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Paediatrics 3 Flashcards

1
Q

What are the techniques that can be used to collect a urine sample from a baby?

A

Clean catch sample

Catheter specimen

Suprapubic catheter

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2
Q

List some causes of gross motor developmental delay:

A

Cerebral palsy

Duchene muscular dystrophy

Traumatic brain injury

Infections
- TORCH

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3
Q

At what age can a Diskus dry powder device for asthma be used?

A

> 8 years and above

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4
Q

If a cystic fibrosis patient presents with abdominal pain, what diagnosis should always be considered? and how is it diagnosed?
and how is it treated?

A

Distal Intestinal Obstruction Syndrome
- DIOS

Abdominal x-ray
+
Water- soluble contrast study

Stool softeners

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5
Q

What is the device used to deliver regular prophylactic antibiotics centrally to children and what group of patients maybe likely to have one?

A

Port-a-cath
(differs to a Hickman line as the tubes are underneath the skin)

Cystic fibrosis

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6
Q

What ages are children vaccinated against H. Influenza?

A

2,3,4 and 12

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7
Q

What things must you NOT do when presented with a child with likely epiglottitis?

A

Distress

Examine the throat

Cannulate (distressing)

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8
Q

What are the differentials for stridor:

A

Croup

Bacterial tracheitis

Foreign body

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9
Q

List some causes of stridor in children:

A

Epiglottitis

  • very high temperature
  • drooling
  • very unwell looking

Croup

  • barking cough
  • coryzal symptoms

Laryngomalacia
- 4 weeks of age

Inhaled foreign body

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10
Q

What is the term when the skull sutures widen apart and why is it clinically significant?

A

Suture Diastasis

if this is present with a fracture it is suggestive of Non- Accidental injury

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11
Q

What is the treatment of hypoglycaemia in a child who is unconscious? - with dose

A

Glucagon - IM or IV

2ml/kg of 10% Dextrose
or
2.5ml/kg of 10% Dextrose in neonate

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12
Q

What are the congenital disorders causing hypothyroidism? and what is the signs and symptoms?

A

Thyroid dysgenesis
- poorly formed or non existent

Thyroid dyshormonogenesis
- enzyme defect

Maternal Hypothyroidism
- iodine deficiency causing cretinism

Symptoms:

  • poor feeding
  • lethargy
  • hoarse cry

Signs:

  • prolonged jaundice
  • coarse faces
  • hypotonia
  • wide fontanelle
  • bradycardia
  • goitre
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13
Q

List some aetiologies to Vesico-Ureteric reflux and highlight the investigations and management:

A

Primary:

  • abnormal ureteric orifice
  • short submucosal tunnel

Secondary:

  • Obstructive - posterior urethral valves
  • Neuropathic bladder
  • dysfunctional bladder

Investigations:

  • MCUG
  • DMSA (for scarring)

Management:

  • prophylactic antibiotics
  • Laxatives to prevent constipation

Surgical:

  • STING operation - bulking
  • Re-implantation of ureters
  • Nephrectomy
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14
Q

What are the signs of a complex febrile seizure?

A

> 15 mintues

Focal neurology

> 2 seizures within 24 hours

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15
Q

What other disorders are associatted with austism?

A

ADHD
Tourettes
Depression
Fragile X syndrome

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16
Q

When is performing a LP contraindicated in suspected meningococcal disease?

A

In shock
- as they are unstable

Rash development
- DIC has begun so will have coagulopathy

Signs of raised ICP

*the rash if pathomenomic and the bacteria are not resistant to any forms of the antibiotics. therefore cultres and sensitivity from a LP add little value in the acute setting.
Further PCR of blood cultures can be obtained with 24 hours

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17
Q

What are the classic signs of infantile spasm (West Syndrome?)
and what is the treatment?

A

Flexion of head
Flexion of hips and legs
Extension of arms
- looks like a startled response

Prednisolone

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18
Q

What is the first line management for intussusception?

A

Catheter insertion with air inflation.
- done under fluoroscopic guidance

2nd line:
- urgent laparotomy with manual reduction

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19
Q

How can you distinguish oligoarticular JIA from Systemic JIA?

A

Systemic:

  • more severe
  • destructive
  • swinging fever
  • maculopapular rash

Oligo-articular affects larger joints and the patient is usually relatively well.

  • <4 joints
  • asymmetrical
  • uveitis
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20
Q

In precocious puberty in boys, if the testes are small what does this highlight and name a typical condition?

A

Shows a peripheral cause. Most commonly adrenal hyperplasia as this will create a negative feedback to FSH and LH which means reduced enlargement of testes.

