Paediatrics Flashcards by Belle Storey

Give 4 clinical signs of bronchiolitis

Coryzal symptoms preceding:
Dyspnoea with feeding difficulties
Auscultation findings include widespread harsh breath sounds, wheezes and fine inspiratory crackles
Mild fever (under 39ºC)

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Commonest cause of bronchiolitis

respiratory syncytial virus

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Investigation for bronchiolitis

Immunofluorescence of nasopharyngeal secretions may show RSV

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NICE immediate referral criteria for bronchiolitis

Apnoea
Child looks seriously unwell to a healthcare professional
Severe respiratory distress (grunting, marked chest recession, RR >70)
Central cyanosis
Hypoxia <92% on air

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Except for difficulty breathing, what other symptoms are associated with croup?

Barking cough, worse at night
Hoarseness
Stridor (laryngeal oedema + secretions) - DO NOT EXAMINE THROAT
Fever
Corzyal symptoms

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Other than croup, give 2 other causes of developing stridor in a 4 year old

Epiglottis
Foreign body
Anaphylaxis

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Name the virus most commonly responsible for causing croup

Parainfluenza virus

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Treatment prescribed for croup

Single dose of dexamethasone regardless of severity

Emergency:
High flow O2
Nebulised adrenaline

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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 RUQ

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What acid-base disturbance would you expect to find in pyloric stenosis?

hypochloraemic, hypokalaemic metabolic alkalosis - from vomiting

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Name the four sections of the stomach

cardia
fundus
pylorus
body

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Typical SUFE patient

obese boy aged 10-15

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What cartilage makes up the epiphyseal plate?

Hyaline cartilage

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SUFE 3 features

Hip, groin, medial thigh or knee pain
Loss of internal rotation of the leg in flexion
Bilateral in 20%

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Name 3 differential diagnoses for hip pain in a child

SUFE
Perthes
Acute transient synovitis
Septic arthritis

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Give 2 causes of jaundice within the first 24 hours of life

JAUNDICE IN THE FIRST 24H IS ALWAYS PATHOLOGICAL

Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD

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Most common cause of jaundice 2-14 days

Physiological (more RBC, fragile RBC, less developed liver) - more common in breastfed babies

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Give 2 investigations (other than bilirubin) for jaundice in first 24h

Rhesus status
ultrasound?

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Pale stools and raised conjugated bilirubin

Cause of prolonged jaundice in a baby?

Obstructive picture: biliary atresia

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What complication may occur if raised levels of unconjugated bilirubin remain untreated?

Kernicterus

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Give 1 methods of treating neonatal jaundice?

Phototherapy

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What prenatal investigation can be used to detect congenital heart diseases?

Echocardiography

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In which direction is blood flowing in the heart in acyanotic congenital heart disease?

Left to right

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Give 2 causes of acyanotic congenital heart disease

Ventricular septal defect
Atrial septal defect

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In which direction is blood flowing in cyanotic heart disease?

Right to left

Give 2 causes of cyanotic congenital heart disease?

Tetralogy of fallot Transposition of the great arteries

In decompensated congenital heart disease, give 2 clinical features

Poor feeding Tachycardia Cold peripheries Hepatomegaly Engorged neck veins

What is Eisenmenger's syndrome?

Left to right shunt causes pulmonary hypertension which leads to shunt reversal (acyanotic to cyanotic)

Apart from prematurity, give 2 risk factors for IRDS

Maternal diabetes C-section

What substance is deficient in the lungs of premature babies (<32w), giving rise to IRDS?

Surfactant produced by mature alveoli Lack of it leads to high surface tension within alveoli which leads to lung collapse

What prenatal medication can be given to mothers with suspected preterm labour to prevent respiratory distress syndrome?

Dexamethasone Increases production of surfactant

Give 2 signs of IRDS

Tachypnoea Cyanosis Inspiratory recession Grunting Nasal flaring

What is seen on a chest X-ray in a baby with IRDS?

Ground glass appearance

In what age range do febrile convulsions typically occur?

