Paediatrics Flashcards
1
Q
What is the most common pathogen causing respiratory infections in children?
A
Respiratory Syncytial Virus (RSV)
2
Q
Which virus causes the common cold?
A
Rhinovirus
3
Q
What is the treatment for tonsillitis?
A
10 day course of penicillin
4
Q
What would you see on examination of the ear in otitis media?
A
Red, bulging, non reflective tympanic membrane
5
Q
How to treat otitis media?
A
co-amoxiclav, analgesia
6
Q
What are the symptoms of croup?
A
Barking cough, stridor, hoarseness
7
Q
What is stridor?
A
A low pitched inspiratory sound caused by upper airways obstruction
8
Q
What precededs croup?
A
Coryza and a fever
9
Q
In what season does croup most commonly occur?
A
Autumn
10
Q
What age would you expect a child with croup to be?
A
2
11
Q
Treatment of croup
A
- Oral dexamethasone - 15mg/kg
12
Q
What would you hear on auscultation in a patient with bronchiolitis?
A
Widespread wheeze and crepitations
13
Q
What are the risk factors for bronchiolitis?
A
Premature birth, pre-existing lung pathology, immunosuppression
14
Q
If you suspect upper airways obstruction (e.g. in croup and epiglottitis) what should you not do and why?
A
EXAMINE THE THROAT - may close airways fully
15
Q
How will a child with epiglottitis look?
A
Drooling, sitting open mouthed and upright, not speaking or swallowing, tripod position
16
Q
Treatment for epiglottitis?
A
IV Cefuroxime
17
Q
How to tell the difference between croup and epiglottitis?
A
- No cough in epiglottitis vs barking cough in croup
- Drooling in epiglottitis
- High grade fever in epiglottitis
18
Q
What bug causes whooping cough?
A
Bordetella pertussis
19
Q
What is the treatment for whooping cough?
A
Erythromycin
20
Q
What are the symptoms of whooping cough?
A
Inspiratory whoop in between coughs, severe cough which may end in vomiting, subconjunctival haemorrhage
21
Q
What is the most likely cause of pneumonia in newborns?
A
Group B strep from mother’s genital tract
22
Q
What are the symptoms of pneumonia?
A
- Fever
- Increased work of breathing
- Tachypnoea
23
Q
LABAs e.g. …………. should always be used in conjunction with………?
A
Salmeterol, inhaled corticosteroids
24
Q
Asthma add-on therapy in under 5s?
A
Montelukast
25
What are the features of a severe asthma attack?
1. Silent Chest
2. Sats <92%
3. Cyanosis
4. Fatigue and drowsiness
26
How to treat a severe asthma attack? (4)
1. Oxygen
2. Steroids
3. B2 agonists
4. Ipratropium bromide nebulised
27
What would you be worried about in a persistent wet cough?
Bronchiectasis
28
What changes happen in the heart at birth?
The foramen ovale (link between atria) closes
| The ductus arteriosus (shunt between aorta and pulmonary arteries) closes
29
When will neonates present with heart failure?
When the ductus arteriosus closes at 1-2 days old
30
How will a neonate present with heart failure?
murmur, shock, cyanosis, acidosis, collapse
31
What makes you think a heart murmer is NOT benign?
1. Diastolic
2. Thrills
3. Radiation
32
How to treat heart failure in neonates?
Prostaglandins to keep the ductus arteriosus open
33
What causes heart failure in neonates?
Coarcted aorta, aortic valve stenosis
34
What causes heart failure in infants?
VSD, AVSD
35
How does heart failure in infants present?
Breathlessness, pulmonary oedema
36
How to treat heart failure in infants?
Diuretics and catopril
37
What is the pathophysiology of kawasaki disease?
Vasculitis of the coronary arteries - causing clots and coronary aneurysms
38
Who gets kawasaki's disease?
Boys under 5 years
39
What are the symptoms of Kawasaki's?
CRASH and burn:
1. Conjunctivitis
2. Rash
3. Adenopathy - enlarged cervical lymph nodes
4. Strabery tongue
5. Hands and feet swell and get a rash
6. Burn/fever
40
Treatment of Kawasaki's?
IVIg and aspirin
41
What is the possible complication of aspirin in children?
Reye's syndrome - brain and liver damage
42
What are the SEPSIS 6? (3 in, 3 out)
1. Oxygen
2. Fluids
3. Antibiotics
4. Lactate
5. Urine output
6. Blood cultures
43
Which antibiotic to use in suspected sepsis with CNS infection?
Cefotaxime
44
What are the symptoms of sepsis?
