% of caucasians) are rapid metabolisers of codeine due to an increased activity of the ____ enzyme.
Children under 12 years
CYP2D6