6 months to 5 years

Give 2 features that mean febrile seizures are classified as complex febrile convulsions

15 to 30 minutes Repeated seizures within 24 hours Focal seizure

Give 3 investigations in febrile convulsions

FBC Blood culture U&E Glucose Throat swab

Give 1 pieces of information to give to parents prior to child being discharged after febrile seizure

Advise to phone for an ambulance if seizure lasts >5 minutes

Medication for recurrent febrile convulsions

Benzodiazepine rescue medication

Define cerebral palsy

Disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain

Give 2 of the subtypes of cerebral palsy, using the classification system based on movement disorder

Spastic (70%) - increased muscle tone due to UMN lesion Dyskinetic - basal ganglia and substania nigra cause athetoid movements Ataxic - damage to cerebellum Mixed

Apart from motor complications, give 2 other clinical features that a child with cerebral palsy may have

Learning difficulties Epilepsy Squint Hearing impairment

Give 3 a cause of cerebral palsy from each category a) antenatal b) intrapartum c) postnatal

a) Congenital infection e.g. rubella b) Birth asphyxia c) Meningitis

Name 2 medications a child with cerebral palsy may be prescribed to help with muscle spasm

Diazepam Baclofen

In which gender are intussusceptions more common

Male

Describe the pathogenesis of intussusception

Invagination of one portion of the bowel into the lumen of the adjacent bowel, usually the ileo-caecal region

Investigation of choice for intusseception and sign seen

Ultrasound Target-like mass

1st line treatment for intussuception

Air insufflation under radiological control

What are 2 indications for laparotomy in intussuception

Failed air insufflation Signs of peritonitis

3 month old baby with episodes in which he becomes irritable, struggles with his breathing, and his lips turn blue - name?

Tet spells *Tetralogy of fallot

Anatomical abnormalities that occur in Tetralogy of Fallot

Pulmonary stenosis RVH VSD Overriding aorta

Investigations to identify cause in suspected NAI

FBC Coagulation screen LFTs Cranial CT Skeletal survey Cranial ultrasound

3 professionals outside of hospital involved in NAI

Social workers Health visitors GP Police

2 clinical signs of infectious mono

Splenomegaly Petechial haemorrhages of soft palate White exudate covering tonsils Lymphadenopathy Hepatosplenomegaly Fever

2 complications of infectious mono

Chronic fatigue syndrome Splenic rupture GBS Encephalitis Meningitis

Name 2 notifiable diseases

Acute meningitis Botulism COVID-19 Diptheria Enteric fever

Pyloric stenosis pathophysiology

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 projectile vomiting

Investigation of choice pyloric stenosis

Abdo ultrasound

Definitive management pyloric stenosis

Laparoscopic pyloromyotomy (Ramstedt's)

2 of the 6 in 1 vaccine components

Diphtheria Hep B Whooping cough Tetanus Polio H. influenzae B

8 week vaccinations

6 in 1 Rotavirus Men B

When is jaundice pathological

first 24h of life

3 examples of prolonged jaundice

Biliary atresia Hypothyroidism Breast milk jaundice

What is the serious complication of untreated neonatal jaundice that parents should be warned about?

Kernicterus

Which special tests in the NIPE can detect signs of hip pathology? Follow up imaging?

Ortolani and Barlow tests Ultrasound

What condition are ortolani/barlow/US looking for

Developmental dysplasia of the hip

Name 2 criteria of Wilson and Junger screening test criteria

Important Cost-effective Simple and safe screening test Acceptable to population Agreed diagnostic investigation for positive test results

Epididymo-orchitis presentation

gradual onset, over minutes to hours, with unilateral: Testicular pain Dragging or heavy sensation Swelling of testicle and epididymis Tenderness on palpation, particularly over epididymis Urethral discharge (should make you think of chlamydia or gonorrhoea) Systemic symptoms such as fever and potentially sepsis

Examination findings in testicular torsion

Firm swollen testicle Elevated (retracted) testicle Absent cremasteric reflex Abnormal testicular lie (often horizontal) Rotation, so that epididymis is not in normal posterior position

Explain why trismus occurs in quinsy

The inflammation and swelling associated with the abscess can cause pain and spasm of the muscles involved in opening the mouth (masticator muscles)

Lymph node enlarged in quinsy

Jugulodigastric lymph node

What test on an ABG could help decide the urgency of treatment for pneumonia

Lactate

2 management options for bronchiolitis

Oxygen NG feeding

Investigation for SUFE

AP and lateral (typically frog-leg) views are diagnostic

Management of SUFE

Internal fixation (single cannulated screw in centre of epiphysis)

4 complications of SUFE

Osteoarthritis Avascular necrosis of the femoral head Chrondrolysis Leg length discrepancy