1. Tachycardia
2. Fever
3. Tachypnoea
4. Low blood pressure
45
What would you see in a lumbar puncture in bacterial meingitis?
VERY HIGH WHITE CELLS IN CSF
46
Treatment of meningitis in patients under 3 months?
IV Cefotaxime and amoxicillin
47
Treatment of meningitis in 3 months - 16 year olds?
Ceftriaxone
48
What is the treatment for encephalitis?
IV Acyclovir
49
What is the usual cause of encephalitis?
HSV - Herpes Simplex Virus
50
Fever, bulging fontanelles, loss of consciousness, seizure, behavioural change.... what do you think?
Encephalitis
51
How will the CSF look in bacterial meningitis?
Cloudy/turbid
52
If the CSF is high in protein and low in glucose, what is the cause of the meningitis?
Tuberculosis (really high and low) or bacterial meningitis
53
How is necrotising fasciitis treated?
Clindamycin and debridement of necrotic tissue
54
39 degree fever, diffuse rash, skin shedding, hypotension, fever, chills, vomiting, pain.... what are you thinking?
Toxic Shock Syndrome
55
What drugs are used to treat tuberculosis and duration of each drug?
RIPE
1. Rifampicin (6 months)
2. Isoniazid (6 months)
3. Ethambutol (2 months)
4. Pyrazinimide
56
Side effect of isoniazid?
Peripheral neuropathy
57
What qualities would an infection have that would make you worry about HIV?
SPUR: Serious, persistent, unusual and recurrent
58
A child presents with swollen parotid glands, hepatosplenomegaly, lymphadenopathy and thrombocytopenia - what might they have? How would you test for it?
HIV- DNA PCR
59
What are the clinical features of an IgE immune response?
Rash, facial swelling, anaphylaxis
| Within 10 minutes of ingestion
60
What are the clinical features of a non IgE response to food?
Failure to thrive, abdominal pain, dairrhoea and vomiting
61
What is the distribution of eczema in infants?
Face and trunk
62
A pale patient with recurrent infections, epitaxis and bruising comes to you. What are you worried about? What is causing these symptoms?
Leukaemia
| Bone marrow infiltration
63
Leukemia can cause reticuloendothelial infiltration, what symptoms will you get?
Hepatosplenomegaly, lymphadenopathy and mediastinal obstruction
64
Name 2 drugs used in the treatment of leukaemia?
Dexamethasone and vincristine
65
A headache worse in the morning, vomiting on waking and a personality change in children can be a sign of....?
Raised intracranial pressure e.g. in brain tumours
66
What are the signs of raised intracranial pressure in infants?
Tense fontaelles, head tilt and developmental delay
67
What drug reduces cerebral oedema?
Mannitol
68
What causes painless lymphadenopathy?
Hodgkin Lymphoma
69
A patient comes and has a palpable abdominal mass. What are your 2 differentials? How would you distinguish them? (Cancer)
Neuroblastoma: child is ill
Nephroblastoma: child is well
70
What are the symptoms of neuroblastoma?
Abdominal swelling/mass, bone pain, limp, malaise
71
You take a photo of a 2 year old and her eyes flash white. What condition does she have?You notice something else is wrong with her eye... what is it?
Retinoblastoma, she's squinting
72
How long is the treatment for iron deficiency anaemia in infants?
Works in 3 days, lasts 3-6 months
73
What is the clinical picture in aplastic anaemia?
Features of pancytopenia:
1. Anaemia due to reduced red cells
2. Infection due tor educed white cells
3. Bleeding and bruising due to reduced platelets
74
What is the inheritance pattern of haemophilia A and B?
X-Linked recessive
75
What indicates severe haemophilia?
Spontaneous bleeding into muscles/joint space
76
When does haemophilia present?
Age 1 ish - when children start walking/crawling as they are bumping into things and falling over
77
What is the inheritance pattern of von Willebrand disease?
Autosomal dominant
78
What is the difference in bleeds between haemophilia and vWB disease?
Bleeding is not spontaneous in von Willebrand
79
Which clotting factors are vitamin K dependant?
2, 7, 9 and 10
80
A 7 year old child comes in with easy bruising, and mucosal bleeding. They had a bad cold 2 weeks ago. Blood tests show low platelets. What is the most likely diagnosis?
Immune thrombocytopenia
81
When do children with hypermobility get painful limbs?
After exercise
82
When do growing pains occur?
At night
83
A child who had food poisoning last week presents with a swollen ankle and a low grade fever - what's the diagnosis? What is the prognosis?
