Paediatrics Flashcards
(447 cards)
1
Q
At what age can a child sit without support?
A
6-8m (LA: 12m)
2
Q
At what age will a child begin to walk?
A
12m (LA: 18m)
3
Q
At what age can a child run?
A
2.5y
4
Q
At what age can a child ride a tricycle?
A
3y
5
Q
At what age can a child hop and skip?
A
4y and 5y respectively
6
Q
At what age will a child follow a moving object by turning their head?
A
6w (LA: 3m)
7
Q
At what age will a child reach out for a toy?
A
4m (LA: 6m)
8
Q
At what age does a child develop a mature pincer grip?
A
10m (LA: 12m)
9
Q
At what age can a child build a tower of 3 blocks?
A
18m
10
Q
At what age can a child build a bridge of blocks?
A
3y
11
Q
A what age can a child draw a line?
A
2y
12
Q
A what age can a child draw a circle?
A
3y
13
Q
A what age can a child draw a square?
A
4y
14
Q
A what age can a child draw a triangle?
A
5y
15
Q
At what age will a child start to use the words mama or dad?
A
7-10m
16
Q
At what age can a child join words to make simple phrases?
A
20-24m
17
Q
At what age can a child understand their name?
A
12m
18
Q
At what age can a child smile reponsively?
A
6w (LA: 10w)
19
Q
At what age can a child wave bye bye?
A
10-12m
20
Q
At what age can a child drink from a cup?
A
12m
21
Q
At what age can a child use a spoon?
A
18m
22
Q
At what age will a child start to take turns when playing?
A
2.5-3y
23
Q
How long is age corrected for prematurity when considering milestones?
A
2 years
24
Q
What is the moro reflex?
A
Head extension causes abduction followed by adduction of the arms, till 3-4 months
25
What is the grasp reflex?
Flexion of fingers when object placed in palm, till 4-5 months
26
What is colic?
Paroxysmal crying with pulling up of legs for >3h on ≥3days/week.
27
What are some features of cow's milk protein allergy?
Colic symptoms, GORD, blood/mucus in stools,
| eczema, faltering growth
28
How should cow's milk protein allergy be managed?
Exclude cow’s milk from mother diet or use extensive hydrolysed/amino acid formula
29
How does ammonia dermatitis (nappy rash) present?
Red desquamating rash, sparing skin folds, due to
| moisture retention
30
How should ammonia dermatitis (nappy rash) be treated?
Frequent nappy changes, nappy free periods, careful drying and emollient creams
31
What can cause vomiting in infancy?
Regurg during feeds (posseting) or between feeds
GORD
Overfeeding (150ml/kg/day normal)
Pyloric stenosis – projectile, 6-10 weeks old
Infections
Adverse food reactions – allergies, coeliac
32
What can cause bilous vomiting in infancy?
Duodenal obstruction, volvulus
33
What are some lung complications of mechanical ventilation?
Pneumothorax
Pulmonary haemorrhage
Bronchopulmonary dysplasia
Pneumonia
34
What are some airway complications of mechanical ventilation?
Upper airway obstruction, GORD, laryngomalacia
35
What are some non-respiratory complications of mechanical ventilation?
PDA, RICP
Retinopathy of prematurity
Subcutaneous emphysema
Air in mediastinum, pericardium, peritoneum due to air leak (ruptured alveoli)
36
What is the definition for preterm?
<37 weeks
37
What is the defintion for low birth weight? Very low birth weight? Extremely low birth weight?
L: <2500g
VL: <1500g
EL: <1000g
38
What is symmetric IUGR? And what are some causes?
All growth parameters are symmetrically small suggesting fetus was affected from early pregnancy Chromosomal abnormalities and constitutionally small
39
What is asymmetric IUGR? And what is a cause?
Weight centile is less than length and head circumference
| Pre-eclampsia
40
What is Hirschsprung's disease?
Congenital absence of ganglia in a segment of colon leading to functional GI obstruction, constipation and
megacolon
41
How is Hirschsprung's diagnosed?
Rectal suction biopsy of aganglionic section staining for
| acetylcholinesterase positive nerve excess
42
How is Hirschsprung's treated?
Bowel irrigation and surgery
43
What are some complications of Hirschsprung's?
GI perforation, bleeding, ulcers, enterocolitis
44
What are some signs of oesophageal atresia + trachea-oesophageal fistula?
```
Polyhydramnios
Cough
Airway obstruction
Increased secretions
Distended abdo
Cyanosis
Aspiration
```
45
How should oesophageal atresia + trachea-oesophageal fistula be treated?
Stopping feeding, suck out oesophageal pouch and surgery
46
Describe the features of congenital diaphragmatic hernia:
Developmental defect (left pos. diaphragm) allowing herniation of abdo contents into chest
47
What are some signs of congenital diaphragmatic hernia?
Respiratory distress, bowel sounds over hemithorax, cyanosis
48
How should congenital diaphragmatic hernia be treated?
Large bore NGT to remove air from gut and then surgery
49
What are some complications of inguinal hernia?
Obstruction, incarceration, strangulation
50
When should an inguinal hernia be operated on in a baby <6w, child <6m and child <6y?
Within 2d
Within 2w
Within 2m
51
What is Meckel's diverticulum?
Remnant of the omphalomesenteric duct in small intestine and contains ectopic ileal, gastric or pancreatic mucosa
52
How can Meckel's diverticulum present?
Asymptomatic, abdo pain, rectal bleeding, intestinal obstruction
53
What is gastroschisis?
Paraumbilical defect with extrusion of viscera and abdo contents with no covering
54
What is the management for gastroschisis?
Cover exposed bowel in clingfilm, keep baby warm and hydrated and close defect ASAP
55
What is exomphalos?
Ventral defects of umbilical ring with herniation of abdo viscera covered in peritoneum
56
What are the consequences of congenital diaphragmatic hernia?
Leads to impaired lung development (hypoplasia and pulmonary HTN)
57
How should undescended testis be managed?
Orchidopexy
58
What can cause oligohydramnios prenatally and absent/feeble voiding postnatally?
Posterior urethral valves
59
What is hypospadias?
Abnormal position of external urethral meatus on ventral penis
60
How should hypospadias be managed?
Use foreskin for preschool repair
61
What is patent urachus?
Opening between bladder and navel, urine leaks from umbilicus
62
What is bladder exstrophy?
Extrusion of bladder through defect in abdo wall
63
What is the commonest renal tumour in children?
Wilms’ nephroblastoma
64
How can Wilms’ nephroblastoma present?
Before 4yrs with painless, palpable abdo mass
| Fever, flank pain
65
What is the management for Wilms’ nephroblastoma?
Nephrectomy with neo-adjuvant chemo
66
What is the pathophysiology of congenital adrenal hyperplasia?
Deficiency of 21-hydroxylase.
Cortisol not produced so rise of ACTH, adrenal hyperplasia and overproduction of androgenic cortisol precursors leading to increased testosterone
67
What are some signs of congenital adrenal hyperplasia?
