Paediatrics Flashcards

Question

Long term complications of obses children

Answer 1

* T2DM * Hypertension * Ischaemic Heart Disease

Answer 2

* Picornaviridae family * Coxsackie A16 * Enterovirus 71 ## Footnote *Very contagious and outbreaks in nursery*

Answer 3

* Mild systemic upset * Sore throat * Fever * Oral ulcers * Followed by vesicles on palms and soles of feet

Answer 4

* Symptomatic therapy only * Hydration and analgesia * Advice * No need to exclude from school UNLESS child is feeling unwell, then exclude until feeling better * Contact you if there is a large outbreak * Reassure no link to disease in cattle

Answer 5

* Sporty teenagers * No history of injury * Pain, tender and swelling over tibial tubercle

Answer 6

* Teenage girls * Softening of patella cartilage * Anterior knee pain on walking up and down stairs and rising from prolonged sitting * Responds to physiotherapy

Answer 7

* Pain after exercise * Intermittent swelling and locking

Answer 8

* Medial knee pain due to lateral subluxation of patella * Knee may give way

Answer 9

* Athletic teenage boys * Chronic anterior knee pain that worsens after running * Tender below the patella on examination ## Footnote *Chondromalacia patellae common in teenage girls (anterior knee pain on walking up and down stairs)*

Answer 10

* Moro * Head extension causes abduction followed by adduction of arms * birth - 3/4 months old * Grasp * Flexion of fingers when objects placed in palm * birth - 4/5 months old * Rooting * Placing finger or nipple near baby's mouth causes them to turn towards the stimulus and suck (sucking reflex) * birth - 4 months old * Stepping * Baby walks when held upright and soles of feet touch a flat surface * birth - 2 months old * ATNR * Face is turned to one side, the arm and leg on the side they are facing extend and the opposit arms and legs flex

Answer 11

* Acute cough lasting \>14 days without apprent cause and one or more of: * Paroxysmal cough * Inspiritory whoop * Post-tussive vommiting * Undiagnosed apnoeic attack in young infants

Answer 12

* Nasal swab culture for bordatella pertussis * several days or weeks for results * PCR and serology

Answer 13

* Infants \<6months old = ADMIT * Notifiable disease * Oral macrolide if cough onset within previous 21 days * Houeshold contacts offered prophylaxis * School exclusion until 48 hours after commencing antibiotics OR 21 days from onset of illness if no antibiotic treatment

Answer 14

* Infants \<1 month old * **Clarithromycin** * Children \> 1 month old and non-pregnant adults * **Azithromycin** or **Clarithromycin** * Pregnant women * **Erythromycin**

Answer 15

* Subconjunctival haemorrhage * From cough * Pneumonia * Bronchiectasis * Seizures * From anoxia * Lymphocytosis

Answer 16

* Otoacoustic emmision test * Computer generated click in ear piece which meassures babys response * Auditory brainstem response test if above is abnormal

Answer 17

* Therapeutic cooling 33-35 degrees * Whole body or head cooling * Must be initiated within 6 hours of injury/birth

Answer 18

* retinal haemorrhages * subdural haematoma * encephalopathy

Answer 19

* Initially gonads in foetus are undifferentiated * On the Y chromosome, there is a sex-determining gene (SRY gene) which causes differentation of gonads into testis * If absent, then the donads differentiate into ovaries

Answer 20

* **Congenital adrenal hyperplasia** * True Hermaphodism * Maternal ingestions of androgens

Answer 21

* No Vitamin K at birth * Breat-feeding (breast milk not rich in Vit K) * Maternal use of anti-epileptics

Answer 22

Once-off IM injection at birth Or Oral

Answer 23

* Streptococcus pneumoniae * Mycoplasma pneumoniae * Chlamydia pneumoniae Not immunised/immunocompromised * Haemophilus influenza * Bordatella pertussis *Legionella unlikely in children (unless risk factors -AC)*

Answer 24

* Amoxicillin = first line in ALL children * + Macrolide if no respones to amoxicillin

Answer 25

* Macrolides

Answer 26

* Co-amoxiclav * Amoxicillin + clavulanic acid

Answer 27

* Septal and posterior leaflets of tricuspid valves low insertion into ventricle * Leads to large right atrium and small right ventricle - atrialisation of right ventricle

Answer 28

* Maternal use of lithium for BPD * First trimester association

Answer 29

* Wolff-Parkinson White Syndrome * Delta waves * Pre-excitation syndrome involving accessory pathway between atrium and ventricle * Tricuspid incompetence * Giant V waves (JVP) * Pan-systolic murmur

Answer 30

* Laryngomalacia * congenital softening of the cartilage of the larynx, causing collapse during inspiration. * Laryngomalacia can present at birth, and worsens in the first few weeks of life. It usually self-resolves before 2 years of age.

Answer 31

* Structural * Hereditary spherocytosis * Marfan's syndromes * Marfan's syndromes * Achondroplasia * Huntington's Disease * Neurofibromatosis * Osteogenesis Imperfecta * Exceptions - Ataxias * ataxia telangiectasia * Friedreich's ataxia

Answer 32

* Metabolic * Exceptions * Hunter's * G6PD are X-linked recessive * hyperlipidaemia type II and hypokalaemic periodic paralysis are autosomal dominant * Cystic fibrosis * Sickle Cell Disease

Answer 33

* soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area * may vary with posture * localised with **no radiation** * no diastolic component * no thrill * no added sounds (e.g. clicks) * asymptomatic child * no other abnormality

Answer 34

* Venous Hums * Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below bothclavicles * Still's Murmur * Low-pitched sound heard at the lower left sternal edge Ejection murmurs Due to turbulent blood flow at the outflow tract of the heart

Answer 35

* Jaundice in the first 24 hr of life

Answer 36

* Rhesus Haemolytic Disease * ABO Haemolytic Disease * Hereditary Spherocytosis * G6PD

Answer 37

* Jaundice 2-14 days of life * Breastmilk jaundice

Answer 38

* Jaundice lasting \>14d

Answer 39

* Biliary atresia * Hypothyroidism * Galactosaemia * UTI * Breastmilk Jaundice * Congenital infections (toxoplasmosis, CMV)

Answer 40

* Bilirubin * Conjugated vs Uncongjugated * TFTs * DAT (Coombe's Test) * FBC and blood film * Urine and MC&S and reducing sugars * U&E * LFT

Answer 41

Parvovirus B19

Answer 42

* Newborn = Ultrasound * Infants \> 4.5 months * X-Ray * because ossification of the femoral head has occurred, meaning that x-rays are better able to visualise the joint.