*note if it was a sex-cord stromal tumour you would expect one testes to be larger than the other

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21
Q

What is the main cause of a massive G.I bleed in children between 1-2 years old - often requiring a transfusion?

A

Merkel’s diverticulum

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22
Q

What is the pathogen of Roseola infantum and what is the most common complication?

A

Human herpes -6 disease - HHV-6

Febrile convulsions

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23
Q

If a child <3 months has a UTI, what should the management be?

A

Admitted to hospital.

They will also require an ultrasound
plsu potentially further workup depending on atypical, recurrent etc

*IV amox + Gent

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24
Q

Why is hand preference <18 months a bad thing?

A

Suggestive of Spastic hemiplagia

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25
What are the major types of Cerebral palsy?
Spastic cerebral palsy - hemiplegia (one side) - diplegia (legs) - quadraplegia Extrapyramidal - Dystonic movements - chorea movements - Athetoid movements Ataxic cerebral palsy - cerebellar damage
26
List some key referral points in the developmental history:
No smile - 10 weeks Unable Sit unsupported - 12 month s no walking - 18 months Preferred dominance before 18 months
27
What is the most important cause of conjugated bilirubin to rule out in a baby with jaundice?
Biliary atresia
28
What is the definition of prolonged jaundice in a neonate?
Term baby: - >14 days Pre-term baby: - >21 days
29
What are differentials for respiratory distress in a neonate?
Transient tachypnoea of newborn Respiratory distress syndrome Meconium aspiration Pneumothorax Respiratory infection
30
What are the associated gastrointestinal defects with Down's syndrome?
Increased risk of: - Hirschsprung's disease - duodenal atresia - imperforate anus - oesophageal reflux - Coeliac disease
31
What are some of the symptoms of Rubella syndrome?
``` Cataracts Microphthalmos - abnormal eye formation Sensorineural hearing loss Thrombocytopenic purpura/ Blue berry muffin rash Heart defects: PDA most common ```
32
List some teratogenic drugs and their effects:
Phenytoin: - cleft lip - cardiac defects - craniofacial abnormalities (foetal hydantoin syndrome) Sodium Valproate - neural tube defects Lithium - Ebstein's anomaly Warfarin - frontal bossing - cardiac defects Tetracycline - discoloration of teeth
33
What features of short stature suggest a pathological origin:
Discrepancy between weight and height Movement away from mid-parental height Slow velocity of height
34
What are the definitions of faltering growth:
A drop deceleration of >2 centiles in weight Extremely low BMI Slow height growth or weight for length Weight less than 5th percentile more than 2 occasions
35
When is the Guthrie heel prick test done, what 5 core conditions are tested for and what are some caveats to performing the test?
Completed at 5 days old. ``` PKU Congenital hyporthyroidism (cretinism) Cystic fibrosis sickle cell diseases MCADD Maple Syrup Urine Disease ``` Infants must have been on milk feeds for at least 48 hours and not had a blood transfusion in the last 72 hours.
36
What is the term used to describe a flattened one side of the head due to the position of the child?
Positional plagiocephaly
37
What sign is seen bilaterally on both sides of the costal margin across he diaphragm in chronic asthma and in osteomalacia?
Harrison's sulcus Diaphragm tension pulls the bones in causing a groove. this may be from normal tension with soft bones as seen in osteomalacia or in abnormal tension as seen in chronic lung disease
38
Give some differentials for an acute and chronic cough:
Acute: - URTI - Croup - Bronchiolitis - Acute exacerbation of asthma/ Viral wheeze - Pertussis - Inhaled foreign body Chronic: - Asthma - Infection - GORD - Chronic illness (CF, Kartagener)
39
What is the most common cause of pneumonia in 5-15 year olds?
Mycoplasma pneumoniae
40
What age must a child be to use a dry powder device?
>8 years old
41
High light the key management of cystic fibrosis:
Daily chest physiotherapy Prophylaxis antibiotics - may require portacath Creon supplements Fat soluble vitamins High calorie diet
42
What are the two main screening methods for CF?
Immunoreactive trypsinogen - done on spot test Sweat test, genetic testing *done if failure to thrive and failure of first pass meconium
43
List 5 causes of cyanosis in a child:
Respiratory disease Cardiac During a seizure Stress - infection, hypoglycaemia CNS depression - drugs - trauma
44
List some differentials for hepatosplenomegaly:
Infection - malaria - parasitic infection Congestive cardiovascular disease Extramedullary hematopoiesis - thalassemia Malignancy - leukemia
