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Paediatrics (P4) > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are the four domains of development?

A

Gross motor

Fine motor

Speech, language & hearing

Social,Behavioural &
Emotional

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2
Q

When should a child be walking?

A

By 18 months

If not, check Creatine Kinase as they may have muscular dystrophy.

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3
Q

When does a child develop object permanence?

A

9 months

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4
Q

When should children start using single words/nouns e.g. mummy?

A

1 year

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5
Q

When should children start using two words/verbs?

A

2 years

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6
Q

When should children start smiling?

A

6 months

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7
Q

When should children have bowel control?

A

3 years

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8
Q

When should children have bladder control?

A

4 years

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9
Q

When does right and left handedness start to develop?

A

Around 2 years.

If there is dominance before this then its a concerning sign (MSK/neurological issue?)

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10
Q

When should children start to understand negatives?

A

3 years

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11
Q

When should children develop a fine pincer grip?

A

12 months

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12
Q

When should children be able to sit upright?

A

9 months

if later than a year its concerning

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13
Q

When should children be able to draw a vertical line?

A

2 years

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14
Q

When should children be able to draw shapes?

A

3 years

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15
Q

What is the difference between impairment, disability and handicap?

A

Impairment: Structural or functional problem e.g. neuropathy.

Disability: How they are limited compared to average person e.g. can’t walk.

Handicap: How this stops them doing certain tasks e.g. can’t work or play sport.

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16
Q

What tool is used to assess disability?

A

WHO-DAS
WHO Disability Assessment Schedule

Cognition -understanding, communication

Mobility - moving around

Self-care - hygiene/eating etc

Social - relationships, fun

Life-Activity - work/school

Participation - joining in with the community

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17
Q

What vaccines are included in the 6 in 1 vaccine?

A 
Diphtheria
Tetanus
Pertussis
Polio
Hib
Hep B
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18
Q

Give two examples of live vaccines

A 
MMR
Rotavirus
Smallpox  
Chicken pox
Yellow Fever

[MRS CY]

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19
Q

When is the MMR vaccination given?

A

1 year

3 years 4 months

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20
Q

Give an example of a toxoid vaccine

A

Diphtheria

Tetanus

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21
Q

Give an example of an inactive vaccine

A

Polio
Rabies
Flu
Hep A

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22
Q

Give an example of a sub-unit/conjugate vaccine

A 
Hep B
Pertussis
HPV
Meningoccocal
Pneumococcal
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23
Q

What virus is responsible for causing Chicken Pox?

A

Varicella Zoster

Herpes 3

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24
Q

What is the order of the chicken pox rash?

A

Macules
Papules (raised pink)
Vesicles (fluid filled)
Crusts

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25
Q

When is a child with chicken pox no longer contagious?

A

When the lesions have all crusted over.

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26
Q

Give a complication of chicken pox

A 
Encephalitis 
Myocarditis 
Transient arthritis
Secondary bacterial infection
Purpura fulminans (coagulopathy)
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27
Q

What is the treatment for chicken pox?

A

Paracetamol & Hydration

(Aciclovir only if severe e.g. encephalitis or if immunocompromised).

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28
Q

What is the pathogen responsible for epiglottitis?

A

Haemophilus influenzae Type B (HiB)

[G-ve coccobacillus]

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29
Q

Give two signs of epiglottitis

A 
Drooling
Sitting forwards
Stridor
Fever
Tachypnoea
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30
Q

Which two specialty teams should you urgently involve if you suspect epiglottitis?

A

ENT and anaesthetics as you may need to intubate.

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31
Q

What investigations would you perform if you suspect Epiglottitis?

A

Lateral cervical spine X-ray (look for “thumb sign” = enlarged epiglottis).

Throat swab culture for HiB

Laryngoscope

FBC

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32
Q

What is the treatment for epiglottitis?

A

Oxygen
Ceftriaxone IV
IV Fluids

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33
Q

What is Stridor?

A

High pitched breathing sound made on inspiration

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34
Q

Give two symptoms of otitis externa

A

Otalgia
Itch
Discharge
Hearing loss

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35
Q

What is the treatment for ottitis externa?

A

Analgesia (paracetamol/ibuprofen)

Warm compress e.g. flannel

Typically self-limiting

Only use topical antibiotics/steroids if severe.

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36
Q

What organism typically is the cause of mastoiditis? What is the best treatment?

A

Streptococcus pneumonae

Co-amoxiclav IV (1st line)
May require surgery

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37
Q

What is the treatment for otitis media?

A

Analgesia (paracetamol/ibuprofen)

If systemically unwell then amoxicillin (clarithromycin if allergic to penicillin).

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38
Q

What is the cause of whooping cough?

