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Flashcards in Paediatrics 2 Deck (137):
1

In kids, what 2 inhaled mediations are typically used together as preventers? Which one is started first?

Inhaled corticosteroids and inhaled LABA
Start with the corticosteroid

2

What can be used after LABA in preventing asthma attacks, particularly in younger kids?

Leukotriene antagonists (montelukast)
Or occasionally oral aminophylline

3

What is a nebuliser used for?

Acute attacks of e.g. Asthma, when oxygen is needed alongside inhaled medication

4

Management of acute asthma in kids?

Oxygen + everything possible short acting bronchodilator (consider neb) + oral pred
IV hydrocortisone (-> intensive care)
IV salbutamol and aminophylline

5

What medications are commonly used in pneumonia management in kids?

Amoxicillin/co-Amox
erythromycin

6

When does epiglottitis most commonly occur?

2-8 year olds

7

Most common causative organism of epiglottitis historically? What about now?

HiB
Now more common to be strep pneumoniae, GAS etc.

8

Presentation of epiglottitis?

Sore throat, odynophagia, drooling (can't swallow secretions)
Fever, tachy
Ant neck tenderness over hyoid
cervical lymphadenopathy

9

What features indicate severe epiglottitis?

Stridor, SOB/splinting
Dysphagia and dysphonia

10

Gold standard diagnostic for epiglottitis?

Fibre optic laryngoscopy

11

Most common complication of epiglottitis?

Abscess formation

12

Describe the use of PEFR in asthma investigations?

Do mornings and evenings (diurnal variation)
Observe day-day variation
And do in response to treatment (bronchodilator)

13

If you suspect epiglottitis what must you absolutely not do?

Stick a tongue depressor in

14

What factors of a gastroenteritis suggest a bacterial cause?

Bloody stool
Rapid dehydration
Severe abdo pain

15

What situations should increase index of suspicion for dehydration in kids with gastroenteritis?

Infants under 6m or low BW
Excess diarrhoea/vomiting
Unable to take extra fluids
Malnourishment

16

How is dehydration ideally investigated in kids?

Body weight change over course of illness; less than 5% is not clinically dehydrated, 5-10 % is clinical dehydration and >10% is shocked

17

Features which indicate dehydration in a child?

Look unwell, altered consciousness
Reduced urine output
Reduced skin turgor, dry mucus membranes
Sunken eyes and fontanelles
Tachycardia, tachypnoea

18

Features which indicate severe dehydration/shock in a child?

Features of dehydration + increased CRT, cold peripheries and mottled skin, weak pulses, hypotension, grossly sunken eyes

19

General principles of ORT in gastroenteritis in kids?

Avoid anti-diarrhoeals, Abx may be necessary if septic
If dehydrated and able to take oral fluids, ORT solution for maintenance and rehydration
If severe or unable to take oral, IVT rapid infusion followed by deficit and maintenance

20

What is impetigo?

Staph (occasionally strep) infection in skin causing honey-coloured crusting via vesicles/pustules/bullae rupture

21

RFs for impetigo?

Young kids
Preexisting skin stuff e.g. Eczema

22

Can kids with impetigo go to school?

No - not until lesions are cleared and dry

23

Signs of orbital cellulitis?

Proptosis
Painful eye movement
Reduced visual acuity

24

Causes of petechial/purpural rash and fever in kids?

Meningococcal sepsis or other bacterial
Infective endocarditis
ITP
HSP and other vasculitis
Entero-or other viruses

25

Viral causes of macropapular rashes + fever in kids?

HHV 6/7 (Roseola)
Enterovirus
Slapped cheek (PVB19)
Measles
Rubella

26

Bacterial causes of maculopapular rash + fever in kids?

Scarlet fever (GAS)
Erythema marginatum (rheumatic fever)
Salmonella typhi (typhoid rose spots)
Lyme disease (erythema migrans)

27

Non-infective causes of a maculopapular rash in kids?

JIA
Kawasaki

28

3 viral causes of vesicular rash in kids?

Chicken pox
HSV
Coxsackievirus - hand foot and mouth

29

Bacterial causes of vesicular rash in kids?

Impetigo
Boils and furuncles, carbuncles
Scalded skin, toxic epidermal necrolysis

30

Differentiating factors between nappy rash and thrush in kids?