Answer 43

* Autoimmune thyroiditis * Post total-boyd irradiation * Child previously treated for ALL * Iodine deficiency (developing world)

Answer 44

* pregnancy * sexually transmitted infections, recurrent UTIs * sexually precocious behaviour * anal fissure, bruising * reflex anal dilatation * enuresis and encopresis * behavioural problems, self-harm * recurrent symptoms e.g. headaches, abdominal pain

Answer 45

When HR \> 60

Answer 46

* 5 rescue breaths via 250mL face mask

Answer 47

* Degenerative condition affecting hip joints in children (4-8 years). * Due to avascular necrosis of the femoral head (specifically the femoral epiphysis) * Impaired blood supply causes bone infarction *5 times more common in boys; around 10% cases are bilateral*

Answer 48

* Hip pain that develops progressively over few weeks * Limp, antalgic gait * Stiffness and reduced range of hip movement

Answer 49

* Plain X ray * Technetium bone scan or MRI if normal x-ray/symptoms persist

Answer 50

* Cast/Braces - keep femoral head within acetabulum * \<6 years - observe * Older - surgical management * Operate on severe cases * Heals over 2-3 years

Answer 51

* Osteoarthritis * Premature fusion of the growth plates

Answer 52

* If Baby is formula-fed: * Use exyensive hydrolysed formula (eHF) in mild-moderate * Use amino acid-based formula (AAF) in severe or if no response to eHF * If baby is breastfed: * Continue breastfeeding * Eliminate cow's milk protein from maternal diet (dairy). * Consider prescribing calcium supplements for breastfeeding mothers whose babies have/suspected CMPI to prevent deficiency whilst they exclude dairy from diet * Use eHF when breastfeeding stops until 12 months of age and at least for 6 months

Answer 53

* Cow's milk intolerance * Toddler diarrhoea * Coeliac disease * Post-gastroenteritis lactose intolerance

Answer 54

Children below 0.4th centile for height

Answer 55

* **Environmental** * ****Maternal nutrition and uterine capacity * Placental * Hormonal * Genetic * Primarily maternal

Answer 56

* Infancy * Insulin * Nutrition * Childhood * Growth hormone * Thyroxine * Puberty * Growth hormone * Sex Steroids * Genetic factors most important determinant of final adult height

Answer 57

Trisomy 13 * Microcephalic, small eyes * Cleft lip/palate * Polydactyly * Scalp lesions

Answer 58

Trisomy 18 * Micrognathia * Low-set ears * Rocker bottom feet * Overlapping fingers

Answer 59

Trisomy 21 * Hypotonia at birth * Flat nasal bridge * Upward palpebral fissure (eyes) * Epicanthic fold * Single palmar crease * Sandal gap toe

Answer 60

X-linked dominant (CGG repeat FMR1 gene on X chromosome) * Learning difficulties; delays in S&L * Elongated face and broad forehead * Large ears * High arched palate * Prominent jaw * Strabismus * Macro-orchidism * Hypotonia and joint laxity * Flat feet (pes planus) *FMR1 = Fragile x mental retardation 1*

Answer 61

Autosomal dominant * Webbed neck * Pectus excavatum * Short stature * Pulmonary stenosis * Occular hypertelorism (distance between eyes)

Answer 62

Triad: * Micrognathia (small mandible) * Glossoptosis (posterior displacement of tongue -\> upper airw3ay obstruction) * Cleft palate

Answer 63

Genetic Imprinting * Hypotonia * Hypogonadism * Obesity *

Answer 64

Deletion of genes from chromosome 7s (or autosomal dominant) * Short stature * Learning difficulties * Friendly, extrovert personality * Transient neonatal hypercalcaemia * Suprclavicular aoritc stenosis

Answer 65

Chromosome 5p deletion * Characteristic cry (hence name) due to larynx and neuro problems * Feeding difficulties and poor weight gain * Learning difficulties * Microcephaly * Micrognathism * Hypertelorism

Answer 66

Increased temperature for 2 days then develop clusters of erythematous vesicles of torso and face

Answer 67

Supportive measures Calamine lotion (itch) Paracetamol

Answer 68

Associated risk of developing necrotising fasciitis

Answer 69

* 4 days before rash and 5 days after rash appears * Incubation(10-21d)

Answer 70

* Secondary infection of lesions * Secondary infection from group A Strep -\> necrotising fasciitis * Encephalitis - rare but serious * PC: irritability, confusion, drowsiness, neck stiffness * Cerebellar ataxia * in recovery phase * Pneumonia * Chestp ain , SoB, wheeze * Myocarditis * Transient arthritis

Answer 71

* Congenital diaphragmatic hernia * It is characterised by the herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm. * This can result in **pulmonary hypoplasia** and **hypertension** which causes **respiratory distress** shortly after birth. * usually represents a failure of the pleuroperitoneal canal to close completely * Most common - left-sided posterolateral Bochdalek hernia which accounts for around 85% of cases.

Answer 72

Refer at 18 months for SALT review

Answer 73

* Doctor * Nurse * Dietician * Social worker * Psychologist * Physiotherapist * Respiratory therapist (PFTs)

Answer 74

* Regular (twice daily) chest physiotherapy and postural drainage * High calorie diet, high fat intake * Vitamin supplementation (DEKA) * Pancreatic enzyme supplements with meals * Can give PPIs to maintain alkaline conditions * Minimise contact with other CF patients to prevent cross infection * Symptom management * Pharmacological management * Bilateral lung transplant

Answer 75

* Pseudomonas aeruginosa * Burkholderia cepacia complex

Answer 76

* Salbutamol * Dornase alfa (mucolytic) * Antibiotic * Inhaled tobramycin (aminoglycoside) * Anti-inflammatory * Azithromycin/ibuprofen

Answer 77

* Ivacaftor * Potentiator * Lumacaftor * Moves defective CFTR protein to cell surface * Tezacaftor Usually Lum/Iva or Teza/Iva

Answer 78

* Post-gastroenteritis lactose intolerance * Remove lactose from diet for a few months followed by gradual reintrooduction to resolve

Answer 79

Fragile X Syndrome

Answer 80

Attention Deficit Hyperactivity Disorder (ADHD)

Answer 81

* Antenatally by chorionic villus sampling or amniocentesis * Analysis of CGG repeats using restriction endonuclease digestion and southern blot analysis

Answer 82

* Regurgitation and vomitting * Diarrhoea * Urticaria * Atopic eczema * Colic symptoms: irritability, crying * Wheeze, chronic ocugh * Rarely angioedema and anaphylaxis

Answer 83

* Diagnosis = clinical * Investigations * Skin prick/patch testing * Total IgE and Specific IgE (RAST) for cow milk protein

Answer 84

* **Tetralogy of Fallot** * Transposition of the great arteries

Answer 85

* Ventricular Septal Defect (VSD) * Right ventricular outflow obstruction - **pulmonary stenosis** * Right Ventricular Hypertrophy * Overriding aorta ## Footnote *Degree of RV outflow tract obstruction determines degree of cyanosis and clinical severity*

Answer 86

* Cyanosis * Right-To-Left Shunt * Ejection systolic murmur (due to pulmonary stenosis) * CXR: Boot shaped heart * ECG: RV hypertrophy * Right-sided aortic arch in 25% patients

Answer 87

* TOF: 1-2 months * TGA: at birth

Answer 88

* Surgical repair in two parts * Beta blockers for reduction of infundibular spasms - less cyanotic episodes

Answer 89

Human Herpes Virus 6 (HHV6) ## Footnote *Incubation 5-15 days ant affect 6 months - 2 year olds*

Answer 90

* High fever followed by: * Maculopapular rash * Nagayama spots - pauplar enanthem on uvula and soft palate * Febrile convulsions 10-15% * Diarrhoea and cough *Consequences:* * *Aseptic meningitis* * *Hepatitis*

Answer 91

* Serum bilirubin and total bilirubin * Conj/unconj * LFT * Raised GGT (maybe raise AST/ALT) * Serum alpha1-antitrypsin * Neonatal cholestasis * Sweat chloride test * Cystic fibrosis * Ultrasound of biliary tree and liver * Distension and tract abnormalities * Percutaneous liver biopsy with intraoperative cholangioscopy

Answer 92

* Never present at start of the day when child wakes * No limpNo limitation of activity * Systematically well * Normal physcial exmination * Normal motor milestones * Intermittent symptoms and worse after vigorous activity

Answer 93

* Oxygen via facemask (in severe and life-threatening) * B2 bronchodilator by spacer or nebuliser * 1 puff with tidal breathing every 60sec to a maximum of 10 puffs * Oral prednisolone 3-5 days * 20mg in 2-5 yrs * 30-40mg \>5 yrs * Assess response * Poor - repeat B2 bronchodilator and admit * Good - continue bronchildator therapy but not exceeding 4 hourly * Continue prednisolone until recovery (min 3-5 days) * Arrange follow up clinic in next 48 hrs * Refer to secondary care if 2nd attack in 12 months

Answer 94

Roseola infantum is a common viral illness that causes a characteristic 3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever. The fever is typically rapid onset and can often predispose to febrile convulsions. The rash typically starts on the trunk and limbs (this is different to chickenpox which is typically a central rash). HHV6 is neurotropic (attacks the nervous system) and thus a rare complication is encephalitis and febrile fits (after cessation of the fever).

