Paediatrics Flashcards
1
Q
What is the first line medication for children >6months old with threadworm?
A
Mebendazole
2
Q
Symptoms of Acute Lymphoblastic Leukaemia is children?
A
Bleeding and clotting abnormalities, persistent fatigue, dyspnoea and intermittent fevers
3
Q
Signs of ALL in children?
A
Hepatosplenomegaly
Pallor
Easy bruising
Petechiae
4
Q
When is hand preference abnormal?
A
Before 12 months - It could be an indicator of Cerebral Palsy
5
Q
Treatment of Transient Synovitis
A
Self limiting- rest + analgesia
6
Q
What antibiotics should you give for Whooping cough?
A
Azithromycin or Clarithromycin if the onset of cough is within the previous 21 days
7
Q
What is the pathogen causing Whooping cough?
A
Gram-negative bacterium Bordetella pertussis
8
Q
What is the treatment for slipped capital femoral epiphysis?
A
Internal Fixation: Typically a single cannulated screw placed in the centre of the epiphysis
9
Q
What is the treatment for intussusception?
A
Reduction by air insufflation
10
Q
How long is the exclusion for Scarlet Fever?
A
24 hours after commencing antibiotics
11
Q
How long is the exclusion for Rubella?
A
5 Days from onset of rash
12
Q
How long is the school exclusion for Measles?
A
4 days from onset of rash
13
Q
How long is the school exclusion for Mumps?
A
5 days from the onset of swollen glands
14
Q
How long is the school exclusion for Scabies
A
Until Treated
15
Q
What is the organism in threadworm?
A
Enterobius Vermicularis
16
Q
What is the investigation of choice for Intusussusception?
A
Ultrasound may show a target like mass.
17
Q
What is the test used to screen for newborn hearing problems?
A
Otoacoustic emission test
18
Q
What is the surgical treatment of Malrotation?
A
Ladds procedure
19
Q
What are some risk factors for necrotizing enterocolitis?
A
- Prematurity
- Low birth weight
- Non-breast-milk feeds
- Sepsis
- Acute Hypoxia
- Poor Intestinal Perfusion
20
Q
What are some signs and symptoms of NEC?
A
- Vomiting
- Bloody Stools
- Abdominal Distention
- Absent Bowel Sounds
- Signs of Systemic Compromise
21
Q
What are the Investigations and Findings for NEC?
A
Abdominal X-Rays showing:
- Dilated Bowel loops
- Pneumatosis Intestinalis ( gas within the bowel wall)
- Portal venous gas
- Pneumoperitoneum
22
Q
How is NEC classified?
A
Using the Bells Classification which utilises a combination of clinical signs and radiological findings
23
Q
What is the management for NEC?
A
- Making the patient nil-by-mouth and passing a nasogastric tube for gastric decompression.
- Administration of broad-spectrum antibiotics.
- Providing total parenteral nutrition to rest the bowel.
- Supportive treatments, including IV fluids and ventilation.
- Surgical intervention, such as resection of necrotic sections of bowel, may be necessary and is essential in cases of bowel perforation. Early involvement of paediatric surgeons is advised.
24
Q
What is the most common long-term complication associated with untreated vesicoureteric reflux in children?
A
Renal scarring from recurrent urinary tract infections
25
What is the initial treatment of chronic constipation?
Movicol Disimpaction regimen
26
Features of chickenpox?
- Fever initially
- Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
27
Features of Measles?
- Prodrome: irritable, conjuncitivis, fever
- Koplik spots: white spots ('grain of salt') on the buccal mucosa
- Rash: Starts behind the ears then to whole body, discrete maculopapular rash becoming blotchy and confluent
28
Features of Mumps?
- Fever, malaise, muscular pain
- Parotitis ('earache', 'pain on eating')
unilaterally then becomes bilateral in 70%
29
Features of Rubella?
- Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
- Lymphadenopathy: suboccipital
30
Features of Erythema infectiosum?
- Also known as fifth disease or 'slapped-cheek syndrome'
- Caused by Parvovirus 19
- Lethargy, fever, headache
- 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
31
Features of Scarlet Fever?
- Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
- Fever, malaise, tonsillitis
- 'Strawberry' tongue
- Rash, fine punctate erythema sparing the area around the mouth
32
Features of hand foot and mouth disease?