Thrush may be present elsewhere e.g. Mouth, has satellite lesions, may have exudate and may appear in creases

31

What lesions are pathognomic of measles?

Koplich spots - White lesions in mouth

32

Symptoms of measles?

Coryzal, conjunctivitis, coughing
Febrile
Diffuse MP rash and Koplich spots

33

Describe urticaria?

'Hives' - itchy, blotchy skin (inflammation of superficial skin)
Central White papule (wheal) surrounded by erythematous flare
Can precede angioedema

34

What can HSV 1 and 2 cause in kids?

As well as cold sores, can cause gingivostomatitis
Eczema herpeticum
Herpetic whitlows
CNS infection
Conjunctivitis

35

Describe progression of chicken pox?

Papules appear day 0
Typically start crusting after 5 or 6 days
May be fluctuant fever and coryza

36

Progression of lesions in chicken pox?

Macule -> papule -> vesicle -> pustule -> crust

37

Complications of chickenpox?

Bacterial superinfection
Encephalitis

38

What infection does EBV most classically cause?

Mono

39

What virus is implicated in Burkitts lymphoma?

EBV

40

Common differential for measles and rubella?

Roseola infantum (HHV 6/7)

41

3Cs of measles? Other Sx?

Cough coryza conjunctivitis
Fever
MP rash and koplichs spots

42

Sx of mumps?

Fever, malaise, coryza
Parotitis - unilateral->bilateral

43

What blood result may be present in mumps? If associated with abdo pain what might be going on?

Increased amylase
Can cause pancreatitis

44

What complication may arise from the parotitis associated with mumps? Other major complications?

Transient unilateral hearing loss
Orchitis (mumps orchitis)

45

Features of rubella?

Major importance in congenital infection
Otherwise mild illness associated with non-itchy MP rash (like measles)

46

Describe the rash in rubella?

Maculopapular (ddx for measles, Roseola)
Non-itchy in kids

47

What is transient tachypnoea of the newborn?

Presumed retained lung fluid which causes tachypnoea amongst other symptoms in the newborn lasting 1-2 days

48

Major RFs for transient tachypnoea of the newborn?

Slightly preterm infants delivered by CS

49

CXR findings for transient tachypnoea of newborn?

Hyperinflation signs
Prominent pulmonary vasculature
Fluid in fissures

50

What is neonatal respiratory distress syndrome?

Combo of lack of surfactant and structural lung immaturity in preterm infants
Leading to tachypnoea, tachycardia, increased respiratory effort etc.

51

CXR findings of NRDS?

Reduced chest volume, ground glass appearance, air bronchograms
Absent thymus

52

Prevention and management of NRDS?

Prevention is maternal steroids before 34 weeks
Management is CPAP and other respiratory support

53

What is meconium aspiration syndrome?

Meconium passed into amniotic fluid in response to Fetal distress/hypoxia and then aspirated by fetus causing respiratory distress

54

RFs for NRDS?

Prematurity
Maternal DM
Multiple pregnancy

55

Indications of meconium aspiration syndrome?

Yellow-green amniotic fluid
Tachypnoea, brady/tachycardia
Cyanosis
Barrel chest
Low APGAR scores

56

Findings and CXR/ABG findings indicating meconium aspiration?

Crackles in chest
Respiratory acidosis
Hyperinflation, patchy atalectasis

57

In what babies is meconium aspiration more common?

Over 40 weeks

58

What is the likely cause of respiratory distress in a newborn at 41 weeks with yellow-green amniotic fluid?

Meconium aspiration

59

2 likely differentials for tachycardia at preterm gestations?

NRDS
TTN

60

What is meconium ileus?

Meconium sticky and creates obstruction in lower GI tract

61

What disease is meconium ileus suggestive of?

Cystic fibrosis

62

What is hypoxic ischaemic encephalopathy?

Evidence of asphyxia-related brain injury in neonates

63

2 common causes of hypoxic ischaemic encephalopathy?

Systemic hypoxaemia secondary to respiratory distress etc.
Reduced cerebral blood flow

64

Symptoms of severe hypoxic ischaemic encephalopathy?