Answer 95

* Transcutaneous bilirubinometer * Serum bilirubin

Answer 96

* _\>_ 35 weeks gestation * \>24 hours old * Baby visibly jaundiced * Baby not on phototherapy

Answer 97

* \< 35 weeks gestation * \< 24 hrs old and visibily jaundived * If transcutaneous bilirubinometer shows \>250 micromol/litre, check bilirubiun using SBR * Any baby whose bilirubin level is at or above the treatment threshold for their postnatal age or is on phototherapy * If baby appears severely jaundiced * If haemolysis is likely cause * Baby clinically unwell (not feeding well, dehydrated) * Baby needs other blood tests other than SBR

Answer 98

* 5-9 days of life

Answer 99

* congenital hypothyroidism * cystic fibrosis * sickle cell disease * phenylketonuria * medium chain acyl-CoA dehydrogenase deficiency (MCADD) * maple syrup urine disease (MSUD) * isovaleric acidaemia (IVA) * glutaric aciduria type 1 (GA1) * homocystinuria (pyridoxine unresponsive) (HCU)

Answer 100

* seizures provoked by fever in otherwise normal children. * Occurs in 6 months to 3 years old, happens in 3% children

Answer 101

* Viral infection * Commonly tonic-clonic

Answer 102

Simple * \<15 minutes * Generalised seizure * Typically no recurrence within 24hrs * Complete recovery within an hour post-seizure Complex * 15-30 minutes * Focal seizure * May recurr within 24 hours Febrile Status Epilepticus * \> 30 minutes

Answer 103

* Admit children if: * 1st seizure OR * Features of complex seizure * Recurrences: * Teach parents how to use rectal diazepam or buccal midazolam * Parents to phone ambulance if seizure lasts \>5 minutes

Answer 104

* 1 in 3 * Varies greatly depending on risk factors for further seizure, more likely if * age of onset \< 18 months * Fever \< 40 * Short fever duration before seizure (\< 1hr) * FH of febrile convulsions * child previously had complex febrile seizure * Attending nursery - more likely to get viral illness * No evidence to show regular antipyretics reducing chance of febrile convulsion recurring

Answer 105

* Childen with Hx of febrile convulsion at increased risk of developing epilepsey but risk is VERY SMALL * Child with Hx of simple = 1 in 50 (2%) * Child with Hx of complex = 1 in 20 (5%) * Child with no Hx of febrile convulsions = 1 or 2 in 100 (1-2%)

Answer 106

* FH * Having complex febrile convulsions * BAckground of neurodevelopmental disorder

Answer 107

* Autism * Asperger's Syndrome * Rett Syndrome * Childhood disintegrative disorder * Pervasive developmental disorder not otherwise specified (PDD-NOS) * Diagnosed when criteria not met for specific disorder

Answer 108

NICE * Suspect septicaemia * Blood and/or mucus in stool * Immunocompromised child Consider stool culture if: * Child recently abroad * Diarrhoea not improved by day 7 * Uncertain about the diagnosis of gastroenteritis

Answer 109

* Subcutaneous, extraperiosteal, collection of fluid that collects as a result of pressur on the baby's head during delivery

Answer 110

* Haemorrhage between the skull and periosteum. * Sweeling is sub-periosteal so limited by the boundaries of the baby's cranial bones

Answer 111

Caput succedaneum * Present at birth * Typically over the vertex * Crosses suture lines * Resolves within days Cephal Haematoma * Typically develops several hours after birth * Commonly in parietal region * Does not cross suture lines * May take months to resolve Both * Swelling on the head of newborn * More common following prolonged and difficult deliveries * Managed conservatively

Answer 112

Transient synovitis

Answer 113

* Transient inflammation of the synovium of the hip * Children 2-10 years; **most common acute onset non-traumatic limp in children** * Difficult to differentiate between transient synovitis and septic arthritis as children can still be unwell from preceeding viral illness Septic arthritis is an orthopaedic emergency

Answer 114

Kocher's Criteria: * \> 38.5^o * Refusal to bear weight on affected limb * Raised inflammatory markers * ESR \> 40 mm/hr; CRP \> 20 mg/L * Peripheral WCC \> 12.0 x10⁹ cell/L

Answer 115

Acute: * Transient synovitis * Septic arthritis Gradual: * Perthes Disease * Slipped Upper Femoral Epiphysis (SUFE) * Abnormal X-Ray

Answer 116

* Presents with severe pain over both calves * Raised Creatinine kinase

Answer 117

Age 3 - 4 years

Answer 118

* Involuntary discharge of urine by night in child aged 5 years or older * In the absence of conggenital or acquired defects of the nervous system or urinary tract * Primary - child has never achieved continence * secondary - child dry for at least 6 months before

Answer 119

* Routine and reward system MUST TRY FIRST * Enuresis alarm * 1st line for \<7yrs * Desmopressin * Considered for children over 5 years * may be first line for \>7 years * Oxybutynin - This is an anticholinergic medication that is used for nocturnal enuresis associated with overactive bladder. It is also used for urinary frequency, incontinence and neurogenic bladder instability. * Imipramine - TCA. It can be used in nocturnal enuresis in children who have failed to respond to all other treatments and have undergone specialist assessment.

Answer 120

* Iniitiate * Review in 4 weeks * Continue for 3 months if no response * Desmopressin should be withdrawn at regular intervals (1 week every three months) for full assessment * Care in avoiding fluid overload * Restrict fluid intake 1 hour before taking desmopressin until 8 hours after * Gradual withdrawal needed for desmopressin

Answer 121

* Skull deformity producing unilateral occipital flattening, which pushes ipsilateral forehead ear forwards producing a parallelogram appearance * Majority improve by age 3-5 due to adoption of upright posture * More common since campaigns to encourage babies to sleep on their backs to reduce risk of SIDS

Answer 122

* Re-assure parents * Turn cot around to allow other side and take pressure off affected side * give baby time to be on their tummy during the day - supervised * Ensure all advice is in-line with prevention of SIDS

Answer 123

Plagiocephaly * Parallelogram shaped head * Unilateral occipital flattening Craniosynostosis * Premature fusion of skull bones

Answer 124

* Sensitivity to gluten protein. Repeated exposure leads to villous atrophy leading to malabsorption * Present before age 3, following introduction of cereals into diet

Answer 125

* HLA-DQ2 (95%) * HLA-DQ8 (80%) * Incidence 1:1000

Answer 126

* failure to thrive * Diarrhoea * Abdominal distension * Older children = anaemia * Many cases not diagnosed until adulthood