- Caused by the Coxsackie A16 virus
- Mild systemic upset: sore throat, fever
- Vesicles in the mouth and on the palms and soles of the feet
33
Treatment of choice for Patent ductus arteriosus?
Indomethacin
Inhibits prostaglandin synthesis
34
Risk factors for Developmental dysplasia of the hip?
Risk factors
- Female sex: 6 times greater risk
- Breech presentation
- Positive family history
- Firstborn children
- Oligohydramnios
- Birth weight > 5 kg
- Congenital calcaneovalgus foot deformity
35
What is the examination of choice for DDH
Ultrasound unless >4.5 months then X-Ray
36
When is hand preference abnormal?
Before 12 months and may indicate cerebral palsy
37
Diagnosis of pyloric stenosis?
Abdominal Ultrasound
38
Management of pyloric stenosis?
Ramstedt pyloromyotomy
39
Features of PDA?
- Left subclavicular thrill
- Continuous 'machinery' murmur
- Large volume, bounding, collapsing pulse
- Wide pulse pressure
- Heaving apex beat
40
When should a child smile?
6 weeks (refer at 10 weeks)
41
When should a child laugh and enjoy friendly handling?
3 months
42
What is the main complication of Kawasaki disease?
Coronary artery aneurysms
43
Acyanotic heart disease types?
- VSD
- ASD
- PDA
- Coarctation of the aorta
- Aortic valve stenosis
44
What are most common causes of cyanotic congential heart disease?
- Tetralogy of Fallot
- Transposition of the great arteries (TGA)
- Tricuspid atresia
45
At what age should a child sit without support?
7-8 months (refer at 12 months)
46
At what ages should a child pull to stand/crawl?
9 months
47
At what age should a child cruise/walk with one hand held?
12 months
48
At what age should a child walk unsupported?
13-15 months (refer at 18 months)
49
At what age should a child squat to pick up a toy?
18 months
50
At what age should a child run/walk upstairs and downstairs holding on to a rail?
2 years
51
Most common complication of Measles?
Otitis Media
52
A newborn child is noted to have cerebral calcification, chorioretinitis and hydrocephalus. Which one of the following congenital infections is most likely to be responsible?
Toxoplasmosis
53
What are the characteristic features of Rubella?
- Sensorineural deafness
- Congenital cataracts
- Congenital heart disease
- Glaucoma
54
What is the presentation of Hirschsprung's disease
- Abdominal distension and vomiting
- Late meconium
- Dilated colon on X-Ray
55
What are the features of congenital cytomegalovirus?
- Low birth weight
- Purpuric skin lesions
- Sensorineural deafness
- Microcephaly
56
What is the mode of inheritance of Duchenne Muscular dystrophy?
X-Linked Recessive
57
What are the signs and symptoms of a Wilm's Tumour?
- A palpable abdominal mass that does not cross the midline, although it may be bilateral in up to 5% of cases
- Abdominal distension
- Haematuria
- Hypertension
58
What is the management for a Wilm's Tumour?
Management depends on the tumour's stage and histological profile:
- Surgical resection, typically nephrectomy, is often the primary treatment.
- Adjuvant chemo- and radiotherapy are key components of management.
- Prognosis is generally excellent, with a greater than 90% five-year survival rate.
59
What would you see on X-Ray in rickets?
Cupping
Fraying
Metaphyseal widening
60
What is the management of rickets?
- Supplementation: Vitamin D, Calcium, and phosphorus are commonly prescribed
- Diet and Lifestyle modifications
- Orthopaedic intervention
61
What does bile-stained vomit and abdominal distention indicate?
Intestinal obstruction
62
What age children does transient synovitis usually affect?
3-11 years of age
63
What investigations should you do in Transient synovitis?
Raised WBCs and CRP may suggest septic arthritis
Imaging: Ultrasound of the joint may show effusion. X-Ray may be normal in either condition
64
How does Croup usually present?
- Barking, seal-like cough, stridor, fever and signs of increased work of breathing
65
What is the most common cause of croup?
Parainfluenza virus
66
What are some antenatal/intrapartum causes of cerebral palsy?
- Hypoxic-ischaemic encephalopathy
- Infection
67
What are some postnatal causes of cerebral palsy?