Generalised seizures
Stupor/coma, loss of pupillary reflexes
Cardiorespiratory collapse
Hypotonia and absent primitive reflexes

65

Symptoms of mild hypoxic ischaemic encephalopathy?

Transient hypertonia and brisk reflexes
Behavioural abnormalities

66

Signs of moderate hypoxic ischaemic encephalopathy?

Hypotonia and diminished reflexes
Absent primitive reflexes
Apnoeas and mild seizures

67

Why is neonatal hypoglycaemia common?

Neonates have large glucose demand and poor glucose regulatory mechanisms

68

RFs for neonatal hypoglycaemia split into causes?

Decreased glucose - IUGR, prem, inborn errors of metabolism
Increased insulin - maternal DM
Increased requirements - hypothermia, sepsis, NRDS
Misc - hypothyroidism, polycythaemia, CNS stuff

69

What is hirschprungs disease?

Aganglionic bowel segments which therefore can't relax, meaning meconium cant be passed and leading to obstruction

70

When should meconium have been passed?

Most by 24 hours
Definitely by 48 hours

71

Gold standard investigation for hirschprungs?

Suction rectal biopsy

72

Other than failure to pass meconium, features suggestive of hirschprungs?

Greeny brown vomit
Obstruction - distension, flatus
Explosive bloody stools post PR

73

Management of hirschprungs?

Surgically resect the aganglionic segment, followed by reanastamosis

74

What chromosomal abnormality is linked to hirschprungs?

Down's syndrome

75

Aetiology of enlarged adenoids?

Recurrent or chronic infection e.g. EBV
Allergies and irritants
GORD

76

When are the adenoids largest? When have they significantly atrophied by?

Largest age 5ish, atrophy by age 7 and normally gone by teenage years

77

Symptoms of enlarged adenoids?

Recurrent sinusitis, OM, OME etc.
Chronic cough
Difficulty nose breathing, instead mouth breathing
Snoring, sleep apnoea and noisy breathing
Nasal voice

78

Investigation for suspected enlarged adenoids?

Flexible fibre optic nasopharyngoscopy

79

Management of enlarged adenoids?

Can try steroids and stuff, might end up whipping them out along with tonsils

80

What is used to screen for hearing abnormalities in the newborn?

EOAE (evoked otoacoustic emission)

81

How does visual acuity change in newborn? When is it like that of adults?

Starts off poor
Adult by about 3 years

82

Eye positional problem 'normal at birth'? When should this by gone by?

Squint - gone by 12 weeks

83

When does a palmar grasp arise?

4-6 months

84

When should lost body weight at birth be gone by?

10 days

85

When do motor problems manifest in kids?

Within first 18 months

86

When do speech and language problems manifest in kids?

Around 18m to 3yrs

87

When do social and communication problems manifest in kids?

2-4 years

88

Up to what age can brain injury potentially cause cerebral palsy in kids?

2 years

89

When are temper tantrums normal in kids?

15m-4yrs

90

When should kids have grown out of temper tantrums?

Around 5-6 years

91

1-2-3 approach to temper tantrums?

Ask child to stop and tell them what you want to do
Warn them what will happen if they don't stop
Punish them

92

Describe autistic spectrum disorders?

Pervasive developmental disorders which are lifelong

93

3 categories of ASD required symptoms?

Difficulty communicating
Difficulty with social interaction
Difficulty with behaviours, interest and activities

94

What 3 other disorders are common with ASDs?

Anxiety
Depression
ADHD

95

When does ADHD usually manifest in kids?

Age 5/6

96

3 criteria of ADHD?

Poor attention
Hyperactivity
Impulsivity

97

Management approaches to ADHD?

Behavioural, social support
Meds e.g. Methylphenidate (Ritalin)

98

Side effects of Ritalin (methylphenidate)?

Insomnia (give melatonin)
Reduced appetite

99

What personality disorder are kids with conduct disorder at 50% risk of growing into as an adult?

Dissocial PD

100

5 common causes of false positives for CF sweat test?

Atopic eczema
Dehydration
Malnutrition
Hypothyroid
Adrenal insufficiency

101

False negative for CF sweat test?

Oedema

102

2 breathing techniques for CF in kids? 1 for older kids?

Percussion and postural drainage
Forced expiration techniques

103

Symptoms of cardiac failure in kids?

