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Paediatrics Flashcards

1
Q

Immunisations for 2 months, 3 months, 4 months, 1 year, 3-4 years, 12-13 years, 14 years?

A

2 months = 6-in-1, oral rotavirus, Men B
3 months = 6-in-1, oral rotavirus, PCV
4 months = 6-in-1, Men B
1 year = Hib/Men C, MMR, PCV, Men B
3-4 years = 4-in-1, MMR
12-13 years = HPV (6, 11, 16 & 18)
14 years = 3-in-1, men ACWY

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2
Q

When should premature babies be immunised?

A

No adjustment needed
→ if < 28 weeks vaccines should be given in hospital

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3
Q

What is included in the 6-in-1, 4-in-1 and 3-in-1 vaccines?

A

6-in-1 = diphtheria, tetanus, whooping cough, polio, Hib and hep B
4-in-1 = diphtheria, tetanus, whooping cough and polio
3-in-1 = diphtheria, tetanus and polio

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4
Q

Extra vaccination offered at birth if TB risk factors?

A

BCG

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5
Q

Features and management of measles?

A

Generally unwell e.g. fever
White (Koplik) spots in mouth
Rash that starts behind ears
Management = supportive

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6
Q

Features and management of mumps?

A

Generally unwell e.g. fever
Parotitis, orchitis, pancreatitis
Management = supportive

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7
Q

Features and management of rubella?

A

Generally unwell e.g. fever
Lymphadenopathy
Rash that starts on face
Management = supportive

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8
Q

School exclusion for children with measles vs mumps vs rubella?

A

Measles = 4 days from rash onset
Mumps = 5 days from swollen gland onset
Rubella = 5 days from rash onset

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9
Q

Hearing test done after birth vs before entering school?

A

Birth = otoacoustic emission test
→ brainstem response test is abnormal
Before school = pure tone audiometry

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10
Q

When is the heel-prick test carried out?

A

5-9 days after birth

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11
Q

Conditions the heel-prick test screens for?

A

Congenital hypothyroidism
Maple syrup urine disease
Cystic fibrosis
Sickle cell disease
Phenylketonuria
Homocytinuria
MCADD
Isovaleric acidaemia
Glutaric aciduria type 1

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12
Q

When should a child smile?

A

6 weeks

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13
Q

When should a child sit without support vs crawl vs walk unsupported?

A

Sit = 7-8 months
Crawl = 9 months
Walk = 13-15 months

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14
Q

When should a child hold things with palmar grasp vs have good pincer grip?

A

Palmar grasp = 6 months
Pincer grip = 12 months

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15
Q

Referral indications for child developmental delay?

A

Does not smile by 10 weeks
Cannot sit unsupported by 12 months
Cannot walk unsupported at 18 months

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16
Q

Hand preference before 12 months?

A

May indicate cerebral palsy

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17
Q

Milestone age correction for premature baby?

A

Normal age + number of weeks born early

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18
Q

Neonatal period?

A

0-28 days

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19
Q

APGAR score components and when is it assessed?

A

Appearance, Pulse, Grimace, Activity, Respiration
1, 5 and 10 minutes post-delivery

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20
Q

Normal HR and RR for children < 1?

A

HR = 100-160
RR = 30-40

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21
Q

Newborn resuscitation?

A
  1. Dry baby and maintain temperature
  2. Gasping or not breathing = 5 inflation breaths
  3. Reassess and repeat inflation breaths if needed
  4. No improvement = 30 seconds ventilation
  5. No improvement = 3:1 CPR
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22
Q

Most common cause of NRDS and main risk factor?

A

Transient tachypnoea of the newborn (TTN)
C-section delivery

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23
Q

Features, investigation and management of TTN?

A

Tachypnoea
Nasal flaring and grunting
Use of accessory muscles
Investigation = CXR (fluid in horizontal fissure)
Management = supportive

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24
Q

Features and management of meconium aspiration syndrome?

A

Meconium stained liquor
Green staining of infant
Post-term or difficult delivery
Respiratory distress
Management = supportive

