PAEDIATRICS Flashcards
1
Q
What is the treatment for whooping cough?
A
If admission is not needed, prescribe an antibiotic if the onset of cough is within the previous 21 days. A macrolide antibiotic is recommended first-line:
- -> Prescribe clarithromycin for infants less than 1 month of age.
- -> Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
- -> Prescribe erythromycin for pregnant women.
2
Q
What is the management of an inguinal hernia in infants?
A
Urgent surgery due to high incidence of strangulation
3
Q
What is the difference between a caput succedaneum and cephalhaematoma?
A
Both cranial swellings that present after birth
Caput succedaneum = Crosses suture lines
Cephalhaematoma is bounded by cranial bones
4
Q
Where should you check for a pulse in paediatric BLS?
Child < 1 years?
Child > 1 years?
A
Under 1: Femoral, Brachial
Over 1: Femoral, carotid
5
Q
What are the green features of the traffic light system?
A
6
Q
What are the amber features of the traffic light system?
A
7
Q
What are the red features of the traffic light system?
A
8
Q
How should you use the traffic light system?
A
9
Q
What are the features of respiratory distress?
A
Tracheal tug
Intercostal recessions
Accessory muscle use
10
Q
When to admit in bronchiolitis?
A
Apnoea O2 <92 Fluid <50% Severe resp distress Lower threshold in co-morbidities Assess care giver Clinical discretion - senior only
11
Q
Management of bronchiolitis?
A
O2
NG feed
NOT nebs, steroids or abs
12
Q
What is the cause of bronchiolitis?
A
RSV
13
Q
What is the MAB given to high risk children in bronchiolitis?
A
Pavilizumab
14
Q
Name 3 causes of stridor
A
croup foreign body epiglottis anaphylaxis laryngomalacia
15
Q
What is the management of croup?
A
Dexamethasone
If can’t swallow - neb budesonide
If very unwell - neb adrenaline
16
Q
Why should you ask about vaccination status in stridor?
A
H.influenza type B causes epiglottis
17
Q
Why is it important to distinguish between viral induced wheeze and multiple trigger wheeze?
A
Multiple trigger wheeze benefits from preventer therapy
18
Q
How should you diagnose asthma in children?
A
< 5 years = symptoms (worse at night, non viral triggers, eczema, atopic, positive response to asthma therapy)
> 5 years = symptoms + objective tests (FeNO)
19
Q
How do you treat asthma in <5 years?
A
- SABA
- 8 week trial of paediatric moderate dose ICS, no response = alternative dx, if symptoms reoccur after 4 weeks continue at low dose
3.
20
Q
How do we categorise asthma attacks in children?
A
Mild/moderate
Severe
Life-threatening
21
Q
If a child is shocked, what treatment is needed?
A
- 20ml/kg bolus of saline
2. Senior help
22
Q
Which children need immediate abx?
A
Shocked
unrousable
signs of meningococcal disease
23
Q
What age do we REALLY worry about high temperatures? When do we start Abx?
A
< 3 months
<1 months, <3 months and unwell
24
Q
What is the septic screen for a <3 month child?
A
FBC, VBG, blood cultures
Urine dip
CXR
LP (< 1 month, or <3 months unwell)
25
What do you worry about in a child with fever > 5 days?
Kawasaki disease
26
What are the differentials for Kawasaki disease?
Scarlett fever
| Multisystem inflammatory syndrome (post-covid)
27
What investigations should be done to look for congenital cardiac abnormalities?
ECG
CXR
ECHO
28
What are the features of ToF?
Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy
29
What murmur is heard in ToF?
Loud harsh ejection systolic murmur at left sternal edge
30
What is the management of ToF?
Medical - captopril & diuretics
| Surgery - Black-taussig shunt if cyanotic
31
How do you treat hypercyanotic
32
When does transposition of great arteries present?
2 days
| Cyanosis
33
What does the CXR show in transposition of the great arteries?
Egg on side appearance
34
How is transposition of the great arteries managed?
