Paediatrics Flashcards by Maia Cunningham

Child in resp distress/probably bronchiolitis, what investigation do you do?
Blood culture
Blood gas
FBC
Nasopharyngeal aspirate
Echo

Unsure - maybe blood gas to know severity of resp distress…

Some argued NPA just for public health reasons but isnt it usually RSV?

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NZ Euro kid with the sniffles , sore throat(low grade fever, red tonsils no exudate), what organism is responsible
Rhinovirus
S. pyogenes
EBV
RSV

Rhinovirus

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6 mo with wheeze, increased work of breathing etc, had sibling who was sick last week. On exam had diffuse crackles. Diagnosis?
Bronchiolitis
Bronchiectasis
Asthma
VIral induced wheeze

Bronchiolitis

<1 year pretty confident with bronchiolitis

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Baby with stridor that goes away when they sleep
a. Laryngomalacia
b. Vascular ring
c. Subglottic stenosis
d. Croup

Laryngomalacia

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Baby with a arm lesions (chickenpox). When can she go back to kindy?
When they’ve dried
Immediately
2 days antibiotics first
Wait 7 days

When they’ve dried

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5yo Maori boy with viral sx and wheeze. No sx any other time.
Viral induced wheeze
Asthma
Bronchiolitis

VIW

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Child had GTCS on waking. Has twitches in arms and legs occasionally. ?potentially had febrile seizure when younger. EEG showed generalised spike and wave when sleep deprived and with photostimulation. Diagnosis?

Juvenile myoclonic seizures

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Something like this on newborn baby. Getting bigger with time, parents concerned. Treatment?

Observe, usually just regress. Only need surgery if obstructing visual field or something.

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Baby who can turn over on tummy but needs help sitting up on it’s own, passes hand to hand, doesn’t have a pincer grip, no words but babbles, responds to name, holds bottle to feed
3 months
6 months
9 months
12 months

6 months

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4 year old child with fever (39), looking toxic, respiratory distress and high pitched inspiratory stridor, what do you do first? He had already had neb adrenaline
IV hydrocortisone
Inhaled corticosteroids
Nebulised salbutamol
Inhaled adrenaline
Intubation

Intubation (epiglottitis)

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10 month old child recovering from viral gastro, is on formula + solids, gets diarrhoea 10 days later. What do you do?
- Lactose free milk
- Soy formula
- Gluten free diet
- Revert to clear fluids for 48 hrs
- Metronidazole

Lol i want to give him extensively hydrolysed formula!

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Pregnant lady who has had varicella vaccines at pre-pregnancy check 6 months ago. Presents with vesicles on hands and feets. Causative pathogen?
- Coxsackie A16
- Syphilis
- Varicella Zoster
- Parvovirus

Coxsackie A16

Hand foot + mouth

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What does this kid have

Meningococcal septicaemia

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Kid with UTI, still febrile after 5/7 ABx, now has palpable painful flank mass
Renal U/S
CT abdo
DMSA
DTPA

Renal U/S

?abscess

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Child with egg allergy comes in with a fever 38.5 and coryzal symptoms. What would stop you giving them the vaccine
a) Egg allergy
b) URTI
c) Temp >38

c) Temp >38

Egg allergy no longer a contraindication for any vaccines. Mild URTI okay.

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Kid with partial seizures. Having multiple attacks per day gazing off into the distance associated with hand movements. Tiredness after the event, jerking and lip smackin with chewing motions. What is the best medication?
a) Lamotrigine
b) Levetriracetam
c) Ethosuximide
d) Valproate

d) Valproate

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Lady with a baby that was fine at birth, presents 3 days later with increasing jaundice, bilirubin 380 (normal <200), direct bilirubin 12 (normal<6). What is your initial management?
a) Formula supplement
b) Stop breastfeeding
c) Phototherapy
d) Exchange transfusion
e) Recheck bilirubin in 23 hours

Phototherapy

This is physiological jaundice

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Term baby born by elective caesar, birthweight 3.6 kgs, c section. APGAR scores 8 and 9 at 1 and 5 or 10 minutes. 4 hours later becomes breathless with low O2 sats, X-ray shows fluid in interlobar fissures
ARDS
Transient tachypnea of the newborn
Meconium aspiration
Pneumonia
Congenital diaphragmatic hernia

Transient tachypnea of the newborn

More common in C-section - retained fluid as not squeezed out by vagina lol

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Enuresis at 4yo (he was rly young), never successfully toilet trained
Trial of enuresis alarm
Reassurance
Psych referral

Reassure

Alarm usually only ok >5 year old, need maturity and understanding to respond.

