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Paediatrics Flashcards

1
Q

What fluids are given for maintenance in children?

A

0.9% saline + 5% glucose

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2
Q

How is amount of fluid per day determined in children?

A

100ml/kg/day for first 10kg
50ml/kg/day next 10kg
20ml/kg/day after that

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3
Q

What is the bolus fluid and volume in children?

A

0.9% saline 20ml/kg

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4
Q

What are the exceptions for the bolus volume in children and what is it in these cases?

A

Trauma
Diabetic Ketoacidosis
Neonates

10ml/kg 0.9% NaCl

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5
Q

How to assess asthma control?

A

How many courses of steroids?
Any hospital admissions?
Any ITU visits?

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6
Q

If bronchodilators and steroids are not controlling an asthma attack, what other treatments can be used?

A

Magnesium bolus
Aminophylline
IV salbutamol

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7
Q

What must be done while giving a magnesium bolus?

A

Cardiac monitoring

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8
Q

Before changing medications is asthma, what should be assessed?

A

Compliance with medication
Inhaler techniques
Environment - pets, smoking

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9
Q

What further investigations can be done after a UTI?

A

DMSA - radioisotope study

MCUG - micturating cystourethrogram

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10
Q

What is sepsis?

A

Dysregulated host response that leads to end organ dysfunction

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11
Q

What pathogen typically causes croup?

A

Parainfluenza virus

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12
Q

What is used to treat croup?

A

O2 if needed
Oral steroids - dexamethasone/prednisolone
Nebulised adrenaline if needed

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13
Q

List some complications of prematurity

A

Retinopathy
Chronic lung disease
Necrotising enterocolitis
Intraventricular haemorrhage

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14
Q

How can retinopathy of prematurity be prevented/treated?

A

Controlled oxygen therapy

Laser therapy

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15
Q

What is a complication of intraventricular haemorrhage in neonates?

A

Cerebral palsy

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16
Q

What is given at 8 weeks in the childhood vaccination schedule?

A

6-in-one
Pneumococcal
Men B
Rotavirus

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17
Q

What is covered in the 6-in-one vaccine?

A

Diphtheria, tentanus, pertussis, polio, Hib, Hep B

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18
Q

What strains of HPV is covered in the vaccine?

A

16 and 18 - cervical cancer

6 and 11 - genital warts

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19
Q

When is the first dose of MMR given?

A

1 year

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20
Q

What pathogen can cause an aplastic crisis in sickle cell?

A

Parvovirus B19

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21
Q

What is the inheritance pattern of Fanconi’s anaemia?

What type of anaemia does it cause?

A

Autosomal recessive

Aplastic anaemia

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22
Q

What are the signs of newborn respiratory distress syndrome? (5)

A 
Tachypnoea 
Intercostal recessions
Expiratory grunting
Cyanosis
Tachycardia
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23
Q

What is the management of newborn respiratory distress syndrome? (3)

A

Synthetic surfactant
Oxygen
Mechanical ventilation

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24
Q

What is the management of bronchiolitis? (3)