Vomiting, dehydration, ambiguous genitalia
Boys may have precocious puberty or incomplete masculinisation
Growth and fertility impairment
68
What is the management for congenital adrenal hyperplasia?
Glucocorticoid replacement in all, mineralocorticoid replacement if salt-wasting
69
What are some signs of an adrenal crisis?
N+V, abdo pain, lethargy, hypotension
70
What is the management for an adrenal crisis?
Hydrocortisone IV, saline IVI, glucose, fludrocortisone
71
What are some causes of cleft lip and palate?
Genes, benzodiazepines, antiepileptics, rubella
72
How can cleft lip and palate be managed?
Feeding with special teats
Plastic surgery (lip at 3 months, palate at 6)
Speech therapy
73
What is spina bifida? What are the 3 types?
Incomplete closing of spine and meninges during development
| 3 types: spina bifida occulta, meningocele, myelomeningocele
74
What is meningocele? What is myelomeningocele?
Herniation of dura and arachnoid mater through bony defect
| If involving cord, myelomeningocele
75
How can neural tube defects be prevented?
0.4mg folic acid daily from 3 months preconception to 13 weeks gestation
If high risk, 5mg
76
What are some features seen in fetal alcohol syndrome?
```
Short palpebral fissure
Hypoplastic upper lip
Smooth/absent philtrum
Learning difficulties
Microcephaly
Growth retardation
```
77
What is Eisenmenger's syndrome?
Increased pulmonary resistance causes reversal of left to right flow through shunt
78
How can ASD and VSD be managed?
Small defects can close spontaneously
| Larger may need patch surgery
79
Describe some features you may elicit if a pt has a PDA:
Continuous machine murmur below left clavicle, collapsing pulse
80
How should PDA be managed?
Ensure no duct dependent circulation by echo
| Treat with oral or IV ibuprofen
81
What are some features of coarctation of the aorta?
HTN, radio-femoral delay, ejection systolic murmur at ULSE
82
How should coarctation of the aorta be managed?
Stent or surgery by 5 years
83
How should TGA be managed?
Maintain PDA, balloon catheter atrial septal perforation, surgery with arterial switch
84
What are the defects in tetralogy of Fallot?
Large VSD, overriding aorta, pulmonary stenosis, RVH
85
What can cause innocent murmurs in children?
Fever, anxiety, exercise
86
Describe the classification of murmurs:
1. Just audible
2. Quiet but easily audible
3. Loud, no thrill
4. Loud with thrill
5. Audible even if stethoscope makes partial contact with skin
6. Audible without stethoscope
87
What are the steps in the management of cyanotic spells?
```
Place child in knee to chest position
O2 through non-rebreather
Morphine
Fluid bolus
Propanolol, adrenaline
```
88
What are some of the main causes of HTN in children?
Renal parenchymal disease (80%)
| Renal vascular disease, COA, endocrine, essential HTN
89
What are some investigations that should be performed in a child has HTN?
```
Urine for albumin and blood
U+Es, creatinine, FBC
Renal US
Fasting lipids, glucose
ECG, echo
```
90
What are some signs of infective endocarditis?
Fever, splenomegaly, clubbing, splinter haemorrhages, anaemia, rash, HF, microscopic haematuria, new murmur
91
What are the main causative organisms of infective endoccarditis?
Streps, staphs
92
What investigations should be done if infective endocarditis is suspected?
Blood cultures (different times, different sites), echo
93
What treatment should be given for infective endocarditis?
Benpen + gentamicin
94
What is rheumatic fever?
Systemic febrile illness caused by a cross-sensitivity reaction to group A betahaemolytic strep and may result in permanent heart valve damage
95
What diagnostic criteria is used in rheumatic fever?
Jones diagnostic criteria
96
What are is the management of rheumatic fever?
Rest, aspirin, prednisolone and penicillin (pharyngitis)
97
What are the features of Kawasaki disease?
```
Conjunctivitis
Rash
Adenopathy (cervical LNs)
Strawberry tongue
Hands (palmar erythema)
And Burn (fever for >5 days)
```
98
How should Kawasaki disease be treated?
High-dose aspirin, IV immunoglobulin, echo (screening test for coronary artery aneurysms)
99
What are the main causes of stridor?
Viral croup, bacterial tracheitis, epiglottitis, foreign body, laryngomalacia
100
What are the signs of croup?
Stridor, barking cough, hoarseness
101
What are the main causative organisms of croup?
```
Parainfluenza virus (1, 2, 3)
Respiratory syncytial virus, measles
```
102
What is the management for mild croup?
Sent home if settles with dexamethasone
103
What is the management for severe croup?
Nebulised adrenaline and high flow O2, and if fails take to ITU
104
How can croup and bacterial tracheitis be differentiated?
Bacterial tracheitis often affects those >6y
Continuous stridor as opposed to stridor when upset
High fever in BT
105
What is the main causative organism in epiglottitis?
Haemophilus influenzae B
106
What is the management for epiglottitis?
Take child to theatre for inhalation induction of anaesthesia and EUA if necessary
Cefotaxime
107
What are some features of epiglottitis?
Sudden onset, continuous stridor, drooling of secretions, fever, cough not prominent
108
What are some symptoms of tonsillitis?
Pain on swallowing, fever, tonsillar exudate, cough, earache
109
How should need for antibiotics in tonsillitis be decided?
Centor or FeverPAIN
110
If needed, how long should antibiotics be given for in tonsillitis?
10d
111
What are some symptoms of otitis media?
Otalgia, irritability, decreased hearing, poor feeding, fever
Bulging, erythematous tympanic membrane
112
What are some causes of snoring in children?
Obesity, nasal polyps, deviated septum, recurrent tonsillitis, Down’s, hypothyroidism
113
What are some features of acute bronchiolitis?
Coryza, cough, fever, tachypnoea, wheeze, inspiratory crackles, apnoea, intercostal recession
114
What are the main causative organisms of acute bronchiolitis?
RSV
| Mycoplasma, parainfluenza, adenovirus
115
What signs of acute bronchiolitis mean the child may need admitting?
Inadequate feeding, resp distress (grunting, recessions), hypoxia, cyanosis
116
What is the management for acute bronchiolitis?
O2 (stop when 92%)
Nasogastric feeds
May need CPAP
117
What are some features of pneumonia?
Fever, malaise, poor feeding, tachypnoea, cyanosis, grunting, recessions, accessory muscles
Older children may get pleural pain, crackles, bronchial breathing
118
What are the main causative organisms of pneumonia?
Pneumococcus, mycoplasma, haemophilus, staph, TB, viral
119
What signs of pneumonia mean the child may need admitting?
O2 <92%, signs of resp distress
120
What investigations should be performed if pneumonia is suspected?
CXR, FBC, sputum culture
121
What is the management for pneumonia?
Abx - oral amoxicllin
122
What are some signs of TB in children?
Anorexia, low fever, failure to thrive, malaise, cough
123
What investigations should be performed if TB is suspected?
Tuberculin tests
Interferon gamma release assays
Culture and Ziehl-Neelsen stain of sputa (x3)
CXR
124
What is the causative organism of whooping cough?
