Paediatrics Flashcards
1
Q
What is the normal HR, systolic BP and RR for a child under 1?
A
HR - 110-160
SBP - 70-90
RR - 35-45
2
Q
What is the normal HR, systolic BP and RR for a child aged 1-5?
A
HR- 95-140
SBP- 80-90
RR- 25-35
3
Q
What is the normal HR, systolic BP and RR for a child aged 5-12?
A
HR- 80-120
SBP- 90-110
RR- 20-25
4
Q
What infections are covered by the 6 in 1 vaccine?
A
Diptheria, Tetanus, Pertussis, Polio, Haemophilus influenza, Hep B
5
Q
What vaccines are given at 2 months?
A
6 in 1
Pneumococcal
Rotavirus
Meningococcal B
6
Q
What vaccines are given at 3 months?
A
6 in 1
Rotavirus
7
Q
What vaccines are given at 4 months?
A
6 in 1
Pneumococcal
Meningococcal B
8
Q
What vaccines are given at 12-13 months?
A
Hib/Men C
Pneumococcal
MMR
Men B
9
Q
What vaccines are given at 3 years 4 months?
A
DTP and polio
MMR
10
Q
What vaccine is offered to girls aged 11-13?
A
HPV
11
Q
What vaccines are given to teenagers?
A
Tetanus, diptheria, polio
Meningococcal ACWY
12
Q
When is considered precocious puberty?
A
Girls <8
Boys <9
13
Q
When is normal range of puberty?
A
Girls- 8-13
Boys- 9-14
14
Q
When is the average age of puberty?
A
Girls- 11
Boys- 11.5
15
Q
What is considered delayed puberty?
A
Girls- >13
Boys- >14
16
Q
What are the 3 stages of puberty in girls?
A
Thelarche - budding of breast tissue
Adrenarche - development of body hair and odour
Menarche - commencement of menstruation (usually about 2 years after thelarce)
17
Q
How is puberty defined in boys?
A
Growth of testicles >4ml
18
Q
What are the benefits of breast feeding for the mother?
A
Bonding
Reduces risk of breast cancer
Weight loss
19
Q
What are the benefits of breastfeeding for the baby?
A
Transfer of IgA
Reduced lifetime risk of obesity, diabetes and atopy
20
Q
What is the ratio of formula to water?
A
1 scoop per 30 ml of water that has been boiled and cooled
21
Q
When should the process of weaning be started?
A
Around 6 months
22
Q
When can full fat cows milk be introduced to infants?
A
From 1 year
23
Q
What organisms cause the common cold?
A
Rhinovirus, RSV, coronavirus
24
Q
How does the common cold present?
A
Sneezing, rhinorrhoea, mild fever, associated sore throat, AOM
25
How is the common cold managed?
Analgesia, rest, fluids
26
What are complications of the common cold?
Secondary bacterial infection, bronchitis
27
What is croup?
Acute laryngotracheobronchitis
28
What age group does croup affect?
6 months to 6 years
29
What is the commonest cause of croup?
Parainfluenza virus
30
How does croup present?
Viral prodome over a few days followed by barking cough, rasping stridor, hoarseness. Still able to eat and drink. If severe may be recession and cyanosis
31
How is croup diagnosed?
Mainly clinical signs
| Can do AP neck x-ray
32
What does an AP neck x-ray show in croup?
Narrowing of trachea - steeple sign
33
How is croup managed?
```
Steroids stat (dexamethasone/prednisolone)
If severe can give nebulised adrenaline, oxygen +/- intubation
```
34
What is a complication of croup?
Secondary bacterial tracheitis - thick mucopurulent exudate and pronounced tracheal tenderness
35
What is epiglottitis?
Acute bacterial infection of epiglottis
36
What ages does epiglottitis affect?
Ages 2-7
37
What causes epiglottitis?
Haemophilus Influenzae
38
How does epiglottitis present?
Sudden onset, drooling, unable to swallow, soft stridor, muffled voice, feverish, systemically upset, respiratory distress, adopts tripod position
39
What investigation would you do for epiglottitis and what would it show?
Lateral neck x-ray - thumb print sign
40
How is epiglottitis managed?
Do NOT wait for x-ray before initiating management
Do NOT examine throat
Call ENT/anaesthetics for rigid laryngoscopy and intubation
Antibiotics - IV ceftriaxone
41
What is bronchiolitis?
Acute lower respiratory tract infection
42
What age group is bronchiolitis seen in?