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Otitis externa- Can’t visualise tympanic membrane. Rx
Give broad spectrum ABs ear drop
Oral amoxicillin
Urgent ENT referral
Warm saline wash

Give broad spectrum ABs ear drop

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Dehydrated kid post gastro, 2 year-old boy. BP 90/50, tachycardia (100), tachypnoea, sunken fontanelle and slightly reduced skin tugor. Was drinking normally but now not taking any oral fluids.
Oral rehydration solution +6
Oral rehydration with water
IV Saline 0.45% with dextrose
IV Saline: 0.9%

Saline: 0.9%

THIS IS RESUS, IV. He is not taking oral fluids!!!

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Chick wanting to get pregnant in the near future. Non-smoker, drinks 2 standards per night. Best advice
- Stop drinking alcohol immediately
- stop as soon as you are confirmed pregnant
- cut down to 1/night
- have 2 alcohol free days/week

Stop drinking alcohol immediately

No safe limit.

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Mother worried about SUDI. Best advice?
Don’t sleep with child in bed
Use humidifier in child’s room
Sleep monitor

Don’t sleep with child

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Baby just born, APGAR of 3 at 1 minute, slow to start breathing. What is most important for resuscitation?
· Bag mask ventilation
· Nasal O2
· Intubate
· Suction mouth and nose

· Bag mask ventilation

In neonates born through clear amniotic fluid who do not start breathing after thorough drying and rubbing the back 2-3 times, suctioning of the mouth and nose should not be done routinely before initiating positive-pressure ventilation

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6 week old Asian child. Previously well, now profuse vomiting after feeds. Lost 300 grams in last week. Hyponatraemic hypochloraemic metabolic alkalosis. Abdomen SNT, bowel sounds present. What’s the investigation Abdomen USS Abdominal xray Abdo CT

This is highly suggestive of pyloric stenosis, which is diagnosed by USS 'Ultrasonography of the upper abdomen demonstrates an elongated hypertrophic pylorus through which gastric contents cannot be demonstrated to pass through.'

Child gets meningitis from AOM. What’s the most likely organism? Strep pneumoniae Staph aureus Listeria Haemophilus influenzae

Strep pneumoniae

8 year old boy comes in with fecal soiling. Previously toilet trained, now soiling at night time. No day-time incontinence. Examination shows left iliac fossa mobile mass. Teasing at school has become an issue. What is the best initial management? Psych referral High fibre diet Do nothing Stool evacuation and softening routine Senna Enuresis alarm

1. Stool evac + Softening routine Clean out: enema if >5 years, magnesium citrate, polyethylene glycol He likely has constipation hence LLQ mass.

Kid with meningitis and high ICP, raised WBC predominantly lymphocytes, given antibiotics and fluids, what further treatment: · IV Dexamethasone · Paracetamol · IV Morphine · IV Phenytoin · Rectal diazepam

IV Dexamethasone Reduces swelling (raised ICP)

Kid eats prawns, develops wheezing and urticaria. After 15 minutes he has a rash and wheeze, O2 sats are 95%. What do you give? · Nebulised adrenaline · IV adrenaline · IM adrenaline · Subcut adrenaline · Sublingual adrenaline

IM adrenaline for anaphylaxis

Wee boy 3 years old, presents with fluctuating diarrhoea and constipation. Normal weight gain until about 5 months ago (has lost 1kg since previous check). No blood or mucus. What initial investigation should you do? · Stool culture · Stool reducing substance · Anti-TTG · CRP

Anti-TTG re: coeliacs disease

Kid falls out of tree and has exposed brain and fractured arm. Brought in by ambulance with teacher. Able to talk initially and then starts deteriorating rapidly. Parents are not far from hospital, what do you do. Call neuroreg Intubate Wait for parents Talk to head hospital chap Obtain consent from teacher

Intubate

4 year old child with breathlessness who’d had a VSD repair 3 month. Had no pulses palpable. Heart sounds cannot be heard. CRT 3 seconds. Seemed shocked. What do? · Cold ice water face dunk · Unilateral Carotid sinus massage · IV Adenosine · IV Atropine · DC Cardioversion · IV Amiodarone

Shock that mfer

Boy, aged 7, who began toilet training at 3. Still bed wetting at night, but no accidents during the day. Next step in management?