Bordetella pertussis
125
What ages of children does whooping cough typically affect?
Infants and 2nd peak in those >14y
126
What are some signs of whopping cough?
Apnoea, bouts of coughing ending with vomiting, worse at night or after feeds
127
How long do symptoms typically last in whooping cough?
10-14 weeks
128
What investigations should be performed if whooping cough is suspected?
PCR via nasal swab, culture, FBC (absolute lymphocytosis)
129
What are some complications of whooping cough?
Petechiae, conjunctivital, retinal and CNS bleeds
Apnoea
Inguinal hernias
130
What are some management options for whooping cough?
Admit if <6 months, may need ventilation Clarithromycin to stop spread (after 3w not infective)
131
Describe the features of viral induced wheeze:
Usually >6m with cough and wheeze
Symptoms vary from hour to hour
No symptoms in between episodes
132
What may be the management for viral induced wheeze?
May benefit from inhaled beta-2-agonists
133
What are some causes of acute wheeze in children?
Asthma, viral wheeze, bronchiolitis, atypical pneumonia, foreign body inhalation, anaphylaxis
134
What are some causes of recurrent/persistent wheeze in children?
Asthma, broncho-pulmonary dysplasia, CF,
| bronchiectasis, recurrent aspiration, vocal cord dysfunction, structural abnormality
135
What is the cause of cystic fibrosis?
Mutations (F508) in cystic fibrosis transmembrane
| conductance regulator gene (CFTR) on chromosome 7, coding a cyclic AMP regulated Na/Cl channel
136
How are newborns screened for cystic fibrosis?
Screened for an abnormally raised immunoreactive trypsinogen and 29 CTFR mutations
137
List the cut off values for the sweat test for CF:
Sweat Cl - >60mmol/L support diagnosis
| <40mmol/L is normal and intermediate results are suggestive
138
How can CF present?
Meconium ileus, recurrent pneumonia, failure to thrive, slow growth, steatorrhea
139
What respiratory organisms typically affect those with CF?
S. aureus, H. influenzae, S. pneumonia, pseudomonas aeruginosa
140
How can respiratory problems in CF be managed?
Start physio (3x a day) at diagnosis
Teach parents percussion and postural drainage
Treat infections aggressively
141
Describe the recommended diet in CF:
High calorie, high protein and high fat with Vit A and D
142
What medications can be given to help GI absorption in CF?
Pancrex V/Creon
| Omeprazole
143
What is meconium ileus?
Failure to pass stool or vomiting in first 2 days of life
144
What is the management for meconium ileus?
NGT drainage, washout enemas, excision of gut containing most meconium
145
What are some complications associated with CF?
Impaired glucose tolerance, bronchiectasis, cirrhosis,
| cholesterol gallstones, male infertility
146
Name some triggers for asthma:
Pollen, house dust mite, fur, exercise, chemicals, smoke, traffic, cold air, NSAIDs, beta blockers
147
What are some investigations for suspected asthma?
Spirometry, peak flow, exhaled NO, exercise testing, skin prick
148
Describe the step-wise treatment for asthma:
1. PRN salbutamol. If need >3x per week or asthma
wakes from sleep >1 per week, add step 2.
2. Add inhaled steroid e.g. beclomethasone
3. If <5y, add 1 evening dose of montelukast 4mg. If >5y can try inhaled salmeterol (LABA). If symptomatic increase ICS and add montelukast or theophylline
4. Refer to specialist
5. Add prednisolone at lowest dose
149
Describe the treatment for severe asthma:
```
High flow O2
Salbutamol nebs
Hydrocortisone IV
IV magnesium sulfate
Aminophylline IV
ITU if exhausted or needing IV salbutamol
```
150
What are the defining features of acute severe asthma?
PEFR 33-50%, inability to complete sentences, use of
| accessory muscle, tachypnoea, tachycardia
151
What are the defining features of life-threatening asthma?
Resp acidosis, mechanical ventilation. PEFR <33%, sats
<92%, silent chest, cyanosis, poor resp effort,
bradycardia, hypotension, exhaustion
152
What type of viruses are measles, mumps and rubella?
RNA viruses
153
What are the features of measles infection?
Cough, coryza, conjunctivitis, cranky, increased temp, Koplik spots on palate, rash (behind ears then spreads down body)
154
What are some complications of measles infection?
Otitis media, croup, tracheitis, pneumonia
| Subacute sclerosing panencephalitis (7-13y later)
155
How are viral infections such as MMR treated?
Ensure adequate nutrition and hydration (NGT if poor feeding)
Continue breastfeeding
Treat any secondary bacterial infections
156
Which of measles, mumps, rubella and scarlet fever are notifiable diseases?
All of them
157
What are the features of rubella infection?
Macular rash (starts on face), suboccipital lymphadenopathy
158
What are the features of mumps infection?
Prodromal malaise, increased temp., painful parotid swelling
159
What is the causative organism of slapped cheek/fifth disease?
Parvovirus B19
160
What are the features of Parvovirus B19 infection?
Malar erythema (slapped cheek), gloves and socks rash, lethargy, fever
161
What is the causative organism of hand, foot and mouth disease?
Coxsackie virus A16
162
What is the causative organism of roseola infantum?
Herpes virus 6
163
What are the features of roseola infantum?
Increased temp. then a maculopapular rash, uvulo-palatoglossal junctional ulcers (Nagayama spots)
164
What is the cause of scarlet fever?
Reaction to erythrogenic toxins produced by Group A haemolytic strep (S. pyogenes)
165
What are the features of scarlet fever?
Fever, malaise, headache, strawberry tongue, fine punctuate erythema on torso sparing palms and soles
166
What is the treatment for scarlet fever?
Pen V for 10 days
167
What are the complications of scarlet fever?
Otitis media, rheumatic fever, glomerulonephritis
168
What are the features of chickenpox?
Crops of skin vesicles often starting on face, scalp or trunk. Rash is more concentrated on torso
169
When does chickenpox stop becoming infective?
Once lesions have scabbed over
170
Describe the course of a chickenpox infection:
fever, rash 2 days later (macule -> papule -> vesicle -> ulcers -> crusting)
171
What are some dangerous contexts for chickenpox infection?
Immunosuppression, CF, severe eczema, neonates
172
What is the general management for chickenpox?
Calamine lotion soothes, trim nails, daily antiseptic
173
What is the management for chickenpox in dangerous context (e.g. immunosuppression)?
Antivaricella-zoster immunoglobulin and acyclovir, started within 7 days of rash
174
When should heel-prick test (blood spot screening) be performed?
5-9 days of life
175
What is the purpose of heel-prick test (blood spot screening)?
P.S. name at least 5 conditions
Screening for: congenital hypothyroidism, CF, sickle cell, PKU, medium chain acyl-CoA dehydrogenase deficiency, maple syrup urine disease, isovaleric
acidaemia, glutaric aciduria type 1, homocystinuria
176
Describe the newborn examination, including the 4 key areas to examine:
Focuses on heart (murmurs), eyes (red reflex – retinoblastoma and cataracts), hips (dislocation) and testes (undescended)
Also birth marks, spinal defects, head circumference,
cleft palate, abdo masses
177
Describe the newborn hearing test:
Otoacoustic emission test
| If 2 abnormal tests refer for auditory brainstem response test
178
What are contraindications to live vaccines?