SOB, trouble feeding, sweating, recurrent chest infections

104

Signs of cardiac failure in kids?

FTT, tachycardia, tachypnoea, cyanosis, heart murmurs, cardiomegaly, cool peripheries, hepatosplenomegaly

105

3 Hs of serious causes of constipation in kids?

Hypothyroid
Hirschprungs
Hypercalcaemia

106

Management of childhood IBD?

Elevated diet (amino acids)
Azathioprine
Avoid steroids long term

107

When and in whom does pyloric stenosis present?

6-8 week males

108

Electrolyte disturbances in pyloric stenosis?

Dehydration and hyponatraemia
Hypochloraemic, hypokalaemic metabolic alkalosis

109

What features of history in kids make cows milk intolerance more likely than GORD?

Diarrhoea
Allergic reactions

110

What tests are used in kids for cows milk protein intolerance?

RAST tests (Ab to food proteins)
Serum IgE
Jejunal biopsy - eosinophils in lam prop

111

When and in whom does intussusception present?

5-12 month males

112

What is nocturnal enuresis?

Nighttime bed wetting

113

What must you exclude to make transient synovitis diagnosis in acutely limping kids?

Septic arthritis
Perthes
Osteomyelitis
SUFE
TB arthritis
JIA

114

What is West Syndrome? When does it peak?

Infantile spasms - clusters of head nodding, arm jerks every 3-30 seconds
Peaks around 5m

115

Meds first line for absence seizures?

Ethosuximide

116

What is the presumed mechanism of stillbirth?

Lactic acidosis

117

What test is used for haemolytic disorders in little kids?

Coombs

118

3 reasons for physiological jaundice?

Increased bilirubin production from neonatal blood cell breakdown
Decreased bilirubin excretion due to liver immaturity
Immature gut flora

119

What is SIDS?

Unexplained death in infants less than 1 year old, peak 1-4m

120

3 preventative measures for SIDS?

Don't sleep prone - sleep supine
Don't smoke around kid
Prevent overheating

121

5 things that might make you think of NAI in kids?

Child discloses
Odd, incongruent or inconsistent history
Unusual mode of injury or presenting features
Presenting late to different doctor having missed routine appts
Non-parental adult presents with kid

122

Where are bruises common in toddlers?

Forehead, shins (learning to walk)

123

When are bruises in kids unusual?

Weird places e.g. Back, face, buttocks
Patterns e.g. Hand grip marks, specific objects, slap marks
If they are in immobile babies

124

Causes of NAI head injuries in kids?

Shaking - causes apnoea, hypoxic ischaemic damage
Subdurals or haemorrhages

125

What fractures are almost always due to NAI in kids?

Rib fractures, particularly posterior

126

Things that are suggestive of accidental burn rather than NAI burn?

Asymmetrical, flexure sparing, splash marks etc.

127

3 phases of whooping cough?

Catarrhal (1-2 weeks URTI)
Paroxysmal (cough typically around 1m, whoops)
Convalescent (chronic cough for 2 weeks)

128

Early Sx of tetanus?

Trismus (jaw locking) - muscle spasms in jaw
Worsening spasms in all muscle groups
Tetany

129

What type of vaccine is the DTaP?

Inactivated toxins

130

What does polio cause?

Headache, myalgia, generally unwell
And acute onset flaccid paralysis and areflexia in one limb (LMNL)

131

What does neonatal GH deficiency cause?

Hypoglycaemia
Jaundice
Doll face
Followed by FTT after 6-12 months

132

When should a kid be able to say their 1st and 2nd names?

3 years

133

When should a kid be counting to 10 and beyond?

4 years

134

Clinical features of hypothyroidism/cretinism?

Hypotonia, coarse facial features/big tongue, hoarse cry, dry skin, hypothermia, prolonged jaundice, umbilical hernia, short stature, developmental delay/learning difficulties, constipation
Delayed ant font closure

135

What characterises Kwashiorkor?

Severe protein deficiency (too many carbs) leading to chronic diarrhoea and abdominal distension, oedema, tight skin/funny coloured hair, irritability and anorexia

136

What characterises Marasmus?

Total calorie malnutrition leading to emaciated appearance with no abdominal dysfunction

137

How does the HSP rash change and develop?

Goes rapidly from urticaria to purpura