Answer 127

* **Jejunal biopsy** - subtotal villous atrophy and crypt hyperplasia * Screening antibodies: anti-endomysial and anti-gliadin

Answer 128

* For the disease to occur, patient does not receive the gene from their father * The mother's gene may be normal but it does not prevent the phenotype from occuring * Prader-Willi

Answer 129

RNA paramyxovirus

Answer 130

Spread by droplets

Answer 131

10-14 days

Answer 132

From prodrome until 4 days after rash starts

Answer 133

* Prodrome: irritable, conjunctivits, fever * Koplik spots (before rash): white spots on buccal mucosa * Rash: starts behind ears then to whole body; discrete maculopapular rash becoming blotchy and confluent

Answer 134

* IgM antibodies in oral fluids * Can be detected within few days of rash onset

Answer 135

* Mainly supportive * Admission: immunosuppressed or pregnant patients * Notifeiable disease - inform public health england

Answer 136

* Otitis media - most common * Pneumonia - most common cause of death * Encephalitis * 1-2 weeks after illness onset * Subacute sclerosing panencephalitis * very rare, presents 5-10 years post illness * Febrile convulsion * Keratoconjunctivitis * Corneal ulceration * Diarrhoea * Increased incidence of appendicitis * Myocarditis

Answer 137

* If child not immunised against measels and comes into contact with someone who does, MMR should be offered * Vaccine-induced antibodies develops more rapidly than that from natural infection * Give within 72 hours

Answer 138

* Cyanosis * Tachypnoea * Loud Single S2 * Prominent right ventricular impulse * Egg-on-side appearance on CXR

Answer 139

* Maintenance od ductus arteriosus with prostaglandins * Alprostadil (PGE1) * *Misoprostol is also PGE1 but used to treat missed miscarriage, induce labour and induce abortion* * Surgical correction is definitive treatment

Answer 140

* Does not smile 10 weeks * Cannot sit unsupported at 12 months * Cannot walk at 18 months

Answer 141

* False * It is abnormal and may indicate cerebral palsy

Answer 142

* Variant of normal * Cerebral palsy * Neuromuscular disorders * Duchenne Muscular dystrophy

Answer 143

* Fragile X (CCG) * Huntington's (CAG) * Myotonic dystrophy (CTG) * Friedreich's ataxia (GAA) * Does not demonstrate anticipation * Spinocerebellar ataxia * Spinobulbar muscular atrophy * Dentatorubral pallidoluysian atrophy

Answer 144

* Phenomenon which leads to earlier age of onset in successive generations * Repeat expansions are unstable and may enlarge

Answer 145

* Malpositioning * Too large for pelvic outlet * Manual maneuvres * Forcep blades * Ventouse deliveries

Answer 146

* Soft tissue injury * Nerve palsies * Fractures

Answer 147

* Capput succedaneum * Cephalhaematoma * Chignon * Bruising * Face, genitalia, buttocks after breech delivery * Preterms bruise easliy from mild trauma * Abrasions * From scalp electrodes applied during labour * Accidental scalpel incision at C-Section * Forcep marks * Face from pressure of blades - transient * Subaponeurotic haemorrhage

Answer 148

* bruising and oedemaof presenting part extending beyond sutures (margins of skulkl bones) * Resolves in a few days

Answer 149

* Haematoma below the periosteum and confined within margins of skull sutures * Usually Parietal bone * Centre of haematoma is soft * Resolves after several weeks (month or two)

Answer 150

* Oedema and bruising from ventouse delivery

Answer 151

* Very uncommon * Diffuse, boggy swelling of scalp * Blood loss may be severe and can lead to hypovolaemic shock and coagulopathy

Answer 152

Subaponeurotic haemorrhage * Diffuse, **fluctuant swelling** of head which may **shift with movement**. Palpation of the scalp has been described as a leather pouch filled with fluid. * Can enlarge? Caput succedaneum * Does not cross suture lines, SAH does Cephalhaematoma * Both crosses suture lines but cephalhaematoma does not usually fluctuate or shift with movement

Answer 153

* Breech deliveries * Shoulder dystocia

Answer 154

Erb's Palsy * C5 and C6 (upper nerve root) * Can be accopmanied by phrenic nerve palsy causing elevated diaphragm * Usually resolves completely (by 2 years) - refer to orthopaedic or plastic surgeon if not resolved by 2-3 months Facial nerve palsy * Compression of facial nerve against mother's ischial spine or pressure from forceps * Unilateral with facial weakness on crying but etye remains open * Transient * Methylcellulose drops may be needed for eye Cervical spine damage * Rare * Laack of movement below level of lesion

Answer 155

Clavicle * From shoulder dystocia * Snap may be heard at delivery or infant may have reduced arm movement or callus formation (lump) over clavicle at several weeks of age * No treatment needed, good prognosis Humerus/Femur * From breech deliveries or shoulder sytocia, midshaft * Deformity and reduced limb movement and pain * Heal rapidly with immobilisation

Answer 156

A * Need for resuscitation and stabilisation at birth * Apnoea and bradycardia B * RDS * Pneumothorax * Bronchopulmonary dysplasia C * Resuscitation and stbailisation * Hypotension * Patent ductus arteriosus * Intraventricular haemorrhage * Periventricular leukomalacia * Anaemia or prematurity D * Metabolic * Hypoglycaemia, hypocalcaemia, electrolyte imbalances, osteopenia of prematurity * Temperature control * Nutrition * Infection * Jaundice E * Necrotising enteroclolitis * Retinopathy or prematurity * Iatrogenic * Inguinal hernias

Answer 157

* Airway and breathing prtoection * Manage (clear airway, O2, CPAP) * Monitor * Temperatrue control * Venous/Arterial lines * Preipheral IV line * Umbilical venous catheter * Arterial line * Peripherally iunserted central (PIC) lin for parenteral nutrition * CXR +/- AXR * Investigations * Antibiotics * Minimal handling * Counsel parents and let them see baby

Answer 158

* FBC (Hb, Neutrophil, Plt) * Blood urea, creatinine, electrolytes, lactate * Culture: blood ‎± cerebrospinal fluid ‎± urine * Blood glucose * CRP/acute phase marker * Coagulation screen

Answer 159

* O2 saturation (aim 91-95% at preterm) * HR, RR * Temperature * BP * Blood glucose * Blood gases * Weight

Answer 160

* Diagnos: cold transillumination of chest or CXR * Tension pneumothorax needs urgent decompression with chest drain insertion * Prevent: Ventilated with lowest pressure that provide adequate chest movement and satisfactory blood gases

Answer 161

* Hypoxia * Infection * anaemia * Electrolyte imbalance * Hypoglycaemia * Seizures * Heart failure * Aspiration from GORD * Premature: immature respiratory control

Answer 162

* resipratory stimulant: caffeine or gentle physicla stimulation * CPAP or mechanical ventilation if frequent apnoeic episodes * Often 20-30 s

Answer 163

Symptoms * Asymptomatic * Apnoea (left to right shunt - breathless) * Increased oxygen requirement Signs * Bradycardia * Bounding pulse (from increased pulse pressure) * HF signs from overload

Answer 164

Symptomatic * Prostaglandin synthetase inhibitor * Indomethacin * Ibuprofen * Surgical ligation if pharm does not work

Answer 165

* Term * Double weight at 4.5 months * Treble at 12 months * Preterm (28 weeks) * Double in 6 weeks * Treble in 12 weeks Need lots of nutrition to keep up with fast growht!