Acute febrile illness is a contraindication to any vaccine
| Primary immunodeficiency or on steroids
179
What conditions are included in the 6 in 1 vaccine?
Diphtheria, tetanus, pertussis, polio, haemophilus B, hep B
180
What vaccinations may be given in pregnancy?
Pertussis and Flu
181
What vaccinations are given at 2 months?
```
Infanrix hexa (diphtheria, tetanus, pertussis, polio,
haemophilus B, hep B) + Rotarix (rotavirus) + Bexsero (meningitis B)
```
182
What vaccinations are given at 3 months?
Infanrix hexa (6 in 1) + Rotarix (rotavirus) + Prevenar 13 (pneumococcal)
183
What vaccinations are given at 12 months?
Menitorix (H. influenzae with meningitis C) + Bexsero (men B)
184
What vaccinations are given at 13 months?
MMR + Prevenar 13 (pneumococcal)
185
What vaccinations are between 3.25-5 years?
Repevax (diphtheria, tetanus, pertussis, polio) + MMR
186
What vaccinations are given at 13-18+ years?
Revaxis (low dose diphtheria, tetanus, polio) + Gardasil + Menveo (meningococcal ACWY)
187
What vaccinations are given at 4 months?
Infanrix hexa (6 in 1) + Prevenar 13 (pneumococcal) + Bexsero (men B)
188
What is the definition of child abuse?
Deliberate infliction of harm to a child or failure to prevent harm
189
What is the definition of neglect?
Persistent failure to meet a child’s basic physical or psychological needs that is likely to result in serious impairment of child’s health and development
190
What is Munchausen's by proxy?
Parent fabricates alarming symptoms in their child to
| gain attention via unnecessary interventions
191
What are the types of child abuse?
Physical, sexual, emotional, neglect
192
What are some risk factors for non-accidental injury?
Low birth weight, mother <30, unwanted pregnancy, stress, poverty
193
What are some signs/presentations that may make you suspect non-accidental injury?
Odd story, incongruent with injuries
Delayed presentation
Unexplained fractures e.g. forearm, posterior ribs from squeezing
Bruises of different ages, not on shins and elbows
Buttock, face injuries, cigarette burns, retinal haemorrhages
194
What investigations may be performed if a child has suspected NAI?
Skeletal survey with X-ray
| Clotting screen
195
What are the features of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma, and encephalopathy
196
What are some key interventions to prevent sudden unexplained infant death?
Sleeping supine, preventing overheating and no cigarette exposure
197
What are some features of trisomy 21?
Single palmar crease, hypotonia, flat face, protruding tongue, upward slanted palpebral fissures, speckled iris (Brushfield spots), intellectual impairment
198
What are some conditions associated with trisomy 21?
Congenital heart disease (AVSD, PDA, VSD), duodenal atresia, hypothyroidism, hearing loss, leukaemia, early onset Alzheimer’s, subfertility, repeated resp. infection
199
What are some features of Turner's?
Short stature, webbed neck, widely spaced nipples, primary amenorrhoea, high arched palate, short 4th metacarpal
200
What are some conditions associated with Turner's?
Bicuspid aortic valve, CoA, hypothyroidism, horseshoe kidney, autoimmune disease e.g. Crohn’s
201
What are some features of Duchenne's?
X-linked, Gowers’ sign, imbalance of lower limb strength, delayed motor milestones, falls
202
What are some investigations performed if Duchenne's is suspected?
Serum creatine kinase, genetics, muscle biopsy
203
What are some features of Fragile X?
Learning difficulties, large low set ears, long thin face, macro-orchidism, hypotonia, autism
204
What is the inheritance pattern for achondroplasia?
Autosomal dominant
205
What are some features of achondoplasia?
Short limbs, frontal bossing, flattened nasal bridge, 'trident' hands, lumbar lordosis
206
What are some features of Noonan's?
Webbed neck, widely spaced nipples, short stature, pectus excavatum, low set ears
207
What are some examples of autosomal dominant conditions?
Adult polycystic kidney disease, Huntingdon’s chorea, achondroplasia, Ehlers-Danlos, hereditary
spherocytosis, Marfan’s, osteogenesis imperfecta
208
What are some examples of autosomal recessive conditions?
CF, beta-thalassaemia, sickle cell, congenital adrenal hyperplasia, homocystinuria, PKU
209
What are some examples of X-linked recessive conditions?
Duchenne muscular dystrophy, haemophilia A+B, fragile X
210
What are some examples of X-linked dominant conditions?
Alport’s, Rett, vit D resistant rickets
211
What are some causes of childhood obesity?
```
Fast and processed foods
Lack of exercise
Poor sleep
Deprivation
Steroids and anti-epileptics
Conditions e.g. Cushing's, Prader-Willi
```
212
What are the consequences of childhood obesity?
T2DM, sleep apnoea, orthopaedic problems (SUFE, pains), non-alcoholic fatty liver, atherosclerosis, cancers (breast and bowel), HTN
213
How is a child being overweight, obese or severely obese defined by BMI charts?
BMI over 91st centile is overweight, over 98th is obese and over 99.6th is severely obese
214
How should gastroenteritis be managed?
Oral rehydration therapy and continue breastfeeding
| If poor oral intake, NGT or if severe IV therapy
215
What is the cause of kwashiorkor?
Decreased intake of protein and essential AAs
216
What are the features of kwashiorkor?
Poor growth, diarrhoea, skin/hair depigmentation, distended abdomen
217
What is the cause of marasmus?
Lack of calories and discrepancy between height and weight
218
What are the features of marasmus?
Distended abdo, diarrhoea, constipation, infection, low albumin
219
What are some common causes of acute abdominal pain in the child?
Gastroenteritis, UTI, viral illness (mesenteric adenitis),
| appendicitis, constipation, food allergy
220
What investigations should be done for acute abdominal pain in the child?
Urine dip, AXR, US, FBC, CRP, renal imaging
221
What are the features of appendicitis?
RLQ pain, anorexia, slight vomiting, polyuria, fever, high pulse
222
How can GORD present in children?
Regurg after feeds, apnoea, pneumonia, failure to thrive, anaemia
223
What is the treatment for GORD in children?
Reassurance, check positioning during feed, avoidance of overfeeding, antacids after each breast feed.
224
What often precedes mesenteric adenitis?
Viral infection
225
What are some causes of hepatomegaly in children?
Infectious mononucleosis, CMV, leukaemia, lymphoma, neuroblastoma, galactosemia, sickle cell
226
What is neuroblastoma and where does it commonly arise?
Embryonal neoplasm derived from sympathetic neuroblasts
| Most commonly arises from the adrenal glands
227
What markers are often raised in neuroblastoma?