Medical - Prostaglandin infusion
| Surgery - Artery switch procedure in the first few days of life
35
How does AS present?
Murmur - ejection systolic upper right sternal edge
Angina
Syncope
36
How do you manage AS?
Balloon valvotomy --> aortic valve replacement
37
How does coarctation of the aorta present in children?
Severe cyanosis
38
What cardiac abnormalities do you find in Down's syndrome?
AVSD
| VSD
39
What are the cardiac features of Turner's syndrome?
AS
| Coarctation of the aorta
40
What is the genetic abnormality in Down's syndrome?
Trisomy 21:
- meiotic non disjunction
- translocation
- mosaicism
41
When is screening for Down's syndrome?
Screen 11 weeks to 13 weeks
Nuchal translucency
PAPP-A
b-HCG - if elevated chorionic villous sampling
42
What are the features of Down's syndrome?
```
Short neck
Palmer crease
Wide sandal gap
Hypotonia
Duodenal atresia
Hirschprung's disease
```
Risks:
43
What are the features of Turner's syndrome?
Neonates: lymphoedema in hands/feet, spoon shaped nails, neck webbing, widely spaced nipples
Congenital heart defects
Delayed puberty
Hypothyroidism
Renal abnormalities
44
When should you start insulin in a child with DKA?
After 1 hour of fluids
45
What are the complications of DKA?
Cerebral oedema
Hypokalaemia
Shock
46
What murmur is heard in an ASD?
Ejection systolic
Upper left sternal edge
Fixed and split second heart sound
47
What murmur is heard in VSD?
Pansystolic murmur
| Lower left sternal edge
48
What murmur is heard in PDA?
Continuous murmur beneath the clavicle
49
What is the management of an ASD?
If causing right ventricular dilation, occlusive device or surgery between 3-5 years
50
What is the main measure of renal function in children?
Serum plasma creatinine
51
What organism causes acute pyelonephritis in children?
E.coli
52
What organism causes acute cystitis in children?
E.coli
53
How should you collect urine in children? (suspected UTI)
Clean catch sample = best option
MSU
Suprapubic aspiration
Catheter (esp if very unwell)
54
What imaging should be done in a child with a UTI?
US - looking for VUR
55
Which tests should be done in children with atypical (non-e.coli) UTI?
US
MCUG
DMSA (checks for renal scarring, 2 months after UTI)
56
What is vesicouretic reflux?
Backflow of urine from bladder into ureters
| Common cause of UTI
57
How do you diagnosed VUR in children?
MCUG (Micturating cystourethrogram)
58
What might be seen on US in VUR?
Bilateral hydronephrosis
59
When should you admit children with a UTI?
< 3 months
Systemically unwell
Risk factors: kidney transplant
60
What is the management of UTI in children?
Antibiotics: 7-10 days
- Stable = PO trimethoprim
- Unstable/<6 weeks = IV co-amoxiclav
Fluids
Analgesia
61
Give 7 causes of oedema in children
```
Lymphoedema
venous osbstruction
Malnutrition
Liver disease
Nephrotic syndrome
Kidney injury
heart failure
```
62
What are the 3 features of nephrotic syndrome in children?
Heavy proteinuria
Hypoalbuminaemia
oedema
63
What are the three types of nephrotic syndrome in children?
Congenital (< 1 year)
Non-steroid sensitive
Steroid sensitive (minimal change disease)
64
What is a cause of renal AKI in children post GI infection?
HUS (E.coli)
- AKI
- Anaemia
- Thrombocytopenia
65
What is a cause of AKI in children post nasopharyngeal/skin infection?
Post-streptococcal glomerulonephritis
66
What causes Post-streptococcal glomerulonephritis? What is the treatment?
Group A beta-haemolytic strep
Penicillin
67
What is seen on urinalysis in Post-streptococcal glomerulonephritis?
RBC cast
68
What causes an intra-renal AKI with rash in children?
Henoch Schonlein Purpura nephritis (IgA deposition)
69
What are the causes of CKD in children?