Under 1 years
43
What is the commonest cause of bronchiolitis?
RSV
44
How does bronchiolitis present?
History of cold, dry cough, worsening breathlessness, wheeze, cyanosis, intercostal recession, atelectasis
45
What does a CXR show in bronchiolitis?
Hyperinflation with patchy changes
46
How is bronchiolitis managed?
Supportive - oxygen, oral feeding limited, calpol
47
What are some common causes of pneumonia in children?
Strep pneumoniae, staph A, group A strep
48
How is non-severe bacterial pneumonia treated in children?
```
<1 = co-amoxiclav
>1 = amoxicillin
```
49
How is severe bacterial pneumonia treated in children?
Co-amoxiclav +/- clarithromycin
50
What is whooping cough?
LRTI/acute bronchitis in children
51
What is the cause of whooping cough?
Bordatella Pertussis
52
How does whooping cough present?
1-2 weeks mild cold symptoms
2-6 weeks of paroxysmal cough with inspiratory whoop
2-4 weeks of lessening symptoms that take a whole month to resolve fully
53
How is whooping cough treated?
Clarithromycin (must be given within 21 days of onset)
54
What are the 3 key characteristics of asthma?
Reversible airflow obstruction
Airway hyper responsiveness
Bronchial inflammation
55
What are some symptoms of asthma?
Reversible airflow obstruction, wheeze, dyspnoea, nocturnal cough
56
What are some triggers of asthma?
Pollen, dust, feathers, exercise, viruses, cold air, chemicals
57
What is the initial investigation of choice for asthma?
Spirometry
58
What is the first line treatment for asthma in children?
SABA
59
What should be added to a SABA first line in children over 5?
Very low dose ICS
60
What should be added to a SABA first line in children under 5?
LTRA
61
SABA + very low dose ICS aged 6 - what next?
LABA
62
SABA + very low dose ICS + LABA - what next?
Increase steroid dose or add LTRA
63
What other therapies can be considered in childhood asthma?
Theophylline
| Prednisolone
64
How is a severe asthma attack managed?
```
Oxygen
Salbutamol (inhaler/nebs)
Ipratropium bromide (neb)
Magneium sulphate (150mg in each neb)
Prednisolone (30-40mg if over 5, less if under)
```
65
What is osteogenesis imperfecta?
Defect in maturation and organisation of type 1 collagen
66
What are some symptoms of osteogenesis imperfecta and what is it an important differential for?
Multiple fragility fractures, short stature, deformities, blue sclera, deafness
NAI
67
What is skeletal dysplasia?
Short stature due to a genetic error (e.g. achondroplasia)
68
What is Duchenne MD?
X-linked recessive defect in dystrophin gene
69
How does Duchenne MD present?
Progressive proximal muscle weakness, calf pseudohypertrophy, Gowers sign positive
70
How is Duchenne MD diagnosed?
Increased serum CK, abnormalities on muscle biopsy
71
What is cerebral palsy?
Insult to an immature brain causing irreversible damage
72
What are some causes of cerebral palsy?
Genetics, malformations, IU infection, hypoxia at birth
73
What are some types of cerebral palsy?
Spastic, ataxic, athetoric
74
What is spina bifida?
Failure of primary neural tube to close in 1st 6 weeks of gestation
75
What is the mildest form of spina bifida?
Spina bifida occulta
76
What is polio?
Viral infection affect anterior horn cells resulting in LMN defect
77
What is Erb's Palsy?
Upper brachial plexus damage (C5+6)
78
How does Erb's palsy present?
Internal rotation of the humerus - waiters tip
79
What is Klumpke's palsy?
Lower brachial plexus damage (C8+T1)
80
How does Klumpke's palsy present?
Paralysis of intrinsic hand muscles. Can also cause Horner's syndrome due to sympathetic nerve disruption
81
What is developmental dysplasia of the hip?
Dislocation/subluxation of the femoral head in the perinatal period
82
What are some risk factors for DDH?
```
Female sex
Positive family history
Breech
1st born
Downs syndrome
```
83
What are signs of DDH?
Shortening of limb, asymmetrical thigh and groin creases
84
What tests should be done in the newborn examination to check for DDH?
Barlows (dislocating the hip - click)
| Ortolanis (relocating the hip - clunk)
85
How is DDH investigated?
USS hip
86
How is DDH treated?
Pavlick Harness - keeps hips in flexion and abduction
87
What is transient synovitis?