Urinary excretion of catecholamines are raised (vanillylmandelic and homovanillic acid)
228
How can Coeliac disease present?
Diarrhoea, failure to thrive, anaemia, short stature, deceleration of growth
229
What conditions is Coeliac disease associated with?
T1DM and hypothyroidism
230
How can diagnosis of Coeliac disease be confirmed?
Raised IgA anti-tissue transglutaminase and endomysial antibodies
Confirm by villous atrophy on small bowel biopsy
231
When and how does infantile hypertrophic pyloric stenosis present?
3-8 weeks with projectile vomiting after feeds
232
What metabolic abnormalities can occur in hypertrophic pyloric stenosis?
Hypochloraemic, hypokalemic metabolic alkalosis
233
How should infantile hypertrophic pyloric stenosis be treated?
Ramstedt’s pyloromyotomy/endoscopic surgery
234
What is intussusception?
One segment of small bowel telescopes inside another
235
What ages does intussusception usually occur between?
5-12m
236
How does intussusception present?
Episodic intermittent inconsolable crying, drawing legs up ± vomiting and red currant blood PR
237
How is intussuscpetion managed?
US with reduction by air enema
| If fails, reduction at laparoscopy or laparotomy and resection of necrotic bowel
238
What is phimosis?
Foreskin is too tight and doesn't retract
239
Up to what age is it normal to have non-retractile foreskin?
4y
240
How does testicular torsion present?
Severe, sudden onset pain with N+V
241
What ages does testicular torsion commonly affect?
13-15y
242
What is the management for testicular torsion?
Surgical exploration, fix both if torted testis identified
243
How can a UTI present in a child?
Dysuria, frequency, sepsis, vomiting, colic, abdominal pain, fever
244
What investigations may be done if a UTI is suspected?
Dipstick, urine culture, USS, micturating cystogram
245
What is the treatment for UTI in <3m olds?
IV amoxicillin and gentamicin
246
What is the treatment for UTI in those >3m old?
Trimethoprim, nitrofurantoin or co-amoxiclav
247
What are some cause of AKI in children?
```
Toxic drugs (NSAIDs, aminoglycosides, acyclovir, contrast)
Sepsis, dehydration, glomerulonephritis, cardiac surgery, bone marrow transplant
```
248
What changes in plasma chemistry (electrolytes) may be seen in AKI?
Increased potassium, creatinine, urea, phosphate
| Decreased calcium, sodium and chloride
249
What are the features of haemolytic uraemic syndrome?
Acute haemolytic anaemia, thrombocytopenia, renal failure and endothelial damage to glomerular capillaries
250
What organism is haemolytic uraemic syndrome associated with?
Shiga toxin producing E. coli
251
How can acute glomerulonephritis present?
Haematuria, oliguria, increased BP, periorbital oedema, fever, loin pain
252
What investigations should be performed if acute glomerulonephritis is suspected?
FBC, U+Es, complement (low C3, normal C4), antinuclear factor, anti-DNA, ANCA, blood cultures, MSU, renal US
253
Describe the features of post-streptococcal glomerulonephritis:
Presents 7-21 days after a strep infection (pharyngitis, impetigo) with gross haematuria, oedema, HTN, abdo pain, fever
254
How should post-streptococcal glomerulonephritis be treated?
Restricting sodium, diuretics, anti-hypertensives, penicillin for 10 days
255
Describe the features of nephrotic syndrome:
Oedema, proteinuria, albumin <25g/L ± hypercholesterolemia
256
What are some symptoms of nephrotic syndrome?
Insidious onset oedema (starts periorbital), anorexia, GI disturbance, infections, irritability, ascites, oliguria, frothy urine
257
What are some complications of nephrotic syndrome?
Pneumococcal peritonitis, increased susceptibility to infection (loss of Ig)
258
How should nephrotic syndrome be managed?
Fluid restrict to 800- 1000ml/day
| Diuretics if oedematous and no hypovolemia Prednisolone for 4 weeks
259
What are some side effects of steroids in children?
Obesity, poor growth, increased BP, diabetes, osteoporosis, avascular necrosis (hip), adrenal suppression
260
What is failure to thrive?
Poor weight gain in infancy
| Weight affected first then height then head circumference
261
What is the cause of failure to thrive in the majority of cases?
Not enough food being offered or taken
262
What are some causes of failure to thrive?
Malnutrition, CF, coeliac, cleft palate, GORD, CMPA, congenital heart defects, infection
263
How is short stature defined?
Height <3rd centile
264
What are the causes of short stature?
Constitutional (80%), neglect, poverty, steroids, genetic
| (Turner’s, CF), hypothyroidism, low GH
265
What are some causes of increased height in children?
Thyrotoxic, precocious puberty, Marfan’s, homocystinuria
266
What are some causes of increased weight in children?
Diet, not enough exercise, hypothyroidism, Cushing’s, Prader-Willi, PCOS
267
Falling below which centile for height means a child should be reviewed by a GP?
2nd
268
Falling below which centile for height means a child should be reviewed by a paediatrician?
0.4th
269
What are some signs of hypothyroidism in children?
Prolonged neonatal jaundice, poor feeding, dry skin, inactivity, slow feeding, constipation, bradycardia, poor growth, decreased IQ
270
What is the treatment for hypothyroidism in children?
Levothyroxine
271
What are some signs of hyperthyroidism in children?
Palpitations, tremor, anxiety and tachycardia
272
What is the treatment for hyperthyroidism in children?
Carbimazole or propylthiouracil
273
What is the issue in glycogen storage disorders?
Defects in enzymes required for synthesis and degradation of glycogen
Abnormal stores are deposited in liver, muscle, heart or kidney causing organ damage
274
Describe the pathophysiology of phenylketonuria:
Mutation of phenylalanine hydroxylase gene (autosomal recessive) leading to absent or reduced activity and accumulation of phenylalanine
275
What are some features of PKU?
Fair hair, fits, eczema, musty urine, decreased IQ
276
What is the treatment for PKU?
Diet low in phenylalanine
| Protein substitute lacking phenylalanine but enriched in tyrosine
277
Describe the pathophysiology of homocystinuria:
Deficiency of cystathionine beta-synthase, results in accumulation of homocysteine, oxidized to homocystine
278
What are some features of homocystinuria?
Fine fair hair, arachnodactyly, learning difficulties, increased VTE risk, malar rash
279
What is the definition of precocious puberty in girls and boys?
Puberty before 8y in girls, before 9y in boys
280
What is the treatment for precocious puberty?
Synthetic GnRH analogues suppress secretion of pituitary gonadotropins
281
What ages is the onset of T1DM common at in children?
5-7 years and just before onset of puberty
282
How can T1DM present in children?
Polyuria, lethargy, polydipsia, weight loss, infections, poor growth, ketosis
283
Hows is T1DM diagnosed?
Signs of hyperglycaemia with random blood glucose ≥11.1mmol/L or fasting ≥7mmol/L
Raised venous blood glucose on 2 occasions without
symptoms
284
What is the management for T1DM?
Insulin - short and long acting
| Advice on diet
285
What are some signs of hypoglycemia?