Enuresis alarm nb desmopression is used short-term and can help with conditioning, but very high recurrence rate. carries risk.

Kid with viral gastro now profuse yellow diarrhoea what do you advise Lactose free milk formula feeds Soy milk

Lactose free milk Post-viral lactase deficiency

Young kid with otitis media, redness and bulging tympanic membrane, not resolving & paracetamol/analgaesics no longer helping. Bacterial otitis media? What abx? penicillin amoxicillin azithromycin Ciprofloxacin ear drops

Amoxicillin

Baby born at term, normal pregnancy and delivery, indrawing, nasal flaring, tachypnoea TTN pneumothorax RDS Diaphragmatic hernia

TTN

Kid with a spot on the chin, mum said previous spots on back had disappeared leaving white zones behind? What should you do? 1) Skin biopsy 2) Cryotherapy 3) Corticosteorids 4) Reassurance

Reassurance = halo naevus

3 yo Kid with 3 week history of halitosis and unilateral nasal discharge a. Tonsillitis b. Chronic adenoiditis c. Foreign body d. Poor oral hygiene e. Sinusitis

Foreign body

What vaccine do you give at 6 weeks? You explain the importance of having immunisations on time and you name one of them. Apparently one is more time sensitive than others. Which vax is most important? a. HiB b. Pertussis c. Diphtheria d. Polio e. Measles f. Varicella g. Tetanus

Pertussis most important

Kid with varicella for 24 hours. Family has a domestic flight trip in 3 days a. Advise family to cancel flight b. Vaccinate family c. Immunoglobulins d. Oral acyclovir e. No treatment needed

Advice to cancel - contagious until scabbed over completely.

6-week old with a flat occiput. Mum was a single working parent. Best management a. Plagiocephaly helmet b. Reassure as normal c. Refer to social worker to check everything is okay at home d. Advice mum to sleep baby prone

Reassure

Silly kid decided to eat a battery from his granddad’s hearing aid. X-ray shows battery stuck in kid’s inferior oesophagus a. immediate endoscopic removal b. laparoscopic removal c. ipecac syrup d. check in 24 hours

immediate endoscopic removal

8. 7 year old with a BMI of 19.5 on a BMI chart. Put him around 95-97th percentile a. Adequate weight b. Obese c. Mild over weight d. Under weight e. BMI not indicated for paediatric use

Obese based on percentile

9. Kid got 5 days of sore hip and knee with fever. Couldn’t weight bear. Marked limitation of hip movement a. Septic arthritis b. Rheumatic fever c. Perthes d. Transient synovitis

Septic arthritis

5-year-old Niuean kid with a sore tibia, fever/tibia felt hot, raised neutrophils, normal xray. What treatment? a. Flucloxicillin b. Vancomycin

Flucloxicillin - osteomyelitis

Lady worried about her 8 month old babies feeding. Says he isn’t gaining weight. And seems smaller than babies the same age. Weight 25th percentile, height and head circumference 50th percentile. What do you do? a. Admit to hospital to observe feeding b. Dismiss her concerns c. Reassure d. Social work referral to observe home environment e. Reassess in 8 weeks

Reassess in 8 weeks

Kid fell off monkey bars and hit head. Remembers falling and hitting his head. GCS 15, vomited once and has a headache. Tenderness on frontal region. a. Admit for neuro observation b. CT head c. Observe for 4 hours and D/C if neuro obs normal d. D/c with information about head injuries e. Skull x-ray

Observe for 4 hours and D/C if neuro obs normal

Kid with petechiae and bruises, otherwise well, what investigation is most appropriate? a. Full blood count exam b. Coagulation screen c. Skeletal survey

FBC - platelets ?lymphoma/leukaemia

14yo Girl brought in by concerned parents to clinic against her will. She is listening to iPod & not engaging. What should you try? a. Ask if she is willing to be spoken to alone b. Telling her to wait outside while u speak w parents c. Ask if she wants to come with a friend d. Tell her to stop listening to ipod

Ask if she is willing to be spoken to alone 14 old enough lol

Newborn baby- distressed and appeared to be cyanosed when lie on back. Becomes better when lie on belly. Has small jaw

Pierre robin sequence - hyperflexed in utero so jaw doesn’t form properly (e.g. oligohydramnios) - tongue falls back into airway.