Answer 166

* Breast milk ASAP * Fortified with phosphate, protein, calories and calcium and Vit D * Formula milk - used but does not provide maternal immunity or breast milk benefits * NEC risk with cow-milk based * Parenteral nutrition in very imatture and sick infants (\<1kg) * Risk of infection and thrombosis * Iron supplements * Iron loaded onto baby usually in last trimester

Answer 167

Serious illness caused by inflammation of the gut in preterm babiees

Answer 168

* Ischaemic injury * Bacterial invasion * Cow's milk formula

Answer 169

* feeding intolerance * abdominal distension * bloody stools * Progress to: abdominal discolouration, perforation and peritonitis.

Answer 170

* dilated bowel loops (often asymmetrical in distribution) * bowel wall oedema * pneumatosis intestinalis (intramural gas) * portal venous gas * pneumoperitoneum resulting from perforation * air both inside and outside of the bowel wall (Rigler sign) * air outlining the falciform ligament (football sign)

Answer 171

* Bowel rest - STOP oral feeding * Broad spectrum anti-iotics (aerobic and anaerobic cover) * Parenteral nutrition * Mechanical ventilation and circulatory support * SURERY - bowel perforation- resction of bowel

Answer 172

* Keep sats 91-95% * High saturations may lead to increased free radicals * sats \> 95% increased risk of retinopathy of prematurity * sats \<91% increased risk of NEC and death Start neonatal resuscitation on 21-30% oxygen in preterms - avoid saturating to 95%. Air should be used in term infants

Answer 173

* Stricture development * Malabsorption in extensive bowel resection * Increased risk of poor neurodevelopmental outcome

Answer 174

* failure of the normal circulatory transition that occurs after birth - ie there is no decrease in pulmonary resistance at birth * characterized by marked pulmonary hypertension that causes hypoxemia secondary to right-to-left shunting of blood at the foramen ovale and ductus arteriosus - these dont close as pulmonary resistance still high3 * Presents as cyanosis at birth, heart murmurs and signs of HF are often absent

Answer 175

* Birth asphyxiation * meconium aspiration * Septicaemia * RDS * Congenital diaphragmatic hernia

Answer 176

* CXR * Normal heart size * Oligaemia * Urgent echocardiogram * Exclude congenital heart disease * Identifty signs of pulmonary HTN (raised pulmonary pressures and tricuspid regurgitation)

Answer 177

* Infants require mechanical ventilaion and circulatory support for adequate oxygenation * Vasodilators * Nitric oxide * Sildenafil * ECMO in severe bu reversible cases

Answer 178

* MOst common cause of respiratroy distress in term infants * Caused by delay in resorption of lung liquid * Most common after C-section birth * CXR may show fluid in horizontal fissure * MAy need ambient oxygen * Usually resolves within first day of life but can take several days to resolve completely * Diagnosed after consideration and exclusion of other causes (infection)

Answer 179

* Increasing gestational age * 20-25% babies delivered by 42 weeks affected * Maternal * Hx maternal HTN * Pre-eclampsia * Chorioamnionitis * Smoking * Subsatnce abuse

Answer 180

* May be response to foetal hypoxia before or at delivery * Infant may be gasipng and then aspirating meconium * Meconium causes mechanical obstruciton and chemical pneumonitis predisposing infant to infection and respiratory distress

Answer 181

* Lobar collapse and consolidation * Pneumothorax * Pneumomediastinum * PPHN -\> difficult to achieve adequate oxygenation despite high pressure ventilation * Morbidity and mortality

Answer 182

* Neisseria gonorrhoea * Gram negative diplococcus * Obligate anaerobe * Conjunctivites

Answer 183

Retinoblastoma Average age of diagnosis= 18 months

Answer 184

Autosomal dominant

Answer 185

Loss of function of retinoblastoma tumour suppressor gene on chromosome 13 10% cases are hereditary

Answer 186

* absence of red reflex (replaced by white pupil, leukocoria) * Most common presenting symptom * Strabismus * Unable to align eyes together normally (cross-eyed) * Visual problems * *Fhx of enucleation*

Answer 187

* **Enucleation** * Dependent on how advanced tumour is: * External beam radiation therapy * Chemotherapy * Photocoagulation

Answer 188

Excellent prognosis, \>90% surviving into adulthood

Answer 189

Human herpes virus 6 ## Footnote *Exanthem subitum, sixth disease*

Answer 190

5-15 days Affects 6 months to 2 yo

Answer 191

* High fever: lasts a few days followed by a: * Maculopapular rash * Nagayama spots * Papular enanthem on uvula and soft palate * Febrile convulsion (10-15%) * Diarrhoea and cough

Answer 192

* Aseptic meningitis * Hepatitis

Answer 193

Fals, school exclusion is NOT needed

Answer 194

* URTI in infants and toddlers * Characterised by stridor (due to laryngeal oedema and secretions) * Barking cough

Answer 195

Parainfluenza

Answer 196

6 months - 3 years More common in autumn

Answer 197

* Stridor * Barking cough (worse at night) * Fever * Coryzal symptoms

Answer 198

* Occasional barking cough * No audible stridor at rest * No/mild suprasternal and/or intercostal recession * Child is happy and is prepared to eat, drink, and play

Answer 199

* Frequent barking cough * Audible stridor at rest * Suprasternal and sternal wall recessions at rest * No or little distress or agitation * Child can be placated and is interested in its surroundings

Answer 200

* Frequent barking cough * Prominent inspiratory (and occassionally expiratory) stridor at rest * Marked sternal wall recessions * Significant distress and agitation, or lethargy or restlessness (sign of hypoxaemia) * Tachycardia occurs with more severe obstructive symptoms and hypoxaemia

Answer 201

Admit if child has moderate or severe croup and any of the features below: * \< 6 months age * Known upper airway abnormalities (laryngomalacia, Down's Syndrome) * Uncertainty about diagnosis * Epiglotittis, bacterial tracheitis, peritonsillar abscess, foreign body inhalation

Answer 202

* clinical diagnosis * CXR: * PA view shows subglottic narrowing -\> Steeple sign * Lateral view in epiglottitis shows swelling of epiglottis - thumb sign

Answer 203

* Single dose oral dexamethasone (0.15mg/kg) regardless of severity * Prednisolone is alternative if dexamethasone not available Emergency treatment: * High flow oxygen * Nevulised adrenaline

Answer 204

* Respiratory Syncytial virus (RSV) 75-80% * Other * Mycoplasma * Adenovirus

Answer 205

LRTI in \<1 year olds * 90% 1-9 months old * Peak incidence 3-6 motnsh * MAternal IgG provides protection to newborns against RSV * Higher incidence in winter

Answer 206

* Coryzal symptoms FIRST, then * Dry cough * Breathlessness * Wheeze, inspiratory crackles * Feeding difficulties associated with dyspnoea - \> admit

Answer 207

* Apnoea (observed or reported) * Child looks unwell * Severe respiratory distress * Grunting, recession, RR \> 70 * Central cyanosis * Persistent O2 sat \<92% on air

Answer 208

* RR \>60 * Difficulty breastfeeding or inadequate oral fluid intake (50-75%) * Clinical dehydration

Answer 209

Immunofluorescence of nasopharyngeal secretion may show RSV

Answer 210

SUPPORTIVE * Humidified O2 via head box if O2 sats \<92% * Nasogastric feeding ifinadequate feed * Suction sometimes for excessive secretions