Weakness, hunger, fitness, sweating, abdo pain, vomiting, fits
286
What is maturity onset diabetes of young (MODY)?
Autosomal dominant type of non-ketotic diabetes in childhood or young adults
Pancreatic beta cell dysfunction leading to impaired insulin secretion
287
How can diabetic ketoacidosis present?
Confusion, vomiting, polyuria, polydipsia, weight loss, abdo pain, dehydration, Kussmaul breathing (deep and rapid), ketotic breath, shock, drowsiness
288
What are the main concerns associated with diabetic ketoacidosis in children?
Cerebral oedema, hypokalaemia, aspiration pneumonia
289
How is diabetic ketoacidosis diagnosed?
Hyperglycemia (≥11mmol/L), acidosis (pH <7.3 and
| bicarbonate <15mmol/L) and ketones in urine and blood
290
What is the management for diabetic ketoacidosis?
Correct dehydration with fluids over 48h
IV insulin
Add glucose to fluids when levels start to fall
291
How can cerebral oedema present?
Headache, bradycardia, HTN, restlessness, irritability, focal neurology, posturing, RICP, falling consciousness
292
What is the treatment for cerebral oedema?
IV mannitol, replace fluids over 72h
293
What are some signs of dehydration?
Dry mucous membranes, decreased skin turgor, lethargy, oliguric, weight loss, sunken eyes, increased CRT
294
What are the recommended maintenance fluid requirements based on weight of child?
First 10kg: 100ml/kg
Second 10kg: 50ml/kg
Third 10kg+: 20ml/kg
295
When is the peak age for children to get ALL?
2-6y
296
How does ALL present?
Pancytopenia, pallor, infection, bleeding, fatigue, anorexia, fever, bone pain, lymphadenopathy
297
What investigations can be performed if ALL is suspected?
FBC, urate, LDH, blood film, marrow biopsy
298
How is ALL treated (broadly)?
Chemotherapy including intrathecal therapy
299
What are some complications of ALL?
Neutropenic sepsis, hyperuricaemia (TLS), poor growth, other cancers
300
What are some causes of microcytic anaemia in children?
IDA or thalassemia
301
What are some causes of macrocytic anaemia in children?
Folate def., B12 def. or haemolysis
302
What are some causes of normocytic anaemia in children?
Haemolysis or marrow failure
303
What are the main causes of iron deficiency anaemia in children?
Dietary causes e.g. poverty, lack of education, coeliac
| Bleeding – Meckel’s diverticulum
304
How should iron deficiency anaemia in children be treated?
Ferrous fumarate syrup or Sytron
305
What is the inheritance pattern of hereditary spherocytosis?
Autosomal dominant
306
What infection alongside hereditary spherocytosis can trigger a severe anaemia?
Parvovirus B19
307
What might be the cause of purpura if the child is ill and has low platelets?
Meningococcal septicaemia, leukaemia, DIC, haemolytic uraemic syndrome
308
What might be the cause of purpura if the child is ill and has normal platelet count?
Viruses (measles), vascultitis
309
What might be the cause of purpura if the child is well and has normal platelet count?
HSP
310
What might be the cause of purpura if the child is well and has low platelets?
Idiopathic thrombocytopenic purpura
311
Describe Henoch-Schonlein purpura:
Acute immune complex mediated vasculitis
| Most have a preceding URTI and are often 3-15yrs
312
What are the features of HSP?
Purpura, arthritis/arthralgias and abdo pain
313
What is the prognosis for HSP?
Most will recover in <2 months
| F/u with GP to check for renal involvement
314
What are some complications of HSP?
GI bleeds, ileus, haemoptysis, acute renal failure
315
How may idiopathic thrombocytopenic purpura present?
Acute bruising, purpura and petechiae
| History of recent infection or live vaccine
316
What is the prognosis for idiopathic thrombocytopenic purpura?
Most can be managed at home with gradual resolution over 3m
| 20% become chronic and need to avoid contact sports
317
What are some general signs of a primary antibody deficiency?
Frequent infections, bronchiectasis, chronic sinusitis, failure to thrive, hepatosplenomegaly
318
What types of infections are those with IgA def. particularly prone to?
Resp and gastro infections
319
Describe the antibody deficiency in common variable immunodeficiency:
IgG and IgA levels are low
320
Describe Bruton X-linked agammaglobulinemia and the type of infections that sufferers are most susceptible to:
Tyrosine kinase gene mutation causes decreased immunoglobulins and decreased mature B cells, hence increased susceptibility to bacterial (but not viral) infections
321
Describe severe combined immunodeficiency and the type of infections that sufferers are most susceptible to:
T-cell dysfunction usually causes combined immunodeficiency as T cells are necessary for B cell differentiation.
Susceptible to all types of bacteria, viral, fungal and protozoal infections
322
How are primary antibody deficiencies managed (broadly)?
Treat intercurrent infections promptly - postural physio, bronchodilators and Ab
Immunoglobulin replacement therapy
323
What are some causes of RICP in children?
Meningoencephalitis, head injury, subdural/extradural bleeds, hypoxia, ketoacidosis, tumours, thrombosis, Reye’s
324
What are some signs of RICP in children?
Irritable, drowsy, headache, diplopia, vomiting, tense fontanelle, decreased level of consciousness
Chronic: papilloedema and hydrocephalus
325
How should RICP be managed?
Elevate head, O2, IV mannitol, dex, fluid restrict
326
What are some signs of a brain tumour in a child?
Unexplained headache
Progressive weakness, unsteadiness, numbness
Behaviour changes
Growth disturbance
327
Give examples of some brain tumours affecting children:
Medulloblastoma, astrocytoma, glioma, meningioma
328
How may meningitis present in children?
Irritability, abnormal cry, lethargy, difficulty feeding, fever, seizures, apnoea, bulging fontanelle
329
What are some signs of meningococcal sepsis?
Fever, irritability, cold hands/feet, abnormal skin colour,
| odd behaviour, rash, DIC, tachycardia, tachypnoea, decreased BP, bulging fontanelle
330
What are meningeal signs that often occur later in meningococcal sepsis?
Stiff neck, photophobia, Kernig’s sign (resistance to knee extension with hip flexed), Brudzinski’s sign (hips flex on bending head forward)
331
What does a lumbar puncture aim to obtain?
CSF for urgent Gram stain, culture, virology, glucose and protein
332
What drug can be given prior to hospital admission if meningitis is suspected?
IM benpen
333
What treatment should be given to <3m with meningitis?
Cefotaxime and amoxicillin
334
What treatment should be given to >3m-18y with meningitis?
Ceftriaxone
335
What are some complications following meningitis?