Machinery murmur in baby

PDA

infant with non-bilious vomiting, well between episode, sausage shaped mass, treatment

Air enema re: intussusception

Girl found shaking in bed every night, parents thought nightmares

?complex partial seizures

Picture of baby with swelling of one side of scrotum, reducible, can transilluminate

Hydrocele

Little boy with purpuric rash involving legs and buttocks, Abdo pain, inguinal Lymph nodes palpable

Henoch schonlein purpura Henoch-Schönlein purpura (HSP) is a small vessel vasculitis characterised by purpuric lesions on the legs and buttocks. It can also cause abdominal pain, arthralgia/arthritis, and renal involvement.

Newborn w/ absent red reflex

Urgent referral Could be a cataract (sight threatening pathology) or retinoblastoma (life threatening pathology)

Baby cyanosed when lying on back, and improves when picked up by midwife and put prone

Sounds like pierre-robin to me, tongue falling back while on back

Baby vomiting, now bilious vomiting, mx

Admit + observe for 24 hours

2 months with, parent says he has fallen, bruising, fractured humerus

?secondary survey ?non-accidental

Infant just born with breathlessness, no breath sounds on one side. Diagnosis?

Congenital diaphragmatic hernia

Distressed child with loud inspiratory stridor, what treatment

Barking cough, croup Dexamethasone

Murmur in a child & (+) JVP on one side

VSD

Child with hearing loss, both ears look fine

Chronic suppurative otitis media CSOM

Child with lymphadenopathy + rash in hands and feet

Kawasakis disease

Baby 6 weeks old, not growing since 3 weeks old. Not cyanotic. Hepatomegaly and elevated JVP. Murmur lower left sternal border?

VSD

Kid having seizures. On EEG abnormal generalised epileptiform activity.

Juvenile myoclonic seizures

Spilly baby who feeds often and wakes often. Parent’s are concerned. Management?

Educate about normal, reassure

3 y/o boy, not eating but drinking cordial. Fever of 38. Ulcer posterior fauce. Runny nose. Clear rhinorrhea. Bronchial breathing. No history of asthma.

This is herpangina (viral illness of mouth, ulcer in mouth + fever). Basically HFM just of mouth at this stage. Reassure as still taking fluids.

Baby that had ‘effortless’ vomiting, no other risk factors, 50th centile weight, height,

This is normal spilling, keep breastfeeding

Kid with suspected meningitis. After resus, what is the next step in management?

IV abx can be started immediately

Kid with huge swelling at back. of mouth, hard to open mouth and not eating. Feverish. Diagnosis?

Peritonsillar abscess

Baby born at term, 2.2kg, SGA what is the most likely complication?

hypoglycaemia

Baby with big head (97th centile) what to do?

Compare with parent head circumference

Kid with rash on face/slapped cheek

Erythema infectiosum, parvovirus

Investigation of choice in childhood seizures?

EEG

Girl with bilateral patchy xray, fever, non-productive cough, SOB. What cause?

Community acquired mycoplasma pneumonia? Idk how can tell it is mycoplasma

Paeds ingestion of 20ml of petrol

Do nothing

19. 16 year old boy with 3 weeks runny nose. Had eczema as a child. Dad has asthma. What is the diagnosis?

Allergic rhinitis

VSD (pansystolic, lower left sternal border) --> Ix = Echo

Baby has signs of RHF VSD most common

Continuous, machinery murmer = PDA.

Coarctation of aorta would have a soft systolic murmur radiating to back too

Testicular torsion - abnormal lie, painful scrotum Epididymitis is older, sexually active boys and has a normal lie.