A

Paracetamol
Oxygen
Maintain fluid balance

NOT salbutamol

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25
When does a child need admitting for acute otitis media? (2)
<3 months old | 3 - 6 months old with a temperature >36
26
What medical treatment can be used to treat mild haemophilia A? (1)
Desmopressin
27
What immune cells are present in asthma? (3)
Eosinophils Mast cells T cells
28
What must be seen on spirometry and bronchodilator test for a diagnosis of asthma?
FEV1/FVC <70% | Bronchodilator test improvement FEV1 >12%
29
What is the first step in the paediatric asthma ladder? (2)
Low dose ICS (beclometasone) | SABA (Salbutamol)
30
What type of jaundice does hypothyroidism cause in neonates?
Unconjugated
31
What is the complication of raised bilirubin in neonates? | Where does this complication occur?
Kernicterus | The basal ganglia
32
What are the symptoms of kernicterus? (4)
Lethargy, irritability, poor suck, abnormal muscle tone and posture, high-pitched cry, apnoea, and eventually seizures and coma
33
At what point should physiological jaundice resolve? In both term infants and preterm infants (2)
14 days | 21 days
34
What management should be used before medical management for GORD in infants? (3)
Thickening agents Sit at 30 degrees after feeds Small feeds more often
35
What three drug classes can be used for GORD in infants? Give an example of each (6)
Alginate - Gavison PPIs - omeprazole H2 receptor antagonists - ranitidine
36
What are the risk factors for pyloric stenosis? (4)
``` Firstborn Male Smoking in pregnancy Family history Early antibiotic use Bottle feeding ```
37
What are the signs of pyloric stenosis? (3)
Projectile vomiting (initially increases in frequency and force before projectile) Gastric peristalsis after feeds Olive shaped mass on examination
38
What is seen on ABG in pyloric stenosis? (3)
Hypochloraemic, hypokalaemic, metabolic acidosis
39
What is the surgical management of pyloric stenosis? (1)
Pyloromyotomy
40
Where does intussusception most commonly occur? (1)
Ileum into caecum
41
What are the signs of intussusception? (3)
Red currant jelly stools Sausage shaped mass Intermittent colicky pain
42
What is the management of intussusception? (1)
Rectal air insufflation
43
What is Meckel's diverticulum? (1)
A remnant of the vitello-intestinal duct
44
What is the pathological process in malrotation? (3)
1) There is impaired rotation of the midgut as it returns into the abdominal cavity during development 2) Early in life Ladd bands obstruct the bowel or a volvulus occurs 3) This leads to ischaemia
45
How does malrotation present? (2)
Bilious vomiting and abdominal pain
46
What investigation should be done in suspected malrotation?
Abdominal xray with contrast
47
What is the pathophysiology of Hirschsprung's?
Failure of the nerve cells to develop from the rectum upwards in the GI tracts
48
What are risk factors for Hirschsprung's? (3)
Male Down's syndrome Family history
49
What investigation should be done in suspected Hirschsprung's? (1)
Rectal biopsy
50
What is the management of Hirschsprung's? (1)
Swenson procedure
51
What is the inheritance pattern of congenital adrenal hyperplasia? (1)
Autosomal recessive
52
What electrolyte disturbances are seen in CAH and why? (3)
Hyponatraemia Hyperkalaemia Due to lack of aldosterone
53
What enzyme is deficient in classic CAH? (1)
21-hydroxylase
54
What is the medical management for CAH? (1)
Lifelong glucocorticoid replacement therapy (hydrocortisone)
55
What specific serology should be done in Nephrotic syndrome? (1)
Varicella serology
56
What should be done in cases of nephrotic syndrome resistant to steroids? (1)
Renal biopsy
57
What is the most common cause of nephritic syndrome? (1)
Post streptococcal glomerulonephritis
58
What is the management for nephritic syndrome? (2)
Antihypertensives | Anti-inflammatories
59
What is the triad of symptoms in HSP? (3)
Purpura Joint pain Abdominal pain
60
What is Kernig's sign?
A sign of meningism where hip flexion and knee extension cause pain
61
What is Brudzinski sign?
A sign of meningism where lift the head off a surface causes involuntary lifting of the legs
62
What is seen in the CSF in bacterial meningitis? (4)
High protein, low glucose, turbid appearance and raised white cell count
63
What is seen in the CSF of viral meningitis? (3)