45
What are the top causes for haematemesis?
Swallowed blood - from cracked nipples - epistaxis Repeated vomit Ulceration/ hiatus hernia Bleeding disorders Oesphageal varices `
46
List 5 medical causes of acute abdomen in a child:
Gastroenteritis Henock sholien Constipation DKA Acute nephritis
47
List 5 surgical causes of acute abdomen in a child:
Acute appendicitis Intussusception Volvulus Strangled inguinal hernia Torsion of testes
48
What are the risk factors for iron deficiency anaemia in children and what can be given alongside the supplements to aid absorption:
Preterm Low birth weight Multiple births Excessive cow's milk Vitamin C increases absorption
49
What are the poor prognostic indicators for leukemia?
``` Age <1 year, >10 years Male T cell linage WCC >50 Failure to respond to chemotherapy ```
50
What are the features of malignancy in lymphadenopathy?
Supraclavicular, epitrochlear nodes Systemic symptoms Hepatosplenomegaly Signs of marrow infiltration
51
What are the top causes of malignant lymphadenopathy in children?
ALL, AML Lymphoma Hodgkin's disease Neuroblastoma Rhabdomyosarcoma
52
List some differentials for abdominal masses which are malignant:
``` Neuroblastoma Wilm's tumour Hepatoblastoma Lymphoma Germ cell tumours ```
53
Highlight some of the signs and symptoms seen in neonates who have meningitis:
High pitched crying Uncontrollable crying Poor feeding Cyanotic episodes Seizures Budging fontanelle
54
What things should be analysed for in CSF of a child with suspected meningitis?
WCC Protein Organism cultures/ staining PCR for pneumococcus/ meningococcus/ HSV/ VZV and enterovirus
55
What is the treatment for bacterial meningitis?
<6 weeks: - IV Cefotaxime - Amoxicillin - Gentamicin >3 months + dexamethasone *only add if no petechial or purpuric rashes
56
What is the management for sepsis in a child (not listing sepsis 6):
High flow oxygen IV fluid - 20mls/kg 0.9% saline IV cefotaxime Correction of metabolic derangements
57
What are the most common causes of oedema in children?
Heart failure Nephrotic syndrome Liver failure Malnutrition
58
What are the risk factors for nephrotic syndrome and what are some investigations into it and how is it treated?
``` Male Asian Previous infection Previous nephrotic syndrome Family history ``` Investigations - FBC - U&Es - LFTs - complement studies - Infection (varicella, Streptolysin O antigen) - Urine - PCR - Biopsy (if indicated) Treatment: - High dose prednisolone - 20% albumin + furosemide - Pneumococcal vaccine - Penicillin prophylaxis - salt/ fluid restriction
59
During an asthma attack or severe croup what blood pressure sign may be seen and why?
Pulsus paradoxical - more than a >10mmHg drop in the systolic blood pressure during inspiration than expiration. probably due to less blood being able to enter the lung, bulging the right atrium compressing the left atrium reduces preload.
60
What are the drugs used in an acute asthma attack in children?
``` Oxygen Salbutamol Hydrocortisone Ipratropium Theophylline ``` "O-SHIT"
61
What are the degrees of dehydration in a child, and what is the volume of replacement?
mild 5% body weight (50ml/kg): - lethargic - loss of skin turgor - dry mouth - fontanelle slack moderate 10% (100ml/kg): - tachycardia - tachypnoea - fontanelle sunken - eyes sunken - mottle skin Severe 15% (>150ml/kg) - shock - hypotension Replacement: - body weight loss - maintenance (150ml/kg infants, 100ml/kg children) - fluid loses *fluid is replaced over 48 hours. so is added onto the chart
62
What are the drugs used in infantile spasm disorders?
ACTH or Corticosteroids
63
What is the complication that can occur with diffuse neonatal haemangiomatosis and segemental haemangiomas?
High output cardiac failure
64
What is the amount of neonatal need for fluid?
150ml/kg/day After day 5
65
What constitutes the HEAD assessment for adolescents?
Home life Education Activities Drinking Driving Drugs Sex Smoking Suicide
66
What is the order of puberty in males and females?
Females: - Breast development - Pubic hair - Rapid growth - Menarche Males: - Testicular enlargement - Pubic hair growth - Height spurt
67
What drug can be used in delayed puberty in males?
Oxandrolone or in older males intramuscular testosterone injections
68
What factors can be implemented to help with transitioning from paediatric services to adult?
inform early Run specific teenage clinics INvolve the GP Encouragement self help
69
Highlight the management of a febrile seizure and list some differentials:
If: less than 5mins and well and present then: - antipyretics If >5mins or not well - Buccal midazolam or - PR diazepam - education o parents and risk of recurrence. *to seek medical advice if it occurs >5mins. differentials: - Meningoencephalitis - Epilepsy

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