Congenital
70
What is Meckel's diverticulum?
Outpouching from the ileum
Presents with painless bleed
Associated with intussesseption
71
How do you diagnose colic in children?
Rule of 3:
>3 hours inconsolable crying
>3 days a week
>3 weeks
Diagnosis of exclusion
72
How does colic in babies typically present?
Back arch, drawing up knees
73
What is the management of colic in babies?
Reassurance
74
What is the most common cause of constipation in children?
Idiopathic
75
How is constipation in children classified?
<3 complete stools per week
Associated with straining, distress on passing stool, overflow soiling
76
Name three signs of faecal impaction in children
Severe symptoms
Overflow soiling
Faecal mass palpable in the abdomen (DRE only done by specialist)
77
Name some red flag signs of constipation
Reported from birth or first few weeks of life
> 48 hours (meconium ileus)
'Ribbon' stools (Hirschprung’s)
Previously unknown or undiagnosed weakness in legs, locomotor delay
Distension (obstruction)
Amber flags:
- Disclosure or evidence that raises concerns over possibility of child maltreatment
- Faltering growth
78
What is the treatment for idiopathic constipation in children?
Movicol & encourage fluids
| Consider investigations if not responsive to treatment
79
What signs suggest a non-viral cause of gastroenteritis in children?
^^^fever
| bloody diarrhoea
80
What most commonly causes gastroenteritis in children?
rotavirus
81
What symptoms suggest gastroenteritis in children?
in 24 hours:
>5 episodes of diarrhoea
>2 episodes of vomiting
82
What is the management of gastroenteritis in children?
Give a 2mls/kg of oral rehydration fluid in syringe every 10mins.
Parents record how much is taken.
If they can take fluid for 4 hours, they can be discharged.
83
When is meconium normally passed?
within 6 hours of birth
84
What condition is associated with meconium ileum?
CF
85
What is the management of meconium ileus?
enema
86
What are the two types of cow's milk protein allergy? Which is more severe?
IgE mediated
| Non-IgE mediated
87
What is the management of CMPA?
Hydrolysed formula
| Change mothers diet
88
How is CMPA diagnosed?
If symptoms resolve after avoiding cow's milk
89
What should you ask in a vomiting history in children?
```
Colour of vomit? – is it bilious (dark green)
Projectile?
Feeding hx?
Hungry after?
Fontanelles
Hernial orifices
Patent anus
```
90
Name 4 red flag causes of vomiting
Obstruction
Infection
Raised ICP
Bleeding
91
Name some red flag symptoms of vomiting
```
Bilious
Distension
Mass
Tenderness
Projectile vomiting
Fever
Irritiability
Bulging fontanelles
Blood vomit
```
92
What can cause vomiting in children? (proximal --> distal)
```
Overfeeding
GORD
Pyloric stenosis
Duodenal atresia
Malrotation with volvulus
Intussusception
Hirschprung's
NEC
```
93
What is the average weight at birth?
3.5kg
94
How much should babies be fed per day?
150ml/kg/day
95
Name an important differential for overfeeding (vomiting) in babies
GORD
96
What are the symptoms of GORD in children?
Vomiting & distress.
No red flags.
<1 year.
97
What causes GORD in children?
Inappropriate relaxation of the LOS due to functional immaturity.
Spontaneously resolves by 12 months.
98
What are the risk factors for GORD in babies?
cerebral palsy and other neurological conditions
Pre-term
Post surgical (atresia)
99
What is the management of GORD in babies?
1. Conservative: reassurance, advice, positioning and prone feeding
2. Medical: H2 antagonist (reduces acid), PPI (4-week course)
3. Surgical: Nissen’s fundoplication (if severe/causing apnoea)
100
When should you refer in children with GORD?
Persists for longer than 6 months
| > 1 year old
101
How does pyloric stenosis present?
Projectile vomiting after feeds (<30 mins).
| 3-5 weeks.
102
What might be seen on examination in pyloric stenosis?
Olive shaped mass.
| Visible peristalsis.