Answer 211

* Occipito-frontal circumference \<2nd centile

Answer 212

* Normal variant * Familal * Congenital infection * Perinatal brain injury (HIE) * Foetal alcohol syndrome * Syndromes : Patau * Craniosynostosis

Answer 213

* Neonatal death = death 0-28 days of birth * Early = within first week of life * Late = after 7th day of life but before 28 days * Puerperal death = maternal death within puerperal period (6 weeks post birth) * Perinatal death = classify deaths as a result of obstetric events (stillbirths) * Miscarriage = death in utero before 24 weeks gestation

Answer 214

* Umbrella term for permanent disorder of movement and/or posture and of motor function due to non-progressive abnormality in the developing brain

Answer 215

* Cognition * Communication * Vision * Perception * Sensation * Behaviour * Seizure disorder * Secondary musk problems

Answer 216

Antenatal origin (80%) * Cerebrovascular haemorrhage * Ischaemia * Cortical migration disorders * Structural meldevelopment of brain * *Associations with gene deletions, others to genetic syndromes and congenital infection* Intrapartum (10%) * Hypoxic-ischaemic injury before or during delivery Postnatal causes (10%) * Meningitis * Encephalitis * Encephaopathy * Head trauma from AI or NAI * Symptomatic hypoglycaemia * Hydrocephalus * Hyperbilirubinaemia

Answer 217

* Abnormal limb and/or trunk posture and tone * Delayed motor milestones * Slowed head growth * Feeding difficulties, with oromotor incoordination, slow feeding, gagging and vomiting * Abnormal gait once walking achieved * Asymmetric hand function before 12 months of age * Primitive reflexes may persist

Answer 218

* Clinical diagnosis * Posture * Pattern of tone in limbs and trunk * Hand function * Gait

Answer 219

Categorised based on neurological features * Spastic (90%) * Bilateral, unilateral, not otherwise specified * Dyskinetic (6%) * Ataxic (4%) * Other In the past description was based on parts of body affected (hemiplegia, quadriplegia, diplegia)

Answer 220

Gross motor function classification system (GMFCS) * Level I * Walks without limitations * Level II * Walks with limitations * Level III * Walks using a handheld mobility device * Level IV * Self-mobility with limitations; may use powered mobility * Level V * Transported in manual wheelchair

Answer 221

* Maintenance of primitive reflexes * Developmental delay * Poor feeding/sucking * Irritability * Hand dominance before 2 years * Toe-walking * Epilepsey * Scissoring of legs

Answer 222

* Upper motor neurone (pyramidal or coticospinal tract) damage - cortical damage * GABA transmission reduced so nerves are over-excited, leading to **hypertonia** * Scissor gait (adductor muscles partly flexed) * Toe-walk (calves flexed) * Really tight or stiff muscles - jerky movements * Hemiplegia - unilateral, upper \>\> lower limb * Quadraplegia - all four limbs, upper \>\> lower limb, most diabling form. Central hypotonia, poor head control * Diplegia - all four limbs affected, lower \>\> upper limbs. Assocaited with prematuriy (periventricular leukoplakia and intraventricular hamorrhage). Cognition often normal (lesion in white matter, so grey matter spared)

Answer 223

* Damage or injury to basal ganglia * Helps initiate and prevent movements * Damage leads to loss of ability to prevent movements * Involuntary movements * Dystonia(random, slow, uncontrolled movements in limb and trunk) * +/- chorea (dance like movements as small uncontrolled movments seem to move from muscle to muscle

Answer 224

* Damage to cerebellum * Coordination, fine movements * Clumsy or unstable movements * Poor balance

Answer 225

* MDT approach * Neurologist * Rehabilitation specialist * OT/PT * SALT * PT * Build strength and improve walking ability * Muscle relaxants * Botulinum toxin may be injected for hypertonicity * Helps with pain associated with hypertonus * Surgery * Loosening tight muscles * Straightening out bones

Answer 226

* Hypoxic-ischaemic injury to organs (braing) due to compromised placental or pulmonary gas exchange * Cardiorespiratory depression occurs leading to hypoxia, hypercapnia, metabolic acidosis * Leads compromised cardiac output and hypoxic-ischaemic injury

Answer 227

* Reduced gas exchange at placenta * Excessive/prolonged uterine contractions, placental abruption, ruptured uterus * Interrupte umbilical blood flow * Cord compression (shoulder dystocia, cord prolapse) * Maternal factors * Decreased placental perfusion, maternal hypotension or hyeprtension * Foetal factors * IUGR, anaemia * Cardiorespiratory adaptation at birth * Failure to breathe

Answer 228

Immediately or upt to 48 hours after asphyxia

Answer 229

* Failed oxygenation across placenta, umbilicus * Cardiorespiratory depression occurs leading to hypoxia, hypercapnia, metabolic acidosis * Leads compromised cardiac output and hypoxic-ischaemic injury * Neuronal damage may be immediate from primary neuronal death OR * delayed damage from reperfusion injury (ie there is a primary energy failure and secondary energy fialure) * This window of delay between the two injuries offer opportunity to treat

Answer 230

Encephalopathy * Abnormal neurological signs * Seizures Respiratory failure * Persistent pulmonary hypertension of the newborn Myocardial dysfiunction * Hypotension Metabolic * HypOglycaemia * HypOcalcaemia * HypOnatraemia Other * Renal failure * DIC

Answer 231

* Mild * Irritable, responds excessively to stimulation, staring of eyes, hyperventilation, hypertonia, imparied feeding * Moderate * marked abnormal movements, hypotonic, cannot feed, may have seizures * Severe * No normal spontatneous movements or response to pain, tone in limbs fluctuate between hypotonia and hypertonia, seizures are prolonged and refractory to treatment, multi-organ failure present

Answer 232

* Nueroprotection * **Therapeutic hypothermia** (33-35) * Monitor * aEEG - detect abnormal brain activity and seizures * Organ support * Respiratory * AED * Fluid restriction due to transient renal impariemtn * Treatment of hypotension by volume and inotrope support * Monitor metabolic problems * low glucose * low Na * low Ca

Answer 233

* Accumulation of CSF in the brain * Can be congenital, associated with cerebral malformations or obstruction to the flow of CSF leading to dilatation of ventricular system proximal to site of obstruction

Answer 234

* Communicating * Obstruction at the arachnoid vili (where CSF absorbed) * Non-communicating * Obstruction within ventricular system or aqueduct

Answer 235

Non-communicating (obstruction to venticula system) * Congenital malformation * Aqueduct stenosis * Atresia of ouflow foramina of 4th ventricle * Chiari malformation (cerebellar tonsils herniation through foramen magnumg) * Posterior fossa neoplasm or vascular malformation * Intraventricular haemorrhage in preterm infant Comomunicating (failure to reabsorb CSF) * Subarachnoid haemorrhage * Meningitis (pneumococcal, tuberculous)

Answer 236

* Disproportionately large head * Skull sutures have not yet fused * Sun setting of eyes (fixed downward gaze) * advanced sign * Signs and symptoms of raised ICP * Older children

Answer 237

* Can be diagnosed on antenatal US screening or in preterm infants on routine cranial USS * Suspected hydrocephalus * 1st = cranial USS (in infants) OR MRI * Head circumference measured and monitored and plotted oer time