Secondary abscesses, subdural effusion, hydrocephalus, ataxia, paralysis, deafness, decreased IQ, epilepsy
336
Describe the appearance, predominant cells, glucose level compared to blood and protein level of normal CSF:
Clear, <5 lymphocytes, >2/3rd of blood, 0.2-0.4g/L
337
Describe the appearance, predominant cells, glucose level compared to blood and protein level of CSF in bacterial meningitis:
Turbid, polymorphs, <2/3rd of blood, increased
338
Describe the appearance, predominant cells, glucose level compared to blood and protein level of CSF in viral meningitis :
Clear, mononuclear, >2/3rd of blood, increased
339
Describe the appearance, predominant cells, glucose level compared to blood and protein level of CSF in tubercular meningitis:
Fibrin web, mononuclear, <2/3rd of blood, increased
340
What are the main causative organisms of meningitis in neonates to 3m olds?
E. coli, Group B strep, listeria
341
What are the main causative organisms of meningitis in neonates to 1m olds to 6 year olds?
N. meningitidis, H. influenzae, S. pneumoniae, TB, viruses
342
What are the different classifications of seizure in epilepsy?
Partial (one part of a hemisphere)
Generalised
Complex (consciousness affected)
Simple
343
Give examples of generalised seizure types in children:
```
Tonic clonic
Absences
Infantile spasms/West syndrome: clusters of head
nodding and arm jerks
Myoclonic
```
344
What investigations may be performed if epilepsy is suspected?
EEG, MRI, CT
345
What is the management for tonic-clonic seizures?
Sodium valproate
346
What is the management for absence seizures?
Ethosuximide
347
What is the management for myoclonic seizures?
Sodium valproate
348
What is the management for infantile spasms?
Vigabatrin
349
What is the management for partial seizures?
Carbamazepine/lamotrigine
350
What are the features of a febrile convulsion?
Single tonic-clonic generalised seizure, lasting <15 min
Occurring as temp rapidly rises in a febrile illness
Child aged 6m-6yrs
No more than 1 attack in 24h
351
How should febrile convulsions be managed?
Recovery position
If fit is lasting >5min can give lorazepam
Early anti-pyretic
If seizure lasts >10min, treat at status epilepticus
352
Describe the features of reflex anoxic attacks:
Paroxysmal, self-limited brief asystole triggered by pain, fear or anxiety
Child is pale and may have hypotonia, rigidity,
clonic movement, upward eye deviation
Usually in 6m-2yrs
353
What is the management for status epilepticus?
Secure airway
After 5 min, give IV lorazepam and repeat after 15 min
IV Phenytoin after 20 min
Intubate and ICU after 40 min
354
What are some side effects of carbamazepine?
Rash, decreased platelets, agranulocytosis, aplasia
355
What are some side effects of valproate?
Vomiting, increased appetite, drowsiness, decreased platelets, teratogen
356
What are some side effects of ethosuximide?
D+V, rash, erythema multiforme, lupus syndromes, agitation, headaches
357
What are some side effects of vigabatrin?
Drowsiness, depression, psychosis, amnesia, diplopia, field defects (test every year)
358
How should food refusal by children be managed?
Discourage parental over-reaction
| Gradual enlarging of tiny portions of attractive food Track growth, weight gain, ferritin and FBC
359
What is pica?
Eating things that are not food
360
What are some causes of pica?
Iron or other mineral def., OCD
361
How may constipation present in children?
```
Large hard stool, rabbit dropping stool
Distress/straining
Abdo pain
Overflow/soiling
Anorexia
```
362
What are some common causes of constipation in children?
Idiopathic, diet, poor fluid or fibre intake, fear (fissure)
363
What are some red flag signs associated with constipation?
Constipation from birth or first few weeks
Failure to pass meconium within 48h
Faltering growth
New weakness/abnormal reflexes in legs
Abnormal appearance of anus or skin in sacral/gluteal region
Gross abdominal distension with vomiting
364
What is the general management for constipation in children?
Movicol/lactulose (osmotic) then senna (stimulant) Increase fluids and fibre, modify diet, behaviour therapy, physical activity
365
What is encopresis?
Repeated passage of solid faeces in the wrong place in those >4yrs
Often due to overflow in constipation
366
How should encopresis be managed?
Enemas, extra fibre, stool softeners
| Mandatory daily toilet sitting after eating
367
How is enuresis defined in girls and boys?
Continued wetting of bed >5y in girls and >6y in boys
368
How should enuresis be managed?
Regular toilet use (4-7/day)
Rewards for agreed behaviour (using toilet before bed)
Alarms triggered by urine in bed can help
369
What is a good short term management option for enuresis?
Desmopressin
370
At what age do children start to say monosyllables e.g. ba, da?
6 months
371
At what age do children start to say two syllables e.g. mama, dada?
8 months
372
At what age do you children start to use words appropriate in context and understand single words e.g. no?
13 months
373
What are some causes of delayed talking?
```
FH of delay
Chronic otitis media
Deprivation, poor social interaction, abuse
Global developmental delay
Autism
```
374
Whta is global neurodevelopmental delay?
Delay in all skill areas although may be more pronounced in fine motor, speech and social skills
375
List some causes of global neurodevelopment delay:
```
Down's
Fragile X
PKU
Hydrocephalus
TORCH infections
Prematurity leading to IVH
```
376
What are some causes of delay in walking?
```
Chronic illness
Global delay
Benign immaturity
Joint hypermobility
DMD and cerebral palsy
```
377
What is cerebral palsy?
Comprises chronic disorders of posture and movement caused by non-progressive CNS lesions sustained before 2yrs
378
What are the main issues in cerebral palsy?
Delayed motor development
Evolving CNS signs
Learning disability
Epilepsy
379
What are some signs of cerebral palsy?
Weakness, paralysis
Delayed milestones language/speech problems
Seizures
Abnormal gait, abnormal tone in early infancy
Early hand preference (<12m)
Retention of primitive reflexes
380
What are the different classes of cerebral palsy?
Spastic - most spastic diplegia or hemiplegia
Dyskinetic (athetoid)
Ataxic
Mixed
381
How can cerebral palsy be managed?
Muscle strengthening
Callipers
Botulinum toxin for spasticity
Epidural cord electrostimulation and intrathecal/oral baclofen
382
At what ages are most ADHD diagnoses made?
3-7y
383
What are the two groups of diagnostic features used in ADHD and how many must a child have to be diagnosed?
Inattention
Hyperactivity and impulsivity
6 features
384
What is the initial management for ADHD?
Ten-week watch and wait period to observe symptoms
385
What are some secondary care management options for ADHD?
Positive parenting and advice on behavioural techniques
| Drug therapy
386
What drugs can be given for ADHD and after what age?
>5y
Methylphenidate, lisdexamfetamine, dexamfetamine
Atomoxetine
387
What monitoring is required for ADHD drugs?
Baseline ECG and BP
| Monitor weight and height every 6 months
388
At what age does autism develop before?
Before 3y
389
What are the 3 core features of autism?
Global impairment of language and communication
Impairment of social relationships
Ritualistic and compulsive phenomena
390
What is the management for autism?
```
Behavioural intervention
School support
Social skills training
Melatonin to help sleep
Parent training
```
391
What are some conditions associated with autism?
Fragile X and Rett's syndrome
392
What are some signs of impaired reciprocal social interaction characteristic of autism?