Reactive arthritis, good! Self limiting
84
A 2 year old child presents with a hot swollen tender joint. Their hip is flexed, abducted and externally rotated. What is the diagnosis? What would you see on FBC?
Septic arthritis
| Raised white cells and inflammatory markers
85
What are the 3 criteria for diagnosing JIA?
1. Persistant joint swelling > 6 weeks
2. In the absence of infection
3. In a child under 16
86
Name one associated complication of JIA?
Uveitis
87
What is the treatment for JIA?
1. NSAIDs or analgesia
| 2. Methotrexate
88
Name some advantages of breast-feeding
- mother and child bonding
- reduces risk of GI infection
- ideal nurtition in the first 4-6 months
- reduces risk of obesity, hypertension and diabetes in later life
89
How many centile lines drop is mild and severe failure to thrive?
```
2 = mild
3 = severe
```
90
Where is the most common site for intussusception?
Ileum invaginating into caecum through ileal-caecal valve
91
What is redcurrant jelly stool a sign of?
Mucous and blood = INTUSSUSCEPTION
92
A child who isn't eating well, with abdominal pain which started at the centre and now is in the iliac fossa... What is the treatment?
Appendectomy
93
A pale child with a saussage shaped mass palpable in the abdomen has colicky pain, they are drawing their legs up in pain. Their vomit has bile in it... what's wrong?
Intussusception
94
If a child presents with bilious vomiting, tenderness and abdominal pain in the first 3 days of life what is the most likely cause?
Malrotation
95
What test must you always perform in unexplained recurrent abdominal pain?
Urine microscopy and culture
96
Abdominal pain associated with headaches is called....?
Abdominal migraine
97
What is the triple therapy for a peptic ulcer?
1. Proton Pump Inhibitor e.g. omeprazole
2. Clarithromycin
3. Amoxicillin
98
What does bile-stained vomit indicate?
Intestinal obstruction e.g. intussusception
99
How might oesophagitis and peptic ulcers present?
Haematemesis
100
What causes projectile vomiting in the first few weeks of life?
Pyloric stenosis
101
What are the clinical feautres of gastroenteritis?
Vomiting associated with fever and runny nose
102
Why might a toddler be pooing out peas and carrots?
Toddler's diarrhoea - intestines are not fully mature, children grow out of this by age 5
103
What would you be worried about if there was no meconium? (first stool)
Hirschsprung's disease, cystic fibrosis
104
What causes Hirschsprung disease?
Absent nerve plexus in smooth muscle, no peristalsis, bowel contents do not move
105
What is the treatment for Hirschsprung's disease?
Resection of the area that lacks nerve fibres
106
What is Potter Syndrome? What can cause it?
Compression of the foetus due to severe oligohydramnios (low amniotic fluid)
Renal agenesis
107
Name 3 features of Potter syndrome
- low ears
- beaked nose
- limb deformities
108
what are the clinical features of autosomal dominant PKD?
haematuria
hypertension
kidney failure in adulthood
Cysts grow on kidneys between normal parenchyma
109
Where will an obstruction cause bilateral hydronephrosis?
Obstruction at the bladder neck or urethra
110
A male baby presents with bilateral hydronephrosis. What would you do?
Urgent ultrasound (48 hours) to rule out posterior urethral valves
111
Which organism causes UTI in boys?
Proteus
112
A child with bacteriuria, fever and abdominal pain has what kind of UTI?
Upper - pyelonephritis
113
Best way to get a urine sample in infants?
Clean catch
114
Treatment of a UTI in < 3 month olds
IV Cefotaxime
115
Treatment of a UTI in > 3 month olds and children with upper UTI
oral co-amoxiclav 7 days
116
Treatment of children with cystitis?
3 days trimethoprim
117
What is the triad for nephrotic syndrome?
1. Oedema
2. Hypoalbuminaemia
3. Proteinuria
118
What is the treatment for steroid resistant nephrotic syndrome?
salt reduction, diuretics, ACE inhibitors
119
A 5 year old boy who has just had a cold comes with haematuria, a trunk-sparing rash, aching joints and abdominal pain. What's the problem?
Henoch-Schonlein Purpura
120
What is Henoch-Schonlein purpura?
Small vessel vasculitis
121
Describe the normal gross motor development in a 9 month old?
Can pull themselves up to stand
122
Describe the age when a child should be able to walk?
1 year
123
If a child can lift their head on their tummy, grasp an object, laugh and smile spontaneously, what is their developmental age?
3 months
124
If a child can bang cubes together, pull to sstand, say "dada" and wave bye-bye, what is their developmental age?
