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Paediatrics Flashcards

1
Q

Which virus is roseola infantum caused by?

A

HHV-6 (occasionally HHV-7)

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2
Q

What is the typical clinical picture in roseola infantum?

A

Fever 3-5 days
Widespread morbilliform rash
3-5mm discrete pink red macules and papules

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3
Q

What type of virus is measles caused by?

A

Paramyxovirus

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4
Q

How long should children with measles be excluded from school from?

A

5d from onset of rash

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5
Q

What type of virus is rubella caused by?

A

Togavirus

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6
Q

What is pinworm infection caused by?

A

Enterobium vermicularis

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7
Q

How do you treat pinworm infection?

A

Mebendazole

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8
Q

What does the 6-in-1 vaccine consist of?

A

DTaP/IPV/Hib/Hep B

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9
Q

Describe the disease course of pertussis

A

Stage 1: catarrhal
Stage 2: Paroxysmal
Stage 3: Convalescent

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10
Q

Name the triad of congenital rubella syndrome

A

Sensorineural hearing loss
Ocular abnormalities
Congenital heart defects

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11
Q

Name some risk factors for RDS

A

Premature
Male sex
Multiple pregnancy
Maternal diabetes
Perinatal asphyxia
Hypothermia

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12
Q

When should a baby be able to sit independently?

A

7-8 months

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13
Q

What is the definitive treatment for pyloric stenosis?

A

Ramstedt’s pyloromyotomy

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14
Q

When should a child be able to squat to pick up a toy?

A

18 months

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15
Q

What is HSP?

A

A systemic vasculitis characterised by deposition of immune complexes containing IgA in the skin and kidney

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16
Q

Which formula can estimate weight in children aged <10?

A

(Age + 4) x2

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17
Q

By which age should children turn towards soft sound?

A

6 months

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18
Q

Name some radiological features of NEC

A

Pneumatosis intestinalis
Air in the portal vein

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19
Q

Name some features of congenital hypothyroidism

A

“Good baby”
Lethargy
Poor feeding
Coarse facial features
Macroglossia
May have umbilical hernia

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20
Q

In which condition may you see the “thumbprint” sign?

A

Epiglottitis

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21
Q

Which organisms now cause epiglottitis?

A

Streptococci

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22
Q

What is the most common form of childhood epilepsy?

A

Benign rolandic epilepsy
Most seizures are focal motor aware (simple partial)
Affecting the rolandic area of the brain - centrotemporal area

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23
Q

What is a “stork mark”?

A

Pink, flat irregularly shaped mark on the back of the neck

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24
Q

What can cause a pseudomembranous pharyngitis?

A

Diphtheria

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25
Q

How should you treat nappy rash?

A

Colonisation with C. albicans is usual
Frequent changing
Washing with warm water
Using a barrier preparation such as zinc or metanium
Consider topical hydrocortisone
Consider topical imidazole cream

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26
Q

What treatments can be used for non bullous impetigo?

A

Hydrogen peroxide 1% cream
Fusidic acid
Mupirocin

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27
Q

Name some risk factors for NEC

A

Premature
Low birth weight
Abnormal intestinal colonisation
Ischaemia

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28
Q

What is the best test for GH deficiency?

A

Insulin tolerance test

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29
Q

Name some clinical features of ALL

A

Anaemia
Bleeding
Infections
Bone pain
Splenomegaly
Lymphadenopathy
Thymic enlargement
CNS involvement

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30
Q

What is Forchheimer’s sign?

A

Petechia on the soft palate
Sometimes seen in Rubella

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31
Q

What are the key features of Pierre-Robin syndrome?

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

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32
Q

What are the key features of Patau syndrome?

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

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33
Q

What are the key features of William’s syndrome?

A

Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

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34
Q

What are the key features of Noonan syndrome?

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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35
Q

By what age to most children achieve day and night time continence?

A

3-4 years

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36
Q

How can you manage nocturnal enuresis in children?

A

Look for possible underlying causes/triggers:
constipation
diabetes mellitus
UTI if recent onset
general advice
fluid intake
Toileting patterns: encourage to empty bladder regularly during the day and before sleep
lifting and waking
reward systems (e.g. Star charts)
NICE recommend these ‘should be given for agreed behaviour rather than dry nights’ e.g. Using the toilet to pass urine before sleep
enuresis alarm
generally first-line for children
have sensor pads that sense wetness
high success rate
Desmopressin
particularly if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family

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37
Q

Describe some normal changes in puberty

A

Gynaecomastia may develop in boys
Asymmetrical breast growth may occur in girls
Diffuse enlargement of the thyroid gland may be seen

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38
Q

Describe some female changes in puberty

A

First sign is breast development at around 11.5 years of age (range = 9-13 years)
Height spurt reaches its maximum early in puberty (at 12) , before menarche
Menarche at 13 (11-15)
There is an increase of only about 4% of height following menarche

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39
Q

Describe some male changes in puberty

A

First sign is testicular growth at around 12 years of age (range = 10-15 years)
Testicular volume > 4 ml indicates onset of puberty
Maximum height spurt at 14

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40
Q

What is the triad of shaken baby syndrome?