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25
Acute management of congenital heart disease?
Prostaglandin E1 e.g. alprostadil
26
Anatomical features of TOF and implication?
Ventricular septal defect Right ventricular hypertrophy Pulmonary stenosis Overriding aorta Implication = right-to-left shunt
27
What determines the severity of TOF?
Degree of pulmonary stenosis
28
Features and management of TOF?
Cyanotic "tet" spells Apnoeic episodes Tachypnoea Failure to thrive Ejection systolic murmur Management = surgery, beta-blockers for tet spells
29
CXR feature of TOF?
"Boot-shaped" heart (due to RVH)
30
Anatomical feature of patent ductus arteriosus and implication?
Connection between pulmonary trunk and descending aorta Implication = left-to-right shunt
31
Features and management of patent ductus arteriosus?
Continuous "machine-like" murmur Left subclavicular thrill Collapsing pulse Wide pulse pressure Management = NSAID e.g. indomethacin
32
Features of innocent murmur?
5 S's: → soft → short → systolic → symptomless → situational (postural)
33
Management of neonatal hypoglycaemia?
Asymptomatic = encourage breast/bottle feed + monitor Symptomatic or severe = IV dextrose 10%
34
Is jaundice normal in newborns?
Yes, between 2-14 days < 24 hours or > 14 days = assess for pathology
35
Causes of jaundice in < 24 hours old?
Rhesus haemolytic disease ABO haemolytic disease Hereditary spherocytosis G6PD deficiency
36
Causes of jaundice in > 14 days old?
Biliary atresia Hypothyroidism Infection Prematurity Breast milk jaundice
37
Features and management of biliary atresia?
Jaundice > 14 days old Hepatosplenomegaly High conjugated bilirubin Management = kasai procedure, liver transplant
38
Features of neonatal GORD?
Milky vomit after feeds Worse when laid flat Cough, hoarse crying
39
Parental counselling on GORD?
- Due to immature LOS - 90% improve by age 1 - Give small and frequent feeds - Keep baby upright and burp regularly - Other options = Gavison, thickened formulas, PPI trial
40
Features of cow's milk protein intolerance and cow's milk protein allergy?
Milky vomit after feeds Diarrhoea, bloating, irritability Urticaria, pruritis, rash (CMPA only!)
41
Parental counselling on CMPA/CMPI?
- Most grow out of it by 2-3 years - Other CMPA options = hydrolysed formula or breast feeding with mum avoiding dairy - Other CMPI options = hydrolysed formula or breast feeding
42
Parental counselling on breastfeeding?
- Recommended exclusively until 6 months - Benefits = contains antibodies and nutrients required by baby, less likely to be overweight, reduced maternal breast and ovarian cancer risk - Disadvantages = cracked/sore nipples, risk of mastitis and abscess
43
Features and management of neonatal sepsis?
Respiratory distress Tachycardia Jaundice, seizures Group B strep infection Management = IV benzypenicillin + IV gentamicin
44
Capput succedaneum vs cepahlohaematoma?
Capput succedaneum = present at birth, vertex, swelling crosses suture lines, resolves quickly Cephalohaematoma = develops after birth, parietal, swelling does not cross suture lines, resolves slowly
45
Main risk factor and management of intraventricular haemorrhage?
Preterm birth Management = supportive, shunt if hydrocephalus
46
Management of undescended testes?
Unilateral = consider referral around 3 months Bilateral = paediatric review < 24 hours
47
Management of hypospadius?
Surgery around 12 months
48
Shaken baby syndrome features?
Triad of: → retinal haemorrhages → subdural haematoma → encephalopathy
49
Inheritance patterns that can only be passed down from maternal line?
X-linked recessive Mitochondrial
50
Genetics and features of Down's syndrome?
Trisomy 21 → small, low-set ears → epicanthic folds → single palmar crease → learning difficulties → hypotonia → heart defect → duodenal atresia → hirchsprung's disease
51
Most common congenital heart defect in Down's syndrome?
Endocardial cushion defect Ventricular septal defect
52
Complications of Down's syndrome?
Glue ear Recurrent infection Hypothyroidism Alzheimer's disease
53
Genetics and features of Turner's syndrome?
45 X or 45 XO → wide chest → webbed neck → primary amenorrhea → learning difficulties → heart defect → horseshoe kidney
54
Most common congenital heart heart defects in Turner's syndrome?
Bicuspid aortic valve Coarctation of the aorta
55
Male version of Turner's syndrome?
Noonan syndrome
56
Genetics and features of Prader-Willi syndrome?
Deletion on chromosome 16 → childhood obesity → hypotonia → hypogonadism → learning difficulties
57
Genetics and features of Fragile X syndrome?
Trinucleotide repeat (CGG) → large, low-set ears → long, thin face → high arched palate → macroorchidism → learning difficulties
58
Genetics and features of Klinefelter's syndrome?
47 XXY → tall → delayed puberty → small, firm testes → gynaecomastia
59
Genetics and features of Kallman's syndrome?
X-linked recessive → anosmia → delayed puberty → hypogonadism → cryptorchidism
60
Genetics and features of androgen insensitivity syndrome?
46 XY (male) with female phenotype → primary amenorrhea → undescended testes in groin
61
First sign of puberty in males vs females?
Males = testicular growth Females = breast development
62
Definition of precocious puberty?
Secondary sexual characteristics in females < 8 years and males < 9 years
63
When should a child be urinary continent?