9 months
125
If a child can walk up steps, built a 2 cube tower,, form 2 word sentences - what is their developmental age?
2 years
126
When can a child build an 8 cube high tower?
Age 3
127
What is the "median age" of developing a skill?
when 50% of children can do the skill
128
When should a squint disappear?
12 weeks
129
When do children develop normal visual acuity?
4 years old
130
What is the difference between impairment and disability?
Impairment is the abnormal function or loss of physical function, disability is the restriction due to the impairment
131
What is the most common cause of cerebral palsy?
Vascular occlusion/stroke before birth
132
What causes 10% of cerebral palsy?
hypoxia during birth (hypoxic-ischaemic encephalopathy)
133
Name some other less common causes of CP?
meningitis, maternal infection e.g. rubella, hypoglycaemia
134
What movements occur in dyskinetic CP?
Uncontrolled movements:
1. chorea
2. athetosis: slow writhing movements which occur distally e.g. splaying fingers
3. dystonia
135
What conditions are associated with quadriplegic spastic CP?
microcephaly, seizures and severe intellectual impairment
136
What is hemiplegic CP?
When the arm and leg on one side is affected - child tip toe walks on the affected side and shows asymmetric hand function
137
Is it normal to have asymmetric hand function before 12 months?
Not usually, may bea sign of hemiplegic cerebral palsy
138
Who is more at risk of conductive hearing loss?
Downs kids, cleft palate and atopic children
139
Give some features of downs syndrome
Flat occiput, sandle gap between toes, single palmar creases, small mouth and ears
140
Name 2 conditions of trisomy (nod DS) and a feature of each,
Edward's (18): prominent occiput, clenched hands with overlapping fingers
Patau (13): cleft palate, polydactyly, absent eyebrows
141
What is the most common heart defect in Turner's syndrome?
Coarction of the aorta
142
What is the treatment for Turner's syndrome?
Growth hormone and oestrogen replacement
143
What is uniparental disomy?
The activity of a gene depends on the parent it was inherited from
144
Give an example of uniparental disomy on chromosome 15?
Prader Willi if Paternal gene is abnormal
| Anglemann if Materna; gene is abnormal
145
Give 5 ways a preterm infant is stabilised.
```
Surfactant therapy
Humidifed incubator
Borad spectrum antibiotics
CPAP
Catheters and IV lines
Minimal handling
```
146
Name 3 ways of treating Respiratory Distress Syndrome (RDS)
1. Surfactant therapy
2. CPAP
3. Raised ambient oxygen
147
Who is most at risk of RDS?
28 week or less premature, boy more than girls
148
What are infants with RDS also at risk of due to ventilation?
Pneumothorax
149
A bounding pulse and systolic murmur are signs of what in a new baby?
Patent Ductus Arteriosus
150
How much fluid does a preterm baby need?
60-90ml/kg in day 1
| Day 2 increase by 20-30ml/kg
151
A preterm infant with difficulty feeding, bile stained vomit, distended abdomen and fresh blood in the stool has what?
Necrotising enterocolitis
152
What are the X-ray features of necrotising enterocolitis?
Distended bowel, intramural gas
153
A newborn baby has an unstable temperature, bradycardia, resp distress and abdominal distension, what could be going on?
Neonatal sepsis
154
What to do if you suspect neonatal sepsis?
Sepsis scree, CXR, FBC
155
Bulging fontanelles in neonates and hyperextension of the neck and back are signs of....?
Neonatal meningitis
156
What antibiotics are used to treat neonatal meningitis?
Ampicillin and cefotaxime
157
What are the risk factors for neonatal infection? (3)
Prolonged rupture of amniotic membranes
preterm babies
maternal fever
158
How would a baby get a listeria monocytogenes infection?
Through the placenta if the mother eats unpasteurised milk, or soft cheese
159
What is meconium staining of the liquor a sign of?
Listeria infection
160
What do you use to treat HSV infectino?
Acyclovir
161
What is the red cell lifespan in neonates?
70 days
162
What type of bilirubin is present in neonatal jaundice?
UNconjugated
163
What is the "never event" risk of neonatal jaundice?
Kernicterus: infiltration of unconjugated bilirubin into thebasal ganglia
164
What is the sign where a baby arches their back due to kernicterus?
Opisthotonos
165
Name 3 haemolytic disorders causing neonatal jaundice?
Rhesus haemolytic disease, ABO incompatibility, G6PD Deficiency
166
What should all unwell, vomiting, feverish babies have?
Urine microscopy
167
What is the treatment for UTI in infants?