Self limiting inflammation of the synovium commonly occurring after an URTI
88
What age and sex is transient synovitis commonest in?
Ages 2-10
| Boys
89
What is the commonest cause of hip pain in kids?
Transient synovitis
90
How is transient synovitis treated?
NSAIDs + rest
91
What is Perthes disease?
Idiopathic osteochondritis of the femoral head
92
How does Perthes present?
Hip pain which may be referred to the knee
Limping
Loss of internal rotation
Positive Trendellenberg
93
How is Perthes treated?
Usually self limiting
| Avoidance of physical activity
94
What does an X-ray show in Perthes?
Flattening of the femoral head
95
What is SUFE?
Femoral head slips inferiorly to the femoral neck
96
Who does SUFE usually affect?
Overweight adolescent boys
97
How does SUFE present?
Pain felt either in groin or solely in the knee (via the obturator nerve)
98
How is SUFE treated?
Surgery to pin the femoral head
99
What is Osgood-Schlatter?
Tibial apophysitis - inflammation of the tendons attachment to the bone
100
How does Osgood-Schlatter present?
Pain tenderness and swelling over tibial tubercle
| Seen in sport teenagers
101
How is Osgood-Schlatter treated?
Rest, ice, analgesia, physio
102
What is patellar tendonitis?
Inflammation of patellar tendon - commonly seen in teenage boys
103
How does patellar tendonitis present?
Chronic anterior knee pain worse after running. Tenderness under patella
104
How is patellar tendonitis treated?
Rest, physio
105
What is chondromalacia patellae?
Softening of the knee cartilage commonly seen in teenage girls
106
How does chondromalacia patellae present?
Anterior knee pain typically on walking up and downs stairs and rising from prolonged sitting
107
How is chondromalacia patellae treated?
Physiotherapy
108
What is osteochondritis dissecans?
Cracks in the articular cartilage and in underlying subchondral bone
109
How does osteochondritis dissecans present?
Poorly localised pain, effusion and occasional locking after exercising
110
How is osteochondritis dissecans treated?
Rest, NSAIDs, microfracture removal, osteoarticular transfer
111
What is talipes equinovarus?
Clubfoot - abnormal alignment of talus, calcaneus and navicular
112
What are some risk factors for club foot?
Male sex
Family history
Breech
Oligohydramnios
113
How is club foot treated?
Ponseti technique
114
How does eczema often present in children?
On the face and extensors
115
What is cradle cap?
Sebhorrhoeic dermatitis - non-itchy yellow scale
116
What is nappy rash?
Contact dermatitis - confluent erythema with sparing of the skin around where nappy is
117
How is nappy rash treated?
Frequent nappy changes, dry baby well post bath, topical steroid + antifungal, barrier cream
118
What causes molluscum contagiosum?
Pox virus
119
How does molluscum contagiusum present?
Itchy pink/white umbilicated pearly papules
120
What causes impetigo?
Staph Aureus
121
How does impetigo present?
Straw coloured lesions with a yellow crust
122
What is Epidermolysis Bullosa?
Genetic condition resulting in easy blistering of the skin due to epidermis separating from dermis
123
What causes rubella?
Rubella virus
124
How does rubella present?
Pink, discrete, maculopapular rash starting on face and spreading to rest of body
Assosicated sub-occipital lymphadenopathy
125
How is rubella treated?
Supportive - rest, fluids, analgesia
| Notify public health
126
What causes Mealses?
Measles virus
127
How does Measles present?
Maculopapular rash starting on face and spreading, lasting 6-8 days.
Koplik spots in the mouth are pathognomonic - look like grains of sugar on the mucosa
128
How is Measles treated?
Supportive - rest, fluids, analgesia
| Notify public health
129
What causes Roseola Infantum?
Human Herpes Virus 6
130
How does Roseola Infantum present?
Usually a high spiking fever, followed by a rose coloured maculopapular rash on the trunk that spreads periperally
131
How is Roseola Infantum treated?
Supportive
132
What causes Scarlet fever?
Group A strep
133
How does Scarlet fever present?
Sandpaper like rash in neck and chest. Red face but peri-oral pallor. Strawberry tongue.
134
How is Scarlet fever treated?
Penicillin V
135
What causes glandular fever?
Epstein Barr Virus
136
How does glandular fever present?
Widespread erythematous rash, exudative pharyngitis, tender lymph nodes, hepatosplenomegaly
137
What causes Erythema Infectiosum?