Answer 238

* Symptomatic relief of raised ICP and minimise risk of neurological damage

Answer 239

* Insertion of ventriculoperitoneal shunt * sometimes endoscopic treatment to create ventriculostomy

Answer 240

Immune thrombocytopenia (ITP) incidence 4 per 100,000 children per year

Answer 241

* Destruction of circulating platelets by antiplatelet IgG * May be some megakaryocytes in bone marrow as compensatory response

Answer 242

* Present between 2-10yo * Onset 1-2 weeks post viral infection * Features: * Petechiae * Pupura * Superficial bleeding

Answer 243

* Epistaxis * And other mucosal bleeding * Profuse bleeding uncommon * Intracrainial bleed * Serious but rare

Answer 244

* Wiskott-Aldrich * Bernard Soulier * Acute leukaemia * Aplastic anaemia

Answer 245

* Diagnosis of exclusion Careful attention to: * History * clinical features * Blood film * Examination * Anaemia, neutropenia * Hepato-splenomegaly * Lymphadenopathy * Bone marrow examination if child is going to be treated with steroids

Answer 246

* 80% is acute, benign and self-limiting, resoplving in 6-8 weeks * Manage at home * Do not need treatment even if their platlet count is \<10x10⁹/L but treatment should be given if there is evidence of major bleeding or persistent minor bleeds that affect QoL * Oral prednisolone * IV anti-D * IVIG * Pletlet transfusions in life-threatening - needs admission * Avoid trauma (contact sport) whilst platelet counts low

Answer 247

* When platlent count remains low 6 months after diagnosis * 20%

Answer 248

* Supportive * Screen for SLE if chronic ITP

Answer 249

Acute Lymphoblastic leukaemia (ALL) 80% of childhood leukaemias

Answer 250

* 2-5 years * Boys \>\> girls

Answer 251

* Bone marrow failure * Anaemia - tired and pallor * Neutropenia - frequent and severe infections * Thrombocytopenia -easy bruising and petechiae * Bone pain (bone infiltration) * hepatosplenomegaly (extra-medullary haematopoiesis) * Fever in 50% new cases * testicular swelling

Answer 252

* Common ALL (75%) * CD10+ve, pre-B phenotype * T cell ALL (20%) * B cell ALL (5%)

Answer 253

* \<2 years or \>10 years * WBC \> 20x10⁹/L at diagnosis * T or B cell surface markers * Non-caucasian * Male

Answer 254

* Affects dvelolping blood vessels at the junction of the vascularise and non-vascularised retina * Vascular proliferation, which may progress to retinal detachment, fibrosis and blindness

Answer 255

* Excessive oxygen use * Prematurity

Answer 256

* Screen susceptible preterm infants (≤1500g birthweight or \<32 weeks gestation) * Laser therapy * Intravitreal anti-VEGF (being investigated)

Answer 257

* Very low birthweight infants (\<1500g) * Perinatal asphyxia * RDS * _Pneumothorax_

Answer 258

Cranial ultrasound scans

Answer 259

* Small = confined to germinal matrix * Large = extends to ventricles

Answer 260

* Ventricular dilatation * Hydrocephalus * separate sutures, tense fontanelle * May need ventriculoperitoneal shunt, or remove CSF by LP or ventricular tap * Cerebral palsy * Periventricular white matter brain injury * Periventricular leukomalacia (bilateral loss of white matter)

Answer 261

* Cystic lesions, bilateral periventricular * Loss of white matter - spastic diplegia, with cognitive impairment

Answer 262

* **Mother-to-child transmission** * Intrauterine (pregnancy) * Intrapartum (delivery) * Breastfeeding (post-partum) * Infected blood products * Contaminated needles * Sexual abuse

Answer 263

Children less than **_18_** months of age who are born to infected mothers will have transplacental maternal **_IgG HIV antibodies_**; therefore, at this age a positive antibody test confirms HIV **_exposure_** but not HIV **_infection_**.

Answer 264

\>18 months * HIV antibody detection \<18 months * HIV DNA PCR * All infants born to HIV-infected mothers should be tested for HIV whether or not they are symptomatic

Answer 265

* Two negative HIV DNA PCR within first 3 months of life, at least 2 weeks after postnatal ART (antiretroviral therapy) * Confirmed by the loss of maternal HIV antibodies from infant's circulation after 18 months age

Answer 266

* Rapid progression and onset of AIDS in the 1st year of life * Asymptomatic for months or years before progressing to clinical disease * Some asymptomatic children are onl;y identified in adolescence at routine screening following diagnosis of another family member

Answer 267

Mild * Lymphadenopathy * Parotic enlargement Moderate * Recurrent bacterial infections * Candidiasis * Chronic diarrhoea * Lymphocytic interstitial pneumonitis * This can look like TB, but its not * May be cause by response to HIV infection or related to EBV infection

Answer 268

* Opportunistic infections * PCP * Severe growth faltering * Encephalopathy * Malignancy * Rare

Answer 269

* Antiretrovirals (ART) * 3 or 4 drugs * Prophylaxis * PCP - cotrimoxazole * infants with HIV or older children with low CD4 counts * Immunisation * Consider influenza, Hep A/B, VZV * Do NOT BCG * MDT * see with family * Compliance * Planning for future (sex, fertility, pregnancy) * Psychological support

Answer 270

* Clinical status * Viral load * CD4 count Infants should always start ART after diagnosis as they have a higher risk of disease progression

Answer 271

* Maternal **ART** during prengnacy and intrapartum -achieve undetectable viral load * **PeP** (post exposure) to infant after delivery * Avoid **breastfeeding** * Active management of labour and delivery * Avoid prolonged ROM and unecessary instrumentation (forceps) * Prelabour c-section * if maternal viral load is detectable close to expected date Mothers who are not taking ART and who breastfeed transmit HIV in 25-40% of infants

Answer 272

* E coli * Listeria monocytogenes * Group B Streptococcus

Answer 273

* RSV * Chalmydia trachomitis * Streptococcus pneumoniae * Haemophilus influenzae * Bordatella pertussis * Staphylococcus aureus * Infrequent but serious

Answer 274

* Mycoplasma pneumoniae * Streptococcus pneumoniae * Chlamydia pneumoniae

Answer 275

* Fever * Cough * Rapid breathing * Preceded by URTI * Lethargy * Poor feedgin * Unwell child * Localised chest, abdo or neck pain * Features of pleural irritation -\> bacterial infection Consider pneuimonia in children with neck stiffness or acute abdominal pain

Answer 276

* Tachypnoea * Very sensitive to pneumonia (unlike in asthma) * Nasal flaring and chest indrawing/recession (work of breathing) * Decreased oxygen saturations * Maybe some end-inspiratory crackles

Answer 277

* CXR to confirm diagnosis * Cannot reliably differentiate between viral and bacterial pneumonia * Blood cultures, urine cultures, LP (in young) * Nasopharyngeal aspirate in younger children * identify viral causes * Blood tests are generally unhelpful in differentiating viral or bacterial cause

Answer 278

* Oxygen saturation \<92% * Recurrent apnoea * Grunting * Inability to maintain adequate fluid/feed intake

Answer 279

Choice of antibiotic dependent on childs age and severity of illness: * Newborns - IV broad-spectrum * Older infants - oral amoxicillin * Complicated/unresponsive pneumonia - co-amoxiclav * \>5 yo - amoxicillin or oral macrolide (erythromycin)

Answer 280

* Full recovery * Follow up not generally needed * Those with lobar collapse should have repeat CXR in 4-6 weeks to check normal lung fields