Urgent surgery While USS could be helpful it should not delay surgery --> risk of ischaemia, infertility

Amoxicillin is first line, use if symptoms do not improve in 48 hours

Otitis media with effusion - otoscope and type B Tympanogram types include: Type A (normal middle ear), Type B (indicative of pathology or fluid accumulation), Type C (suggestive of Eustachian tube dysfunction)

congenital diaphragmatic hernia

Kid with partial seizures lasting 30-60s. Having multiple attacks per day gazing off into the distance associated with hand movements. Tiredness after the event, jerking and lip smacking with chewing motions. What is the best medication a) Lamotrigine b) Levetriracetam c) Ethosuximide d) Valproate

If boy = valproate If girl = lamotrigine

12 year old had GTCS on waking. Has twitches in arms and legs occasionally. Had febrile seizure when younger. EEG showed generalised spike and wave when sleep deprived and with photostimulation. Diagnosis? a) Juvenile myoclonic epilepsy b) SeLECTS c) Childhood absence epilepsy

Juvenile myoclonic epilepsy

Girl has seizure in the morning, child aware and able to think. Dx? a) Myoclonic seizure b) Absence seizure c) Focal impaired awareness seizure

Myoclonic seizure Other two = impaired awareness

8 year old has occasional brief hemifacial seizures, swallowing and chewing movements lasting less than 5 minutes, mostly at night. Once evolved to GTCS. EEG showed high amplitude centrotemporal spikes in drowsiness and sleep. Dx? a) Juvenile myoclonic epilepsy b) Childhood epilepsy with centro-temporal spikes (SeLECTS) c) Childhood absence epilepsy

(SeLECTS)

5 year old has frequent brief (10s) staring spells, unresponsive to parents and teachers. EEG showed generalised spoke and wave when sleep deprived and with hyperventilation. Dx? a) Juvenile myoclonic epilepsy b) SeLECTS c) Childhood absence epilepsy

Childhood absence epilepsy

2 year old boy post gastro, has been vomiting + diarrhea. Thirsty yesterday but today only drinking small amounts of fluid. BP 90/50, HR 100, RR 30. Sunken fontanelle, slightly reduced skin turgor, CRT <2s. Initial tx? a) Oral rehydration solution b) Oral rehydration with water c) IV 0.45% saline with dextrose d) IV 0.9% saline

Oral rehydration solution

You explain the importance of having immunisations on time. Which of the 6 weeks vaccines is more time sensitive than the others? a) Rotarix b) Infanrix c) Prevenar

Rotarix

Distressed child with barking cough and loud inspiratory stridor. What treatment? a) Oral dexamethasone b) Intubate c) Antibiotics

Oral dexamethasone

Infant with respiratory distress and fever likely due to bronchiolitis. What investigation do you do? a) Blood culture b) Blood gas c) FBC d) Nasopharyngeal aspirate (NPA) e) ECHO f) Nothing

Do nothing

3 year old girl whose parents check on her during the night. Sometimes find her sitting upright, eyes open, confused and distressed. Appears awake but doesn’t heart parents or respond to reassurance. Goes back to sleep and doesn’t remember it in the morning. What was it? a) Night terrors b) Nightmare c) Absence seizure d) Complex partial seizure e) Breath holding attack

Night terror - not aware of parents, rapidly back to sleep differentiate this from a nightmare

4 year old NZ European girl with painful right leg (upper tibia area), febrile, not worse on walking/weight bearing. Knee joint ROM normal and no pain in joint on active or passive movement. Normal X-ray. Neutrophilia (WBC 18 95% neuts). Dx? a) Osteomyelitis b) Osgood-Schlatter c) Acute leukaemia d) Septic arthritis e) Osteosarcoma

Think this is osteomyelitis based on location and not worse when weight bearing, no mention of a swollen red joint either.

Young boy with bilateral infrapatellar swelling. Management? a) Advise rest b) Steroid injections c) IV antibiotics d) Surgery

Advise rest Caused by overuse Can use NSAIDs (oral) if v bad pain

16 year old boy with 3 weeks runny nose. Had eczema as a child. Dad has asthma. What is the diagnosis? a) Allergic rhinitis b) Sinusitis c) Bronchitis

Allergic rhinitis

Kid with diabetic ketoacidosis (DKA). First line treatment? a) 0.9% NaCl + KCl IVF b) 0.9% NaCl IVF c) Insulin d) NaHCO3

0.9% NaCl + KCl IVF

Molluscum contagiosum has umbilicated if u look closely

2 year old not wanting to walk, irritable, swollen joints, sorest in the morning. No growth on aspirate. Diagnosis? a) Juvenile inflammatory arthritis b) Osteomyelitis c) Septic arthritis