Clear appearance, raised WCC, monocytes
64
What are the three key features of diabetic ketoacidosis? (3)
Hyperglycaemia Hyperketonaemia Metabolic acidosis
65
What respiratory sign is seen in diabetic ketoacidosis? (1)
Kussmaul's breathing
66
What is the management of DKA? (3)
ABCDE Insulin via fixed rate IV infusion Fluids - 0.9% NaCl, plus K+
67
What can be used to maintain a patent heart duct in congenital heart defects? (1)
Prostaglandin E
68
What does Tetralogy of Fallot consist of? (4)
1) Large VSD 2) Overriding aorta 3) Pulmonary stenosis (causing RV outflow obstruction) 4) Right ventricular hypertrophy
69
What are the five cyanotic congenital heart abnormalities? (5)
``` Tetralogy of Fallot Truncus arteriosus Tricuspid atresia Transposition of the great vessels Total anomalous pulmonary-venous connection ```
70
Where does all blood from the pulmonary and circulatory system return to in TAPVC? (1)
Right atrium
71
What murmur is heard with a VSD? (1) | Where is it heard best? (1)
Pansystolic murmur | Left lower sternal border
72
At what point is a patent ductus arteriosus considered persistent? (1)
1 month after due date
73
What is the treatment for a persistent PDA? (1)
NSAID - Indomethacin
74
What is Eisenmenger syndrome? (3)
A complication of a longstanding VSD There is increasing pulmonary hypertension Eventually this leads to a bidirectional or reversed shunt (From Left to Right to Right to Left)
75
What syndrome is pulmonary stenosis associated with? (1)
Noonan's
76
What syndrome is associated with mitral valve prolapse? (1)
Fragile X
77
Name 6 features of Down's Syndrome (6)
``` Flat nasal bridge Epicanthic folds Small mouth Large tongue Brushfield spots Single palmar crease Hypotonia Short fingers Upwards slanting eyes ```
78
What prenatal signs on scan indicate Turner's syndrome? (2)
Cystic hygroma | Fetal oedema of neck, hands or feet
79
Other than Down's syndrome, name two other trisomies and the chromosome the affect (4)
Edward's syndrome - c18 | Patau's syndrome - c13
80
What are feature's of Edward's syndrome? (4)
``` Low birth weight Micrognathia Short sternum Rocker-bottom feet Flexed, overlapping fingers ```
81
What are features of Neurofibromatosis type 1? (5)
``` Lisch nodules in iris Skin fold freckles Neurofibromas Learning difficulties Cafe au lait spots ```
82
What condition are ash leaf spots associated with? (1) | What other features may be present in this condition? (4)
Tuberous sclerosis | Developmental delay, focal epilepsy, roughed (Shagreen) skin over lumbar spine, cafe au lait spots, infantile spasms
83
What are the features of Klinefelter's? (3) | What is the genotype? (1)
Infertility, hypogonadism, tall stature, gynaecomastia | XXY
84
What are risk factors for hip dysplasia? (4)
``` Breech presentation Family history Oligohydramnios First born Female ```
85
What tests are done in suspected hip dysplasia? (2)
Ortolani's test - reduces joint | Barlow's test - dislocates joint
86
What test is diagnostic in suspected hip dysplasia? (1)
Ultrasound
87
What conservative management is used for hip dysplasia? (1)
Pavlik harness for a minimum of 6 weeks
88
What is a key differential to exclude in transient synovitis? (1)
Septic arthritis
89
What extra-articular manifestation is associated with juvenile idiopathic arthritis? (1)
Chronic anterior uveitis
90
What are the major criteria for diagnosis of Still's disease? (4)
Arthritis Intermittent daily fever >2 weeks Salmon coloured rash Leukocytosis
91
What drugs can be used to treat juvenile idiopathic arthritis? (4)
NSAIDs Intra-articular steroids Methotrexate Biologics - TNF alpha blockers
92
Where does septic arthritis typically occur? What is the most common causative agent? (2)
The metaphysis | Staph aureus
93
What investigations are done in suspected septic arthritis? (4)
Joint aspiration and culture Blood cultures Inflammatory markers X ray
94
What late x ray changes are seen in septic arthritis? (2)
Loss of density | Diffuse rarefaction of the metaphysial area
95
What is the management for septic arthritis? (1)
IV flucloxacillin
96
What is Perthes disease? (1)
Avascular necrosis of the femoral head of unknown origin
97
What are risk factors for Perthes disease? (4)
``` Male Thrombophilias Low socioeconomic status Low birth weight Second hand smoke ```