- Meningitis
- Trauma
- Haemorrhage
- Medication toxicity
- Kernicterus
68
What is Rubella caused by and how does it spread?
Rubella is caused by the rubella togavirus, which is transmitted via respiratory droplets or aerosols.
69
How do you confirm a diagnosis of Rubella?
Primarily confirmed with serological testing. This includes detecting rubella-specific IgM or a significant rise in Rubella- Specific IgG in acute and convalescent serum samples
70
What are the features of Nephrotic syndrome?
Proteinuria and Peripheral oedema
71
What is Perthes disease due to?
Due to disruption of bloodflow to the femoral head, resulting in avascular necrosis of the bone
72
What are the signs and symptoms of Perthes disease?
The cardinal symptoms of Perthes disease include:
- Gradual onset of limp
- Hip pain, which may also be referred to the knee
It is important to note that pain persisting for more than 4 weeks raises the suspicion for Perthes disease, as pain from conditions such as transient synovitis typically resolves within 2 weeks.
73
What is the primary diagnostic investigation for Perthes disease and what would it show?
Hip X-Ray
- Sclerosis and fragmentation of the epiphysis
- In some cases can be normal but should have repeat X-Ray if clinical suspicion persists
73
What is the management of Perthes disease if less than 50% of the femoral head is involved?
Bed rest
Non-weight bearing and traction
74
What is the management of Perthes disease if more than 50% of the femoral head is involved?
Management may necessitate the use of a plaster case to keep the hip abducted or even an osteotomy.
75
What are the investigations you would do for Minimal change disease?
- Urine tests: to identify proteinuria and to look for blood or white blood cells
- Blood tests: to check for low albumin and elevated cholesterol
- Kidney biopsy: Often reserved for patients who do not respond to initial treatment to confirm diagnosis
76
What is the first-line treatment for minimal change disease?
Prednisolone
77
What is the prognosis for minimal change disease?
1/3 of patients resolve completely and never have another episode.
1/3 have further relapses requiring additional steroid treatment.
1/3 are dependent on continued steroid/immunosuppression therapy.
78
What are the components of APGAR and when are newborns assessed?
Appearance (relates to the colour of the child)
Pulse
Grimace
Activity
Respiration
Assessed at 1 and 5 minutes
79
What bacterium is epiglottitis caused by?
Haemophilus Influenzae B
80
How does ALL occur?
Malignant condition that arises from the uncontrolled proliferation of genetically altered lymphoid progenitor cells.
Leads to abundance of early lymphoid precursors that replace the normal haematopoetic cells of the bone marrow
81
How do you diagnose ALL?
Bone marrow biopsy
82
What is the management of ALL?
- Chemotherapy: To kill cancer cells or prevent their growth.
- Radiation therapy: Used in certain cases to kill cancer cells or prevent their spread.
- Targeted therapy: Aimed at specific genes or proteins that contribute to the growth and survival of the cancer cells.
- Stem cell transplant: Can be utilised to replace the diseased bone marrow with healthy stem cells, typically after high-dose chemotherapy or radiation therapy.
83
What are some risk factors for NEC?
- Prematurity
- Low birth weight
- Non-breast-milk feeds
- Sepsis
- Acute hypoxia
- Poor Intestinal perfusion
84
What are some signs and symptoms of NEC?
- Vomiting (which may be bile streaked)
- Bloody stools
- Abdominal distention
- Absent bowel sounds
- Signs of systemic compromise, including an acidosis on a blood gas
85
What is the investigation of choice in NEC and what would it show?
- Dilated bowel loops
- Pneumatosis Intestinalis (gas within the bowel wall)
- Portal venous gas
- Pneumoperitoneum
86
What is the management for NEC?
- Make NBM
- Insert NG tube
- Administer broad-spectrum antibiotics
- TPN to rest the bowel
- IV fluids and ventilation
- Surgical intervention, such as resection of necrotic sections of bowel.
87
What is the correct ratio of chest compressions to breaths in Paediatric Basic Life Support?
15 to 2 breaths
88
If an infant or child is found unresponsive, what should you do?
Open airway
If not breathing normally, 5 rescue breaths
If no signs of life, 15 chest compressions followed by 2 rescue breaths
Continue repetition of compressions and breaths at a 15:2 ratio
89
How should you measure pulses in children?