3 to 4 years old
64
Management of nocturnal enuresis?
1st line = lifestyle advice 2nd line = enuresis alarm 3rd line = desmopressin N.B. desmopressin may also be used short-term e.g. for a sleepover
65
Management of UTI in children?
< 3 months = urgent paediatric referral > 3 months upper UTI = admission + antibiotics > 3 months lower UTI = antibiotics
66
Features and investigation for vesicoureteric reflux?
Hydronephrosis Recurrent UTIs Chronic pylonephritis Investigation = micturating cystourethrogram
67
Red flag in dehydrated child?
Reduced skin turgor
68
Dehydration management in children?
Give 50ml/kg ORS over 4 hours + ORS maintenance
69
Features of infantile colic?
Irritability Crying Drawing up of knees
70
Management of constipation (< 3 stools a week) in children?
1st line = movicol paediatric plain 2nd line = add stimulant laxative 3rd line = stimulant + osmotic laxative
71
Feature, investigation and management of Hirschprung's disease?
Feature = failure to pass meconium Investigation = AXR, rectal biopsy (gold standard) Management = bowel irrigation, surgery
72
Features, investigation and management of intussusception?
Features = bilious vomit, abdominal pain, drawing knees up and turning pale, bloody stool, sausage-shaped mass Investigation = abdo USS Management = air insufflation, surgery
73
Abdominal USS feature of intussusception?
Target sign
74
Most common cause of painless, massive GI bleed in young children?
Meckel's diverticulum
75
Features, investigation and management of Meckel's diverticulum?
Features = usually asymptomatic, abdominal pain mimicking appendicitis, melaena, obstruction Investigation = 99m technetium scan Management = surgery
76
Features, investigation and management of pyloric stenosis?
Features = non-bilous projectile vomit, dehydration, abdominal mass Investigation = abdo USS Management = ranstedt pyloromyotomy
77
Metabolic derangement associated with pyloric stenosis?
Hypochloraemic hypokalaemic metabolic alkalosis
78
Management of gastroschisis vs exomphalos?
Gastroschisis = urgent surgery Exomphalos = staged repair, cover with sac until ready for surgery
79
Features of growing pains?
Not present when child wakes up Intermittent symptoms Systemically well No limp or examination findings
80
Barlow and Ortolani test?
Barlow = trying to dislocate femoral head Ortolani = trying to relocate femoral head
81
Babies who automatically need USS for DDH?
Breech presentation FH of hip problems at birth Multiple pregnancy
82
Investigations and management of DDH?
< 4.5 months = USS > 4.5 months = X-ray Management = Pavlik harness
83
Features and management of transient synovitis?
Mostly children aged 3-8 Limp/not weight bearing Groin or hip pain Should NOT have high fever Management = supportive
84
Features and management of slipped capital femoral epiphysis?
Obese child Hip, groin or knee pain Loss of internal rotation in flexion Management = internal fixation
85
Features and management of Perthe's disease?
Progressive hip pain Limp/not weight bearing Reduced range of movement Management = brace/cast + observation (< 6), surgical management (> 6)
86
Pathophysiology of cerebral palsy and causes?
Non-progressive lesion of the motor pathways in the developing brain → cerebral malformation → congenital infection e.g. rubella → IVH → hypoxia/asphyxiation
87
Most common meningitis organisms in neonates vs > 1 year?
Neonates = group B strep > 1 year = neisseria meningitidis
88
Management of paediatric meningitis?
< 3 months = IV amoxicillin or ampicillin + IV cefotaxime > 3 months = IV cefotaxime or ceftriaxone Steroids can be used in children > 3 months
89
Child has clusters of movements like body scrunching or head bobs?
Infantile spasms
90
Child goes pale, falls to floor and recovers quickly after pain or intense emotion?
Reflex anoxic seizure
91
Child has exclusively nighttime seizures?
Benign rolandic epilpesy
92
Features and management of simple vs complex febrile seizure?
Simple = < 15 mins, generalised, no recurrence within 24 hours Complex = 15-30 mins, focal, may recur within 24 hours Management = supportive, BZD if needed
93
Parental counselling for febrile seizures?
- Affects children 6 months-5years - 1 in 3 risk of recurrence - Anti-pyretics do not reduce risk - Call ambulance if lasts > 5 mins - Small risk of developing epilepsy especially if complex seziures
94
Nerve roots affected in Erb's vs Klumpke's palsy and clinical sign?
Erb's = C5, C6 → waiter's tip Klumpke's = C8, T1 → claw hand
95
Management of a pulled elbow (radial head subluxation)?
Passive pronation with elbow flexed at 90°
96
Management of talipes equinovarus (club foot)?
Ponseti method (progressive casting) Night-time braces until age 4
97
Paediatric resuscitation?
1. Airway manoeuvres 2. Give 5 rescue breaths 3. Check femoral or brachial pulse 4. Give 15:2 CPR
98
Features and management of Kawasaki disease?
Fever resistant to antipyretics Conjunctival injection Red, cracked lips Strawberry tongue Red palms/soles → desquamation Management = high-dose aspirin + IV immunoglobulins
99
Complication of Kawasaki disease and screening test?
Coronary artery aneurysm Echocardiogram
100
Management of threadworms?
Mebendazole and hygiene advice for all household members

Med School Finals (18 decks)

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