98
What gait do children with Perthes disease have? (1)
Trendelenburg gait
99
What is seen on hip x ray in Perthes disease? (2)
Increased joint space | Crescent sign
100
What is Drehmann sign? (2)
Passive flexion of the hip seen in slipped femoral epiphysis
101
What imaging is needed to diagnose slipped femoral epiphysis? (2)
Frog leg lateral view x ray of the hip
102
In children over 5 what is the firstline treatment for frequent enuresis? (1)
Enuresis alarm (plus positive reward system)
103
If Enuresis alarm does not work what medical treatment can be used for enuresis? (1)
Desmopressin
104
What type of cerebral palsy is associated with kernicterus? (1)
Dyskinetic
105
What causes inguinal hernias in children? (1)
Patent processus vaginalis
106
What are the three types of undescended testis? (3)
Retractile Palpable Impalpable
107
What investigations are done for an impalpable undescended testis? (3)
USS HCG - elevated suggested ectopic testis producing testosterone Laparoscopy
108
What is the surgical management for undescended testes and why is it performed? (3)
Orchiopexy | Due to increased risk of malignancy and reduced fertility
109
What does 'blue dot sign' indicate? (1)
Torsion of the testicular appendage
110
What calculation is used to estimate the weight of a child? (1)
(age + 4) x 2
111
What does the APGAR score consist of? (5)
``` Activity (muscle tone) Pulse Grimace (reflex irritability) Appearance (skin colour) Respiration ```
112
What murmur is common in preterm infants? What does it sound like?
Patent ductus ateriosus | Continuous machinery murmur
113
What is the management for necrotising enterocolitis? (6)
Nil by mouth Gastric decompression via NG IV fluids/TPN Amoxicillin + gentamicin + metronidazole
114
How is apnoea of prematurity managed? (3)
CPAP Caffeine Theophylline
115
What is seen on chest x ray in meconium aspiration? (3)
Overinflated lungs Consolidation Collapse
116
How is persistent pulmonary hypertension managed? (2)
Nitric oxide and sildenafil
117
What does the Guthrie test screen for? (10)
``` Phenylketonuria Hypothyroidism MCAD deficiency Isovaleric acidaemia Homocystinuria Haemoglobinopathies Cystic fibrosis Maple syrup urine disease Glutaric aciduria type 1 ```
118
What does the Guthrie test detect in Cystic Fibrosis? (1)
Serum immunoreactive trysinogen
119
What does the Guthrie test detect in Cystic Fibrosis? (1)
Serum immunoreactive trypsinogen
120
What three areas are affected in autism? (3)
Communication difficulties Social interaction Rigidity of thought
121
What GP screening interview is used for autism? (1)
M-CHAT
122
What are the three core symptoms of ADHD? (3) | What must be fulfilled along with these symptoms for a diagnosis? (2)
Inattention Impulsivity Hyperactivity Must be persistent for at least 6 months and have an impact on daily function in multiple environments
123
What type of therapy is best used in ADHD? (1)
Family therapy
124
What must be monitored for ADHD patients on methylphenidate? (1)
Growth
125
What is a poor prognostic marker for neuroblastoma? (1)
N-myc overexpression
126
What investigation is done in suspected Duchenne muscular dystrophy? (1)
Creatinine phosphokinase
127
What are congenital side effects of sodium valproate in pregnancy? (3)
Spina bifida Cleft palate Small fingers and toes
128
What is the mechanism of achondroplasia? (1)
Activation of the FGFR3 gene
129
What is the difference between omphalocele and gastroschisis? (2)
Omphalocele is covered in a sac is and is a defect in embroyological development where the intestine fails to re-enter to body Gastroschisis does not have a sac covering and is caused by an umbilical cord defect
130
What is the most common cause of bacterial meningitis in neonates? (1) Name two other causes in neonates? (2)
E.Coli Group B Strep, Listeria monocytogenes
131
What treatment is given in primary care in suspected meningitis? (1)
IM benzylpenicillin
132
What is the most common cause of bacterial meningitis? (2)
Group B Neisseria meningitidis
133
Why are three CSF samples taken in meningitis? (3)
Microbiology Virology Chemistry
134
What is the management for meningitis? (3)
``` IV Ceftriaxone ( + Amoxicillin in infants) Rifampicin for close contacts ```

Phase 3A (6 decks)

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