Parvovirus B19
138
How does Erythema Infectiosum present?
Bilateral macular erythema on face, maculopapular rash with lacy erythema on trunk, fever
139
How is Erythema Infectiosum treated?
Supportive
140
What causes chicken pox?
Varicella Zoster
141
How does chicken pox present?
Intensely itchy rash that starts with macules and progresses into papules and vesicles that burst and crust over
142
How is chicken pox treated?
Supportive
143
What causes Hand, Foot & Mouth disease?
Coxsackie virus
144
How does Hand, Food and Mouth present?
Viral prodome
| Painful vesicles on hands, feet and mouth. Greyish in colour.
145
What is Henoch-Schonlein Purpura?
Small vessel vasculitis associated with IgA
146
What is the triad of symptoms of HSP?
Palpable purpuric rash
Arthritis
Colicky abdo pain
147
How is HSP treated?
Most resolve themselves within 6 weeks
| Steroids + NSAIDs for symptoms
148
What causes Idiopathic thrombocytopenia?
IgG autoimmunity
149
How does ITP present?
Post infective purpura, petechiae and mucosal bleeding
150
When does pyloric stenosis occur?
Within the first 12 weeks of life - commoner in boys
151
How does pyloric stenosis present?
Projectile vomiting occuring after feeds. Vomit is non-bilius and milky. May be constipated due to dehydration
152
What investigations should you do for pyloric stenosis?
Abdo exam - may palpate an 'olive sized mass'
| USS if unable to feel
153
How is pyloric stenosis treated?
Surgically - Ramstedts Pyloromyomotomy
154
What can cause GORD in children?
Liquid diet, horizontal position, low LOS pressure
155
How does GORD present?
Regurgitation, irritability, failure to thrive, Sandifers syndrome, laryngitis, heartburn
156
How is GORD investigated?
Diagnosis usually clinical - can do endoscopy/oesophageal pH
157
How is GORD treated?
```
Feed in prone position
Sit upright after feeds
Thicken feeds (Carobel)
Antacids (Gaviscon)
Ranitidine
```
158
What is intussusception?
Telescoping of the bowel causing obstruction, commonly at the terminal ileum
159
Who does intussusception commonly occur in?
Infants aged 6-18 months
160
How does intussusception present?
Spasms of colic, bile stained yellow vomit, red jelly stools, palpable sausage like mass
161
What does a USS show in intussusception?
Target sign
162
How is intussusception managed?
Pneumatic reduction
163
What is malrotation and volvulus caused by?
Absent attachments of small bowel mesentery leading to instability and allows other organs to wrap around each other
164
How does malrotation present?
Bile stained vomit, circulatory collapse, tender abdomen
165
How is malrotation/volvulus managed?
Surgery - surgical emergency
166
What is the commonest surgical emergency in kids?
Appendicitis
167
How does appendicitis present?
Vague abdo pain then pain in RIF. Pain worse on movement, flexing of knees, abdominal guarding, McBurneys sign positive
168
What is mesenteric adenitis?
Inflammation of mesenteric lymph nodes, usually secondary to infection
169
How does mesenteric adenitis present?
Fever, acute onset RIF pain,
170
What does USS show in mesenteric adenitis?
Enlarged mesenteric lymph nodes
171
How is mesenteric adenitis managed?
Supportive care
172
What are some causes of gastroenteritis?
Viral - rotavirus
Bacterial - campylobacter, Ecoli, c diff
Parasitic - giardiasis
173
What is an abdominal migraine?
Episodic abdominal pain lasting over 1 hour. Patient well inbetween episodes
174
How is abdominal migraine treated?
Acute - rest, analgesia, sumitriptain
| Prevention - Pizotifen, propranolol
175
What is Toddlers diarrhoea?
Benign and self limiting condition that resolves by ages 5-6
176
How does Toddlers diarrhoea present?
Up to 12 stools per day, visible lumps of undigested food in stool. No abdominal symptoms. Thriving child
177
How is Toddlers diarrhoea managed?
Reassurance. Can use loperamide occasionally
178
How does cows milk intolerance present?
Chronic diarrhoea
179
How is cows milk intolerance managed?
Continue milk free diet with challenge tests every 6 months
180
How does coeliac disease present in children?
Diarrhoea, pale stool, bloating, growth failure, anaemia
181
How is coeliac disease diagnosed?
Anti TTG screening test
Endoscopy with biopsy shows crypt hyperplasia with flattened villi
Kids can be diagnosed solely on bloods if TTG 10x normal level
182
What conditions is coeliac associated with?