Juvenile inflammatory arthritis

Short kid, bronchiectasis and fatty diarrhoea. Diagnosis? a) Cystic fibrosis b) Coeliac disease

Cystic fibrosis

3 year old boy, not eating but drinking cordial. Fever of 38. Ulcer posterior fauce. Runny nose. Clear rhinorrhoea. Bronchial breathing. No history of asthma. Next steps? a) Chest x-ray b) Reassurance c) Refer to ED d) Amoxicillin e) Paracetamol

Reassure Antipyretics (e.g paracetamol) are not necessary in viral URTI if the child does not appear uncomfortable 􏰀 avoid fever phobia

11 year old with short stature and delayed puberty onset. Bone age is 9 years. Diagnosis? a) GH deficiency b) Constitutional delay c) Genetic short stature d) TH deficiency

constitutional delay

Child falls with hematoma over occiput. No neuro signs. Investigation? a) CT scan b) None needed c) MRI

CT Scalp haematoma = important indicator TBI in <6 months or >3cm – associated w/ subdural or epidural hematomas, cerebral or subarachnoid haemorrhages, or cerebral contusion but may have no other signs

Child with EBV. Now sore throat. What treatment? a) Rest and hydrate b) Antibiotic

Rest and hydrate

Baby cyanosed when lying on back but improves when picked up by midwife and put prone. Dx? a) Choanal atresia b) Laryngomalacia

i think this is laryngomalacia

Baby with swelling on one side of scrotum, reducible, transilluminates. Dx? a) Indirect inguinal hernia b) Non-communicating hydrocele

Hydroceles are NOT reducible so this is a hernia

Baby with sunset eyes and frontal head swelling. Investigation?

fixed downward gaze = raised ICP such as in hydrocephalus ?Think CT

9-month-old baby girl presents with episodes of screaming, yellow non-bilious vomit, pallor and a mildly distended abdomen. Well between episodes. A single loose motion was passed when the episodes started. Dx? a) Intussusception b) Pyloric stenosis c) Gastroenteritis d) GERD

Intussusception

9-month-old baby girl presents with episodes of screaming, yellow non-bilious vomit, pallor and a mildly distended abdomen. Well between episodes. A single loose motion was passed when the episodes started. Tx? a) Air/fluid enema b) Urgent surgery c) Conservative

Air/fluid enema

9 days old baby with bilious vomiting and weight loss, no fever. Abdomen distended. Passed meconium at 4 days and was jaundiced day 2. Born at 36 weeks. Best investigation? a) Abdo USS b) Abdo X-ray c) Blood cultures d) Urine e) Serum bilirubin f) Barium meal

This is intestinal atresia - distension, late meconium, resp distress, jaundice Look for dilated bowel on abdo XRAY

Baby vomiting, now bilious. Management? a) Admit and observe 24 hours b) Reassure c) Antibiotics

Admit and observe 24 hours Could be bowel obstruction

5 year old girl, who for the past 3 weeks has been vomiting each morning before breakfast/school, rarely at other times. Occasional headaches, otherwise well. Diagnosis? a) Migraine b) Gastritis c) Medulloblastoma d) Sinusitis

Medulloblastoma raised icp morning - not best.... Most common brain tumour in children

6 month old baby boy with R inguinal mass causing no discomfort. Not evident on exam anymore. Both testes present in the scrotum. R spermatic cord thicker than the left. What should you do? a) Surgery for inguinal hernia repair b) Review once a week c) Reassure that it doesn’t need treatment d) Orchidoplexy

Elective surgery for hernia repair

10 month old, with raised small lymph nodes and is irritable. Red and sore throat. Chest clear. Tonsils enlarged (but no mention of exudate). 2 day history of fever. Clear nasal discharge. Diagnosis? a) Strep pyogenes b) EBV c) Staph aureus d) Adenovirus e) Parovirus

Adenovirus

Kid with sore hip, febrile, WBC elevated, global movement pain. What do you do immediately? a) IV fluclox b) Aspirate synovial fluid

aspirate first actually I think lol

5 year old with a bulge above umbilicus for last few weeks. Soft non-tender. Treatment? a) Reassurance b) Surgical repair c) Aspirate d) Antibiotics

Reassure - epigastric hernia, only need anything if cause discomfort or interferes with activity