Answer 281

* Osteomyelitis * Bone tumours * Septic arthritis

Answer 282

* Distal femur and proximal tibia, but any bone may be affected Infection of the metaphysis of long bones

Answer 283

* Haematogenous * But may be direct spread from wound

Answer 284

* **Staphylococcus aureus** * Streptococcus * Haemophilus influenzae (if not imunised) Children with sickle cell anaemia * Staphylococcus * Salmonella Immunodeficient * TB

Answer 285

* Painful and immobile limb (pseudoparesis) * Febrile * Swelling and tenderness over infected site (erythematous and warm)

Answer 286

* **Blood cultures** * **Usually positive (due to haematogenous spread)** * WCC and CRP raised * X-ray * Ultrasound * MRI * Radionuclide bone scan if site of infection uncleear

Answer 287

* Parenteral (IV) antibiotics immediately for several weeks * Aspiration or surgical decopmression os subperiosteal spave * Atypical presentation or immunodeficient child * Surgical drainage * Unresponsive to antiboiotic therapy * Limb rest in splint Long antibiotic therapy as poor penetration in joint infection

Answer 288

* Bone necrosis * Chronic infection * Limb deformity * Amyloidosis

Answer 289

* Malignant tumour of retinal cells * Rare, 5% of severe visual impariment in children * Affects one or both eye

Answer 290

Retinoblastoma may affect one or both eyes. All bilateral tumours are **_hereditary_**, as are about 20% of unilateral cases. The retinoblastoma susceptibility gene is on chromosome **_13_**, and the pattern of inheritance is autosomal **_dominant_**, but with incomplete penetrance. Most children present within the first **_3_** years of life. Children from families with the hereditary form of the disease should be screened regularly from birth.

Answer 291

* White pupillary reflex * Squint

Answer 292

* MRI and examination under anaesthetic * Tumours are frequently multifocal

Answer 293

* Aim is to cure and preserve vision * Management based on opthalmological findings * Enucleation of eye * Advanced disease * Chemotherapy and laser therapy * Bilateral disease, chemo to shrink tumours * Radiotherapy * Advanced disease * Reserved for treatment of recurrence

Answer 294

* Most patients are cured but may be visually imparied * Significatn risk of second malignancy among survivors of hereditary retinoblatoma

Answer 295

* Presents fiurst 1-3 dyas of life with obstruction from Ladd bands obstructing the duodenum or volvulos * May present at any age with volvulus causing obstruction and ischaemic bowel Features * Billous vomiting * Abdominal pain * Peritonitis or ischaemic bowel tenderness

Answer 296

* Upper GI contrast study to assess intestinal rotation

Answer 297

* Surgical emergency * Surgicla correction

Answer 298

Development of secondary sexual characteristics * \<8 in females * \<9 in males

Answer 299

* Precocious puberty * Thelarche * Adrenarche * Isolated premature menarche

Answer 300

* Gonadotrophin dependent - Central or True precosious puberty * Premature activation of hypothalamic-pit-gonadal axis (HPG axis). * Pubertal development is normal = **consonant** * Gonadotrophin independent - Pseudo or False precocious puberty * Excess sex steroids outside of pituitary gland * Pubertal development is abnormal = **dissonant**

Answer 301

The **_ovaries_** are very sensitive to secretion of gonadotrophins from the pituitary gland, so gonadotrophin-**_dependent_** precocious puberty is fairly common in girls. It is usually **_idiopathic_** or familial. Pathological causes of precocious puberty in girls are rare and can be secondary to either: * gonadotrophin-independent causes such as excess androgens from **_congenital_** **_adrenal_** **_hyperplasia_** or **_adrenal_** tumours, presenting with pubic and axillary hair, adult body odour, acne, and virilization of the genitalia before breast development * gonadotrophin-dependent causes such as pituitary **_adenoma_**, where pubertal development will be **_consonant_**, but perhaps rapid. **_Ultrasound_** examination of the ovaries and uterus is helpful in assessing the progress of puberty. The uterus will change from an infantile ‘**_tubular_**’ shape to ‘**_pear_**’ shape with the progression of puberty and the endometrial lining can be identified close to menarche.

Answer 302

The testes are relatively **_insensitive_** to secretion of gonadotrophins from the pituitary gland, so gonadotrophin-dependent PP is **_uncommon_** in boys. It is important to exclude a pathological cause. Examination of the **_testes_** may be helpful: * bilateral **enlargement** of the testes, with testicular volumes greater than **_4_** mL, suggests gonadotrophin-**_dependent_** PP. This can be caused by an **_intracranial_** **_tumour_** and rarely by secretion of **_B-HCG_** from a liver tumour * **_prepubertal_** testes suggest a gonadotrophin **_independent_** cause, e.g. adrenal pathology such as a **_tumour_** or **_congenital_** **_adrenal_** **_hyperplasia_** * a unilateral enlarged testis suggests a **_gonadal_** tumour. Tumours in the hypothalamic region are best investigated by cranial **_MRI_** scan.

Answer 303

* LH ++ * FSH + * Oestrogen from ovary ++ * Testosterone from: * Testes ++ * Adrenals +

Answer 304

* Low FSH Low LH

Answer 305

* Idiopathic/familial * CNS abnormalities * Hydrocephalus * Acquired (post-irradiation, infection, surgery, brain injury) * Tumours * Hyp**o**thyroidism

Answer 306

* Adrenal disroders * Tumours * congenital adrenal hyperplasia * 21 hydroxylase deficiency - salt losing crisis (low aldo, low cortisol, high sex steroids) * Ovarian tumour (granulosa cell) * Testicular tumour (Leydig cell) * Exogenous sex steroids

Answer 307

* Detection and treatment of underlying pathology * MRI for intracranial tumours (males) * Reducing rate of skeletal maturation * Assess bone age * Early growth spurt may result in early cessation of growth and reduction in adult height * Address psychological/behavioural difficulties

Answer 308

Absence of pubertal development by 14 in females and 15 in males

Answer 309

In contrast to precocious puberty, delayed puberty is more common in **_males_** due to relative insensitivity of the **_testes_** to gonadotrophin secretion. Most commonly, this is **_constitutional_** delay in growth and puberty, often with a **_family_** history of delayed puberty. It is a variation of the normal **_timing_** of puberty rather than a pathological condition. It may also be induced by dieting or excessive physical training. An affected child will have delayed sexual changes compared with his/her peers, and bone age would show moderate delay. The legs will be long in comparison to the back. Eventually, the target height will be reached as growth in affected children will continue for longer than in their peers. The condition may cause psychological upset from teasing, poor self-esteem, and disadvantage in competitive sport. In boys, assessment includes: • pubertal staging, especially **_testicular_** volume • identification of long-term systemic disorders.

Answer 310

Constitutional delay of growth and puberty (familial)

Answer 311

* Low gonadotrophin secretion (hypogonadotrophin hypogonadism) * High gonadotrophin secretion (hypergonadotrophin hypogonadism)

Answer 312

Boys * Treatment not usually required * If needed: * Young = oral oxandrolone * Catch-up growth - NO secondary characteristics * Older = IM testosterone * Accelerate growth + secondary characteristics Girlks * Delayed puberty less common so organic cause should be excluded (due to sensitivity of ovaries to pit GnT) * Karyotyping * TFTs * Sex steroid hormone measurement * If needed: oestradiol to induce puberty

Paediatrics Flashcards

(343 cards)