103
What is the management of pyloric stenosis?
AE and STABILISE
Blood capillary gas - metabolic acidosis:
- Hypochloraemia
- Hypokalaemia
- Hyponatraemia
Test feed
USS: thickened pylorus “hamburger/cervical appearance”
Surgery
104
What is the investigation of choice in pyloric stenosis?
USS: Hamburger sign
105
When does duodenal atresia present?
Few hours old!
106
How does duodenal atresia present?
Bilious (atresia is distal to ampulla of vater), BUT no distension (not THAT distal).
107
What might be seen on prenatal scans if the foetus has duodenal atresia?
Associated with polyhydramnios = can’t swallow amniotic fluid in the womb during breathing practice.
108
What is the investigation of choice for duodenal atresia? What is seen?
AXR - double bubble sign
109
What is the management of duodenal atresia?
”drip and suck” – NG and IV fluids + surgery
110
How does malrotation with volvulus present?
```
Bilious vomiting.
Shock.
< 1 month.
No distension.
Surgical emergency
```
111
What is seen on AXR in malrotation?
AXR = shows malrotation: ‘corkscrew jejunum’.
| Also need a barium swallow = volvulus.
112
What is the management of malrotation with volvulus?
Ladd’s procedure (Ladd’s bands are cut)
113
How can you distinguish between malroation with volvulus and intusseception?
fever = intusseception
114
How do babies present with intesussception?
```
Biliary vomit.
3 months-2 years.
Shock AND fever.
Surgical emergency
RED CURRENT JELLY STOOLS
```
115
What is found on examination in a baby with intesussception?
‘Sausage shaped mass’ in RUQ.
116
What imaging should be done in suspected intesussuption?
USS - donut/target sign
117
What is the management of intesusseption?
Air enema (x3)
--> surgery
118
What is Hirschprung's disease?
Distal section of the bowel cannot contract properly due to failed nerve cell migration.
119
How does Hirschprung's disease present?
```
Bilious vomiting (25%).
Failure to pass meconium.
Abdominal distension (75%) - due to distal obstruction.
Ribbon stools
```
120
When should you definitely do a PR exam in paediatrics?
Suspected Hirschprung's - gold standard
121
How is Hirschprung's investigated?
DRE = GOLD STANDARD
| Confirmed by rectal biopsy = aganglionic portion.
122
What is the management of Hirshprung's?
Laxatives
| Surgical resection
123
How does NEC present?
< 2 weeks.
Abdominal distension.
Blood stools.
124
What are the risk factors for NEC?
Premature babies!!! And feeding too much too quickly.
125
What is the imaging of choice for NEC? What is seen?
AXR: intramural gas and “thumb printing” = oedema
126
What is the management of NEC?
GUT REST: NBM and consider TPN
| Perforation = laparotomy
127
What can cause neonatal hypotonia?
neonatal sepsis
Werdnig-Hoffman disease (spinal muscular atrophy type 1)
hypothyroidism
Prader-Willi
128
What are the four fields of development in children?
Gross motor
Fine motor and vision
Hearing, speech and language
Social, emotional and behavioural
129
What are the developmental milestones at 6 months?
Sits without support (with round back), head control
Palmar grasp, reaches for objects, transfer from hand to hand
Vocalises alone or when spoken to, monosyllabic
Puts food in mouth
130
What are the developmental milestones at 12 months?
Stands independently
Draws, pincer grip
3-4 word sentences, understands two joined commands
Drinks from cup, waves, fear of strangers
131
Give three causes of delayed puberty with short stature
Turner's syndrome
Prader-Willi syndrome
Noonan's syndrome
132
Give four causes of delayed puberty with normal stature
Polycystic ovarian syndrome
Androgen insensitivity
Kallman's syndrome
Klinefelter's syndrome
133
When should you review an undescended testicle?
3 months
134
When should you refer for an undescended testicle?
>3 months (routine referral)
135
What is the most common cause of respiratory distress in newborns?