Autoimmune conditions, Downs syndrome, Turners Syndrome
183
What causes cyanotic heart disease?
Deoxygenated blood mixing with systemic circulation
184
What condition is associated with ostium primum ASD?
Downs syndrome
185
How does a ventricular septal defect present?
Breathlessness, recurrent chest infections, pansystolic murmur
186
What is coarctation of the aorta?
Narrowing of the aorta at the ductus arteriosis
187
What is coarctation of the aorta associated with?
Turners syndrome
188
How does coarctation of the aorta present?
CCF, collapse, weak/absent femoral pulses, hypertension in upper limbs
189
What is tetraology of fallot?
Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy
190
What are Fallots spells?
Episodes of cyanosis due to spasm of subpulmonary muscle
191
What is transposition of the great vessels?
Right ventricle gives rise to aorta
Left ventricle gives rise to pulmonary artery
Incompatible with life
192
What is the commonest cause of a heart murmur in children?
Innocent murmur
193
'Pansystolic murmur heard loudest on the lower left sternal edge with parasternal thrill'
VSD
194
'Ejection systolic murmur heard best at the upper left sternal edge with a fixed splitting of S2'
ASD
195
Ejection systolic murmur heard best between the shoulder blades associated with weak femoral pulses and a radio-femoral delay
Coarctation of aorta
196
Continuous machine like murmur heard best below the left clavicle
Patient ductus arteriosis
197
What is a febrile convulsion?
Infantile seizures that develop as a result of a febrile illness
198
At what age do febrile convulsions usually occur?
Between 6 months and 6 years - peak incidence around 18 months
199
How does a simple febrile convulsion present?
Generalised tonic clonic seizure, duration <5 mins, completely recovery within an hour
200
How does a complex febrile convulsion present?
Focal onset, lasting over 10 mins, recurrent seizures in one febrile illness, febrile status epilepticus
201
What is the risk of recurrence of febrile seizures?
1 in 3
202
What increases the risk of recurrence of febrile seizures?
Age below 18 months
Family history
Low grade and short duration of fever
Multiple seizures
203
What is the risk of epilepsy?
```
Simple = 2%
Complex = 6-8%
```
204
How should a parent manage a febrile convulsion?
Stay calm, protect child from harm
Check nothing in mouth
Once seizure over put child into recovery position
Be aware that child may be sleepy for 1 hour
205
What rescue medication can be given to parents?
Rectal diazepam or buccal midazolam
| Should be given if seizure lasts more than 5 mins
206
What is the triad of symptoms associated with ADHD?
Impulsivity
Inattention
Hyperactivity
207
What are risk factors for ADHD?
Prematurity, LBWW, brain damage, alcohol/smoking/drug use during pregnancy
208
What are some psychological therapies for ADHD?
Parent training
| Social skills training
209
What is the first line pharmacological management of ADHD?
Stimulants - methylphenidate, dexamfetamine
210
What is second line pharmacological management of ADHD?
Non-stimulants - atomoxetine
211
What are the two key areas of difficulty in ASD?
Persistent deficits in social communication and interaction
| Restricted, repetitive patterns of behaviour, interests and activities
212
What symptoms may people with ASD have?
Problems with social cues, fixed thinking style, inflexible thinking, need for routine, odd prosody, echolalia, video speak, sensory issues, may be coexistant LD, behavioral issues
213
Is there a treatment for the core symptoms of autism?
No
214
What pharmacological therapies can be given for aggression in autism?
Risperidone/aripiprazole short term
215
What pharmacological therapies can be given for other symptoms of autism?
Antianxiety drugs, anti-depressants, melatonin
216
What is the ratio of chest compressions to breaths in children?
15:2
217
What should be given before starting chest compressions in paediatric BLS?
5 rescue breaths
218
What should you use for chest compressions in a child under 1?
2 fingers
219
If a child over 1 is choking what should you do?
5 back blows
220
If a child is under 1 and choking what should you do?
5 abdominal thrusts
221
What is Kawasaki disease?
Vasculitis commonly seen in children
222
How does Kawasaki disease present?
```
High grade fever lasting >5 days
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles which later peel
```
223
How is Kawasaki disease managed?
High dose aspirin
IV Immunoglobulins
Echocardiogram
224
Why is an echocardiogram done in Kawasaki disease?
Because coronary artery aneurysm is one of the main complications