A

Retinal haemorrhages
Subdural haematoma
Encephalopathy

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41
Q

What is the most common cause of congenital hypothyroidism in the UK?

A

Autoimmune thyroiditis

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42
Q

Name some fine motor developmental milestones at 3 months

A

Reaches for object
Holds rattle briefly if given to hand
Visually alert, particularly human faces
Fixes and follows to 180 degrees

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43
Q

Name some fine motor developmental milestones at 6 months

A

Holds in palmar grasp
Pass objects from one hand to another
Visually insatiable, looking around in every direction

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44
Q

Name some fine motor developmental milestones at 9 months

A

Points with finger
Early pincer

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45
Q

Name some fine motor developmental milestones at 12 months

A

Good pincer grip
Bangs toys together

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46
Q

How many bricks should a child be able to stack at 15 months?

A

Tower of 2

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47
Q

How many bricks should a child be able to stack at 18 months?

A

Tower of 3

48
Q

How many bricks should a child be able to stack at 2 years?

A

Tower of 6

49
Q

How many bricks should a child be able to stack at 3 years?

A

Tower of 9

50
Q

By what age should a child be able to copy a circle?

A

3 years

51
Q

What are the characteristics of an irritant dermatitis nappy rash?

A

The most common cause, due to irritant effect of urinary ammonia and faeces
Creases are characteristically spared

52
Q

What is the most common cause of headache in children?

A

Migraine without aura

53
Q

What is hypospadias?

A

Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants

54
Q

Name some potential consequences of HHV-6 infection

A

Aseptic meningitis
Hepatitis

55
Q

Name some major risk factors for SIDS

A

Prone sleeping
Parental smoking
Bed sharing
Hyperthermia and head covering
Prematurity

56
Q

Name some potential complications of scarlet fever

A

Otitis media: the most common complication
Rheumatic fever: typically occurs 20 days after infection
Acute glomerulonephritis: typically occurs 10 days after infection
Invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

57
Q

Name some features of Kawasaki disease

A

High-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms of the hands and the soles of the feet which later peel

58
Q

Describe the management of Kawasaki disease

A

High-dose aspirin
Kawasaki disease is one of the few indications for the use of aspirin in children. Due to the risk of Reye’s syndrome aspirin is normally contraindicated in children
Intravenous immunoglobulin
Echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms

59
Q

When is the Men B vaccine given?

A

2 months
4 months
12-13 months

60
Q

What is ITP?

A

(ITP) is an immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.

61
Q

How do you manage ITP?

A

Usually, no treatment is required
ITP resolves in around 80% of children with 6 months, with or without treatment
advice to avoid activities that may result in trauma (e.g. team sports)
Other options may be indicated if the platelet count is very low (e.g. < 10 * 109/L) or there is significant bleeding.
Options include:
Oral/IV corticosteroid
IV immunoglobulins
Platelet transfusions can be used in an emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by the circulating antibodies

62
Q

What are the clinical features of TGA?

A

Cyanosis
Tachypnoea
Loud single S2
Prominent right ventricular impulse
‘egg-on-side’ appearance on chest x-ray

63
Q

What may be given to ensure maintenance of the ductus arteriosus?

A

Prostaglandin E1

64
Q

What is gastroschisis?

A

Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord

65
Q

What is exomphalos?

A

In exomphalos (also known as an omphalocoele) the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.

66
Q

What are some associations of exomphalos?

A

Beckwith-Wiedemann syndrome
Down’s syndrome
Cardiac and kidney malformations

67
Q

Name some important development referral criteria

A

doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months

hand preference before 12 months is abnormal and may indicate cerebral palsy

68
Q

What type of hearing test is performed for newborns?

A

Otoacoustic emission test

All newborns should be tested as part of the Newborn Hearing Screening Programme. A computer-generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea

69
Q

Give some examples of trinucleotide repeat disorders

A

Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
spinocerebellar ataxia
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy

70
Q

Name some causes of obesity in children

A

growth hormone deficiency
hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader-Willi syndrome

71
Q

Give some causes of microcephaly

A

normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis

72
Q

Describe the clinical features of TOF

A

ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta

73
Q

Describe some features of fragile X syndrome

A

learning difficulties
large low set ears, long thin face, high arched palate
macroorchidism
hypotonia
autism is more common
mitral valve prolapse

74
Q

Name some complications of pertussis

A

subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures

75
Q

How do you treat pertussis?