Transient tachypnoea of the newborn
Associated with c-sections
Fluid in horizontal fissure (CXR)
Settles within 1-2 days
136
Why is aspirin normally contraindicated in children?
Reye's syndrome
137
What is the management of Kawasaki disease?
High dose aspirin
IVIg
+ECHO (coronary artery aneurysms)
138
What is the management of nocturnal enuresis?
<5 years = reassurance/safety-netting
>5 years = desmopressin
139
Which rash is seen in scarlet fever?
Sand paper rash
140
What is the management of neonatal hypoglycaemia?
asymptomatic =
encourage normal feeding (breast or bottle)
monitor blood glucose
symptomatic or very low blood glucose =
admit to the neonatal unit
intravenous infusion of 10% dextrose
141
What factors indicate poor prognosis in ALL?
Male sex
presenting <2 years or >10 years
B or T cell surface markers
WCC > 20 * 10^9/l at diagnosis
142
How does HSP present?
Painful non-blanching rash.
Abdominal pain.
N&V.
143
When does HSP present?
10 days post URTI
144
What is the management of HSP? When should you admit?
Prednisolone & paracetamol
| Admit: bleed, ileum, renal failure
145
How does meningococcal septicaemia present?
Non-blanching petichiae.
Meningism: headache, nuchal rigidity, photophobia.
146
What is the most common cause of meningococcal septicaemia in <3 months and >3 months?
<3 months = Group B strep
| >3 months = N.meningitides
147
What is the treatment for meningococcal septicaemia?
GP: IM Benzylpenicillin
IV Cefotaxime & amoxicillin < 3 months
IV Ceftriaxone > 3 months
Penicillin allergy: chloramphenicol
148
What can be given in meningococcal septicaemia to prevent damage to leptomeninges?
+ IV dexamethasone (> 3 months) to prevent damage to the leptomeninges
149
Which two signs are seen on examination in meningococcal septicaemia?
Kernig's sign (back pain on leg flexion)
| Brudzinski's sign (neck raised in hip flexion)
150
What is the management of Steve Johnson syndrome?
```
Stop causative agent.
+ prophylactic AC
+ PPI
+ analgesia
+ Ciclasporin
```
151
Which investigation is contraindicated in meningococcal septicaemia?
LP
152
What are the three main types of cerebral palsy?
Spastic cerebral palsy (10%) - upper motor neurone corticospinal pathway
Ataxic hypotonic (10%) - cerebellar dysfunction
Dyskinetic (10%) - basal ganglia
153
What are the three types of spastic cerebral palsy?
Hemiplegia
Quadriplegia
Diplegia (legs>arms)
154
What is the most common cause of cerebral palsy?
Antenatal causes:
- Cortical migration (genesis of corpus callosum)
- Vascular occlusion
- Structural maldevelopment
- Congenital infection
155
Give some post-natal causes of cerebral palsy
```
Meningitis
Encephalitis
Head trauma
Hypoglycaemia
Hydrocephalus
Hyperbilirubinaemia
```
156
Give 3 causes of delayed puberty with short stature
Turner's syndrome
Prader-Willi syndrome
Noonan's syndrome
157
Give four causes of delayed puberty with normal stature
polycystic ovarian syndrome
androgen insensitivity
Kallman's syndrome
Klinefelter's syndrome
158
What is the definition of precocious puberty?
'development of secondary sexual characteristics before 8 years in females and 9 years in males'
more common in females
159
How can precocious puberty be classified?
1. Gonadotrophin dependent ('central', 'true')
due to premature activation of the hypothalamic-pituitary-gonadal axis
FSH & LH raised
2. Gonadotrophin independent ('pseudo', 'false')
due to excess sex hormones
FSH & LH low
160
What will be seen on blood results in disorders of sex hormones?
Primary hypogonadism (Kleinfelter's) - LH high, testosterone low
Hypogonadotrophic hypogonadism (Kallman's) - LH low, testosterone low
Androgen insensitivity syndrome - LH high, testosterone normal
Testosterone secreting tumour - LH low, testosterone high