Carotid pulse in children ages >1 year old
Brachial or femoral pulses in infants
90
What is the medical management of drooling in children with cerebral palsy?
Glycopyrronium bromide
91
What should you do for inguinal hernias in infants?
Urgent surgery due to the high incidence of strangulation
92
What is Caput succedaneum?
A puffy swelling that usually occurs over the presenting part and crosses suture lines.
- Subcutaneous
- Extraperiosteal
- Results as the result of pressure on the baby's head during delivery
93
What is a cephalohaematoma?
- A haemorrhage between the skull and the periosteum.
- Limited by the boundaries of the baby's cranial bones
94
Where should you check for pulses in a child under 1 year of age?
Brachial and femoral
95
What is a contraindication to circumcision?
Hypospadias
96
What is the management for mesenteric adenitis?
- Central abdominal pain and URTI
- Conservative management
97
What should you do in children who are bradycardic with signs of inadequate perfusion?
Start CPR
98
Where should you feel for a pulse in a child over 1?
Carotid or Femoral
99
What investigations could you carry out in infants younger than 3 months with fever?
- Full blood count
- Blood culture
- C-Reactive protein
- Urine testing for UTI
- CXR only if respiratory signs are present
- Stool culture, if diarrhoea is present
100
What is Ebstein's anomaly?
A form of congenital heart defect that involves abnormal displacement of the posterior and septal leaflets of the tricuspid valve.
101
What is the classic ECHO finding of Ebstein's anomaly?
Atrialisation of the right ventricle.
102
What is Reye's syndrome and what predisposes to it?
This condition can be defined as cerebral oedema and liver derangement with little or no clinical features of liver involvement.
Risk factors for this condition include a preceding, mild viral infection 3-5 days previously, the use of salicylates (including aspirin), winter months and children aged between 5 and 14 years of age.
103
What investigations should a baby <1 year old have with suspected NAI?
Full skeletal survey and a CT head scan
104
How do you confirm a diagnosis of Cerebral Palsy?
MRI
105
What is the first-line treatment of absence seizures?
Ethosuximide
106
What treatments may be involved in hospital for Bronchiolitis?
Oxygen
NG Feeding
107
I f signs o f severe bronchiolitis are presen t a chest X -ray w ould be
perform ed. W h a t w ould it be likely to show in bronchiolitis?
Hyperinflation
108
What symptoms aside from difficulty in breathing are associated with croup?
Hoarseness and Stridor
109
What should you do during a 'Tet spell' and why?
You should pick the child up and bring knees towards the chest.
This manoeuvre compresses the femoral arteries and increases peripheral vascular resistance, reducing the magnitude of the shunt
110
If a child's bilirubin line is below the treatment level but the baby is febrile, tachypnoeic or has any other signs, what investigations would you do next?
A Septic Screen
111
What heart defects would you expect to see in Tetralogy of Fallot?
- Ventricular Septal defect
- Overiding aorta
- Pulmonary stenosis
- Right sided ventricular hypertrophy
112
What are the risk factors for Tetralogy of Fallot?
Rubella infection
Increased age of the mother (over 40 years)
Alcohol consumption in pregnancy
Diabetic mother
113
What are the investigations for Tetralogy of Fallot?
Echocardiogram with doppler flow studies is the first-line
114
What is the definitive treatment of tetralogy of fallot?
Total surgical repair by open heart surgery is the definitive treatment, however mortality from surgery is around 5%.
115
What is the pathophysiology behind pyloric stenosis?
- Hypertrophy of the pylorus prevents food travelling from the stomach into the duodenum as normal
- After feeding there is powerful peristalsis against the narrow pylorus causing food to be ejected into the oesophagus leading to projective vomiting
116
Name the most likely finding upon palpation of the abdomen in pyloric stenosis and where in the
abdomen you would expect to find it?
Olive-shaped mass in the right upper quadrant / hard mass in the right upper
quadrant
117
What is a specific sign of neonatal withdrawal from opiates?
Yawning
118
Anatomically, why are young children more prone to otitis media?
They have short Eustachian tubes
119
What is a seizure?
Transient episodes of abnormal electrical activitiy in the brain
120
What are the Fraser guidelines on contraception?