A

Oral macrolide

76
Q

Name some causes of snoring in children

A

obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism

77
Q

Name some clinical features of osteochondritis dissecans

A

Pain after exercise
Intermittent swelling and locking

78
Q

Name some features of Pierre-Robin syndrome

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

79
Q

Name some features of Cri-du-Chat syndrome

A

Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism

80
Q

Name some speech and language milestones at 3 months

A

Quietens to parents voice
Turns towards sound
Squeals

81
Q

Name some speech and language milestones at 6 months

A

Double syllables ‘adah’, ‘erleh’

82
Q

Name some speech and language milestones at 9 months

A

Says ‘mama’ and ‘dada’
Understands ‘no’

83
Q

Name some speech and language milestones at 12 months

A

Knows and responds to own name

84
Q

Name some speech and language milestones at 12-15 months

A

Knows about 2-6 words (Refer at 18 months)
Understands simple commands - ‘give it to mummy’

85
Q

Name some speech and language milestones at 2 years

A

Combine two words
Points to parts of the body

86
Q

Name some speech and language milestones at 2.5 years

A

Vocabulary of 200 words

87
Q

Name some speech and language milestones at 3 years

A

Talks in short sentences (e.g. 3-5 words)
Asks ‘what’ and ‘who’ questions
Identifies colours
Counts to 10 (little appreciation of numbers though)

88
Q

Name some speech and language milestones at 4 years

A

Asks ‘why’, ‘when’ and ‘how’ questions

89
Q

Name some investigations of vesicoureteric reflux

A

VUR is normally diagnosed following a micturating cystourethrogram
a DMSA scan may also be performed to look for renal scarring

90
Q

Name some gross motor milestones at 3 months

A

Little or no head lag on being pulled to sit
Lying on abdomen, good head control
Held sitting, lumbar curve

91
Q

Name some gross motor milestones at 6 months

A

Lying on abdomen, arms extended
Lying on back, lifts and grasps feet
Pulls self to sitting
Held sitting, back straight
Rolls front to back

92
Q

Name some gross motor milestones at 9 months

A

Pulls to standing
Crawls

93
Q

Name some gross motor milestones at 7-8 months

A

Sits without support (Refer at 12 months)

94
Q

Name some gross motor milestones at 12 months

A

Cruises
Walks with one hand held

95
Q

Name some gross motor milestones at 13-15 months

A

Walks unsupported (Refer at 18 months)

96
Q

Name some gross motor milestones at 18 months

A

Squats to pick up a toy

97
Q

Name some gross motor milestones at 2 years

A

Runs
Walks upstairs and downstairs holding on to rail

98
Q

Name some gross motor milestones at 3 years

A

Rides a tricycle using pedals
Walks up stairs without holding on to rail

99
Q

Name some gross motor milestones at 4 years

A

Hops on one leg

100
Q

Name some features of Patau syndrome (trisomy 13)

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

101
Q

How do you manage labial adhesions?

A

conservative management is appropriate in the majority of cases
if there are associated problems such as recurrent urinary tract infections oestrogen cream may be tried
if this fails surgical intervention may be warranted

102
Q

When do ‘bow legs’ typically resolve by?

A

Typically resolves by the age of 4-5 years

103
Q

How long should children with mumps be excluded from school for?

A

5 days from onset of swollen glands

104
Q

What is the risk of Down’s syndrome in 40 year old mothers?

A

1/100

105
Q

What are the forms of Down’s syndrome?

A

Nondisjunction
Robertsonian translocation
(usually onto 14)
Mosaicism*

106
Q

Which organisms may colonise in CF?

A

Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus

107
Q

Which cardiac complications are common in Down’s syndrome?

A

multiple cardiac problems may be present
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)

108
Q

Which vaccines are given at 2 months?

A

‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B

109
Q

Which vaccines are given at 3 months?

A

‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
PCV

110
Q

Which vaccines are given at 4 months?

A

‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Men B

111
Q

Which vaccines are given at 12-13 months?

A

Hib/Men C
MMR
PCV
Men B

112
Q

Which vaccines are given at 2-8 years?

A

Flu vaccine (annual)

113
Q

Which vaccines are given at 3-4 years?

A

‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR

114
Q

Which vaccines are given at 12-13 years?

A

HPV vaccination

115
Q

Which vaccines are given at 13-18 years?

A

‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY

MSRA (13 decks)

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