Admission needed, IV cefuroxime
168
What bug is most likely to cause osteomyelitis? What is the treatment?
```
Staph aureus (skin colonisation)
IV cefuroxime followed by oral flucloxacillin
```
169
Name the bug: gram negative diplococci in a child with fever and a purple rash...
Neisseria meningitides
170
What is the treatment for severe vs non-severe pneumonia?
IV benzyl penicillin if severe, oral amoxicillin if mild
171
What's wheeze?
A polyphonic expiratory sound caused by the narrowing of small and medium airways
172
name 3 causes of wheeze
1. Persistant infantile wheeze
2. Viral episodic wheeze
3. Asthma
173
What do you give to a preterm baby whos blood glucose has dropped?
IV 10% Dextrose
174
What is the treatment for jaundice?
Phototherapy, exchange transfusion
175
What may a child sitting in the tripod position have?
Epiglottitis
176
What pathogen commonly causes infection in patients with CF? What antibiotic is used to treat it?
Psuedomonas auruginosa, pipercillin
177
Give 2 examples of a cephalosporin - when would they be indicated?
Cefotaxime and ceftriaxone
| Sepsis
178
A strawberry tongue and sandpaper rash is a classic presentation of...?
Scarlet fever
179
What does APGAR stand for?
Appearance, pulse, grimace, activity and respiratory effort
180
When should the APGAR be tested?
At 1, 5 and 10 minutes of age
181
What is unique about the presentation of pertussis in infants?
Instead of a "whoop" there may be periods of apnoea
182
Describe the symptoms of Acute Lymphoid Leukaemia?
Hepatosplenomegaly, bruising, anaemia
183
How might anaemia present in a child?
Soft murmer and shortness of breath on exertion
184
After oral dexamethasone for croup, if the child is not improving what is the next line of treatment?
Oxygen and nebulised adrenaline
185
What is the ratio of compressions:ventilations in child resuscitation?
15:2
186
What causes slapped cheek syndrome?
Parvovirus
187
What is characteristic about the fever in Kawasaki's?
High grade >39 and not responsive to antipyrexials
188
What would you hear in a baby with a PDA?
A continuous machinery urmur
189
What is the treatment for PDA?
Ibuprofen which is an anti-prostaglandin
190
What is the first line treatment for constipation in children?
Movicol
191
What are the 4 cardiac abnormalities in Tetralogy of Fallot?
1. A large VSD
2. Overriding of the aorta (aorta directly over the VSD instead of the left ventricle)
3. Right ventricular outflow obstruction/pulmonary stenosis
Right ventricular hypertrophy
192
When and how would tetralogy of fallot present?
1-2 months after birth with cyanosis and an ejection systolic murmur
193
What is the classic x-ray finding of tetralogy of fallot?
Boot shaped heart
194
A baby presents at 2 days of life with collapse, absent femoral pulses, metabolic acidosis and hepatomegaly - what is the diagnosis?
Coarctation of the aorta
195
What do infantile spasms look like?
repeated flextion of the head/trunk followed by extension of arms
196
Another name for croup is
laryngotracheobronchitis
197
What are the triad of features in shaken baby syndrome?
retinal haemorrhage
encephalopathy
subdural haematoma
198
What is ebstein's anomaly? What causes it?
low insertion of tricuspid valve
large atrium and small ventricle
Lithium exposure in utero
199
What would you see on x-ray in meconium aspiration syndrome?
patchy infiltrations
| atelectasis (collapse of lung)
200
What may congenital rubella lead to?
Sensorineural deafness
| cataracts
201
What are the chracteristic features of toxoplasmosis infection?
Cerebral calcification
Chorioretinitis
Hydrocephalus
202
What are the chracteristic features of cytomegalovirus infection?
growth retardation
| purpuric skin lesions
203
What is in the 6-1 vaccine and when is it given?
diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
Given at 2, 3 and 4 months
204
A child under 3 months has a fever - what should you do?
Refer for paediatric assessment that day
205
What is the barlow's test for developmental dysplasia of the hip?
Try to dislocate an articulated femoral head
206
"goign out to the bar.. .and you ought to come home" refers to what?
Barlow's test - dislocate the hip
| Ortalani test - return the dislocated hip
207
Blood in the stool of a preterm baby probably indicates...
Necrotising enterocolitis
208
What metabolic abnormality do you see in pyloric stenosis?
Hypochloremia
hypokalaemia
metabolic alkalosis
209
How does perthes disease present?
progressive hip pain, limp and stiffness
210
What is the complication of using lithium in pregnancy?
Ebstein's abnormailty