The child understands the advice
They cannot be persuaded to tell their parents
They are likely to continue having sex without the contraception
The child’s physical/mental health may suffer without the contraception
The child’s best interests are that they should receive it
121
What are the investigations for congenital adrenal hyperplasia?
Blood tests : Specific hormone assays such as 17-hydroxyprogesterone, cortisol, and ACTH levels.
Genetic testing
122
What is the management for CAH?
- Acute treatment: fluid and sodium replacement with IV NaCl and hydrocortisone
- Long-term treatment with lifelong hormone replacement therapy
- Surgical interventions: In virilised females, genital surgery may be necessary to correct external genital abnormalities.
- Patient education: Those dependent on steroids should be educated about the critical importance of adhering to their medication regimen and following 'sick day' rules.
123
What is included in TORCH infection?
- Toxoplasmosis
- Other (syphilis, varicella, mumps, parvovirus and HIV and Zika)
- Rubella
- Cytomegalovirus
- Herpes simplex
124
What is included on the newborn blood spot test?
Sickle cell
CF
Congenital hypothyroidism
Inherited metabolic diseases
SCID
125
What is Hirschsprung's disease?
Hirschsprung's disease is caused by an aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses.
126
What are the possible presentations and associations of Hirschprungs disease?
Associations
3 times more common in males
Down's syndrome
Possible presentations
neonatal period e.g. failure or delay to pass meconium
older children: constipation, abdominal distension
127
What are the investigations for Hirschsprung's disease?
Abdominal X-Ray
Rectal Biopsy: Gold standard for diagnosis
128
What is the management of Hirschsprung's disease?
Initially: rectal washouts/bowel irrigation
Definitive management: surgery to affected segment of the colon
129
What is Meckel's diverticulum?
A congenital diverticulum of the small intestine
130
What is the most common cause of painless GI bleeding in children?
Meckel's diverticulum
131
What is Biliary atresia?
A paediatric condition involving either obliteration or discontinuity within the extrahepatic biliary system, which results in an obstruction in the flow of bile. This results in a neonatal presentation of cholestasis in the first few weeks of life.
132
What are the signs and symptoms of a choledochal cyst?
Infants with choledochal cysts can present dramatically with the following:
Jaundice and acholic stools: In early infancy, may prompt workup for biliary atresia
Palpable mass in the right upper quadrant of the abdomen, with hepatomegaly
133
What are the characteristics of Hypospadias?
A ventral urethral meatus
A hooded prepuce
Chordee in more severe forms
134
What is Patau syndrome and what are the key features?
Trisomy 13
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
135
What is Edward's syndrome and what are the features?
Trisomy 18
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
136
What are the features of Noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
137
What are the features of William's syndrome?
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
138
What is a congenital diaphragmatic hernia?
It is characterised by the herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm. This can result in pulmonary hypoplasia and hypertension which causes respiratory distress shortly after birth.
139
When are cleft lips repaired and when are cleft palates repaired?
cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months
cleft palates are typically repaired between 6-12 months of age
140
What are the features of Klinefelter's syndrome?
Klinefelter's syndrome is associated with karyotype 47, XXY
Features
often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels
141
What are the features of Kallman's syndrome?
'delayed puberty'
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal
patients are typically of normal or above average height
Cleft lip/palate and visual/hearing defects are also seen in some patientsc
142
What is Gastroschisis?
A congenital defect in the anterior abdominal wall just lateral to the umbilical cord
143
What is Exomphalos?
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.
144
What type of bilirubin leads to Kernicterus?
Free unconjugated bilirubin can cross blood brain barrier and cause Kernicterus
145
What can cause neonatal jaundice <24 hours of age?
Haemolytic disease: Rhesus incompatibility, ABO incompatibility, G6PD deficiency, Spherocytosis, pyruvate kinase deficiency, congenital infection
146
What can cause neonatal jaundice 24 hours to 2 weeks of age?
Physiological jaundice, breastmilk jaundice, infection, haemolysis, bruising, Polycythaemia, Criggler-Najar syndrome
147
What can cause neonatal jaundice >2weeks?
UNCONJUGATED: Physiological, infection, hypothyroidism, haemolytic anaemia
CONJUGATED:Biliary atresia or neonatal hepatitis
148
Why do you get respiratory distress syndrome in newborns?
Due to deficiency of surfactant excreted by type 2 pneumocytes in the alveolar epithelium