Unaware of other’s feelings, abnormal response to being hurt, impaired imitation, repetitive play, bad at making friends
393
What are some signs of impaired imagination characteristic of autism?
Few facial expressions, avoids mutual gaze, no smiles, no interest in stories, no pretend play, odd speech, difficulty initiating conversation
394
What are some signs of ritualistic and compulsive phenomena characteristic of autism?
Stereotyped movements, preoccupation with parts of objects, marked distress over minor changes, insists on following routines in precise details
395
What are some risk factors for developmental dysplasia of hip?
Female, breech, FH, firstborn, oligohydramnios, very high BWT
396
What examinations should be performed for developmental dysplasia of hip?
USS
Barlow (dislocate femoral head)
Ortolani (relocate dislocated head)
397
What are some management options for developmental dysplasia of hip?
Spontaneous stabilisation at 3-6w
Pavlik harness
Surgery
398
What are the main causative organisms of osteomyelitis?
S. aureus, pseudomonas, E. coli, strep
399
How can osteomyelitis present?
Gradual onset of pain and unwillingness to move Tenderness, warmth, erythema and swelling
400
What is the management for osteomyelitis?
Surgery to drain abscess and Abx
401
What are the features of rickets?
Vit D def. leading to normal bony tissue with decreased mineral content
Knock-knee, bow leg, features of hypocalcaemia
402
How should rickets be treated?
Calcium with Vit D tablets
403
What is the most common cause of hip pain in children?
Transient synovitis
404
What are the features of juvenile idiopathic arthritis?
<16y, lasts >6 weeks
| Pyrexia, salmon pink rash, lymphadenopathy, arthritis, uveitis, weight loss
405
What is Perthes' disease?
Avascular necrosis of the femoral head, specifically the epiphysis
406
Who does Perthes' disease usually affect?
More common at 4-8 years and in boys
407
What is the management for Perthes' disease?
Remove pressure from joint to allow
| normal development, use cast to keep head in acetabulum, may need surgery
408
Who does slipped upper femoral epiphysis usually affect?
10-15 years, obese males
409
What is Osgood-Schlatter disease?
Osteochondrosis characterised by inflammation at the tibial tuberosity due to repeated avulsion of the apophysis where patellar tendon inserts
410
How does allergic rhinitis present?
Nasal congestion, sneezing, itchy nose with allergic triggers
411
What is the management for allergic rhinitis?
Antihistamine, intranasal steroids, allergen avoidance
412
How should food allergies be investiagted?
History, examination, skin prick test, in vitro IgE, oral food challenges
413
What are some common food allergens?
Peanut, tree nuts, milk, egg, fish, shellfish, wheat, soya
414
How can adenotonsillar hypertrophy present?
Obstructive sleep apnoea
| Recurrent middle ear infections
415
How should periobrital cellulitis be investigated?
Clinical examination
CT sinus and orbits with contrast
WCC, swabs and cultures
416
How does impetigo present and how should it be treated?
Blistering infection of skin, that crusts over
| Topical or oral Abx, hydrogen peroxide
417
What are some causes of a maculopapular rash in children?
Roseola infantum, slapped cheek, measles, rubella, scarlet fever, Kawasaki, JIA
418
What are some causes of a vesicular, bullous or pustular rash in children?
HSV1, chicken pox, hand-foot and mouth, impetigo, SSS syndrome, erythema multiforme
419
What are some causes of a petechial or purpuric rash in children?
Enterovirus, meningococcal, HSP, thrombocytopenia,
| vasculitis
420
What is the cause of staphylococcal scalded skin syndrome?
Release of two exotoxins from toxigenic strains of S. aureus
421
How does staphylococcal scalded skin syndrome present?
Fever, irritability, redness of skin, blisters that rupture to give burn appearance
422
How should staphylococcal scalded skin syndrome be managed?
IV abx, analgesia, moisturiser
423
How is the mid parental height calculated for use on a growth chart?
In males, add 7cm to the mean of parental heights; in females by subtract 7cm
Normally vary by two standard deviations, or
5/10cm each way
424
What are some signs of iron poisoning?
N+V, haematemesis, diarrhoea, altered mental state, hypotension
425
What investigations should be done if iron poisoning is suspected?
Blood gas, serum iron concentration, U+Es, FBC, glucose, iron levels (4-6h), AXR
426
What is the management for iron poisoning?
Gastric lavage/endoscopy to remove tablets
IV fluids and sodium bicarbonate to correct acidosis
Whole bowel irrigation
Chelation with IV desferrioxamine
427
What are some signs of salicylate poisoning?
Hearing loss, tachypnoea, resp. alkalosis then metabolic acidosis, N+V, abdominal pain, delirium, seizures
428
What is the management for salicylate poisoning?
Fluid resus
| Haemodialysis
429
What are some signs of paracetamol overdose?
Nausea, pallor, rise in hepatic enzymes (24hr), jaundice, enlarged tender liver, hypoglycaemia, hypotension, encephalopathy, coagulopathy
430
What is the management for paracetamol overdose?
Plot plasma paracetamol concentration on nomogram and if above line give acetylcysteine
431
When may intraossesous transfusion be required?
Cardiopulmonary arrest, severe burns, prolonged status epilepticus, hypovolemic and septic shock
432
What is the most common site used for intraosseus transfusion?
Proximal tibia
433
What are some complications of intraosseous transfusion?
Extravasation of fluid, cellulitis, fractures, osteomyelitis, pain
434
What are some contraindications to intraosseous transfusion?
Osteoporosis, osteogenesis imperfecta, infection/fracture at site of insertion
435
What doses of drug should be given to a <6m old with anaphlyaxis?
Adrenaline 1:1000: 0.15ml
Chlorphenamine: 25mcg/kg
Hydrocortisone: 25mg
436
What doses of drug should be given to a 6m-6y old with anaphlyaxis?
Adrenaline 1:1000: 0.15ml
Chlorphenamine: 2.5mg
Hydrocortisone: 50mg
437
What doses of drug should be given to a 6-12y old with anaphlyaxis?
Adrenaline 1:1000: 0.3ml
Chlorphenamine: 5mg
Hydrocortisone: 100mg
438
What doses of drug should be given to a >12y old with anaphlyaxis?
Adrenaline 1:1000: 0.5ml
Chlorphenamine: 10mg
Hydrocortisone: 200mg
439
How is the dehydration deficit calculated?
% dehydration x weight (kg) x 10
440
How quickly should fluids be replaced in hypo/isonatremic dehydration?
Over 24h
441
How quickly should fluids be replaced in hypernatremic dehydration?
Over 48h
442
What is the compression to breath ratio in paediatric life support?
15:2
443
What should be given before starting compression in paediatric life support?
5 rescue breaths
444
How should chest compressions be performed in an infant?
Using two fingers
445
How should chest compressions be performed in a young child?
Using heel of one hand
446
How should choking in an infant be managed?
Remove any obvious obstructions
5 back blows between scapula
5 chest thrusts
Repeat
447
How should choking in a child >1y old be managed?
Remove any obvious obstructions
5 back blows between scapula
5 abdominal thrusts
Repeat