A

Bordatella pertussis

G-ve coccobacilli

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39
Q

Give two signs/symptoms of whooping cough

A 
Barking cough (seal like)
Cyanosis (turns blue)
Worse at night
Fever
Coughing fits
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40
Q

What is the treatment for whooping cough?

A

Macrolide antibiotic

erythromycin, clarithromycin, azithromycin etc

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41
Q

What is the most common cause of bronchiolitis?

A

Respiratory Scyncytial Virus (RSV)

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42
Q

What is bronchiolitis?

A

A lower respiratory tract infection common in children under 2 years

(1/3rd of kids get it)

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43
Q

What is the treatment for bronchiolitis?

A

Oxygen

Most resolve in 2-3 weeks.

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44
Q

Give two symptoms of bronchiolitis

A 
Very snotty
Fever
Dry cough
Wheeze
Stops feeding
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45
Q

What is the cause of Hand Foot and Mouth disease?

A

Coxsackie A16 virus
Enterovirus

[Hand foot mouth cock guts]

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46
Q

Give two signs of Hand Foot and Mouth disease

A 
Rash on palms/soles
Vomiting
Fever
Off food
Sore mouth/tongue
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47
Q

What is the treatment for Hand Foot and Mouth disease?

A

Analgesia

Supportive

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48
Q

What is the cause of slapped cheek syndrome and what is it also known as?

A

Parvovirus B19

“Fifth Disease”

49
Q

What is the cause of Glandular Fever (aka infectious mononucleosis)?

A

Epstein Barr Virus [Herpes 4]

50
Q

Give a complication of glandular fever

A

Guillain Barre Syndrome
Encephalitis
Hepatitis (+ jaundice)

51
Q

True or false, people with glandular fever should not play sport for a month?

A

True , due to risk of organ rupture.

52
Q

What is the cause of meningococcal septicaemia?

A

Neisseria Meningitidis
[G-ve]

NB: 10% of us have it in the back of our nasopharynx.

53
Q

Give two investigations you would do if you suspect meningococcal septicaemia

A 
Blood culture
Lumbar puncture
CT head
FBC
CRP
54
Q

What is the treatment for meningococcal septicaemia?

A

IV Ceftriaxone
IV fluids
Dexamethasone (if >3months to reduce swelling).

55
Q

What is the cause of mumps?

A

The mumps virus

56
Q

A 17 year old patient presents with parotid swelling, fever and malaise. What do you suspect?

A

Mumps

57
Q

Give two complications of mumps

A

Meningitis
Hearing loss
Orchitis (+infertility)
Pancreatitis

58
Q

What is the treatment for mumps?

A

Supportive

gargle salt water

59
Q

True or false, aspirin is the most common cause of Reye syndrome?

A

False.

Viral infection e.g. cold or chicken pox is the most common cause.

NB: Don’t give aspirin to under 16s

60
Q

Give two signs of Reye syndrome

A 
Vomiting
Confusion
Seizures
Irritability 
Encephalopathy 
Deranged LFTs

NB: Around 30% die or have brain damage.

61
Q

What is the most common cause of UTI?

A

E. coli

[G-ve aerobe]

62
Q

Give one antibiotic you would consider for an lower UTI and an upper UTI

A

Lower:

  • Nitrofurantoin
  • Trimethoprim

Upper:

  • Cefalexin
  • Coamoxiclav

NB: Patients with penicillin allergies can still take cephalosporins safely.

63
Q

If a UTI is resistant to penicillin or cephalosporin, what antibiotic can you use?

A

Meropenem

64
Q

What is vesicoureteric reflux?

A

When urine flows retrograde from the bladder into the ureter.

It is common in paediatric UTI.

65
Q

What three scans should be performed in patient’s under 6 months with UTI

A

Micturating Cystourethrogram (MCUG) - looks at urine flow.

Ultrasound

Dimercaptosuccinic acid scan (DMSA) - checks for scarring.

[MUD]

66
Q

What is the most common cause of scarlet fever?

A

Group A Strep

[Strep Pyogenes]

67
Q

Give two signs of scarlet fever

A

Sandpaper rash
Strawberry tongue
Fever
Lymphadenopathy

68
Q

What is the treatment for scarlet fever?

A

Oral penicillin

[Cephalosporin if allergic]

69
Q

How long should kids be off school with scarlet fever?

A

1-2 days post starting Abx.

70
Q

What is the cause of measles?

A

Measles virus

71
Q

Give two signs of measles

A

Rash starts on face and spreads to body.
Fever
Conjunctivitis
Koplik spots

72
Q

What is the treatment for measles?

A

Supportive

Antipyretics/Analgesic

73
Q

What is the cause of Impetigo?

A

Staph Aureus or Strep Pyogenes.

74
Q

Give two signs of impetigo

A

Yellow crusty skin lesions
Pain
Itchy

75
Q

What is the treatment of impetigo?

A 
Topical antiseptic (1st line) e.g. Hydrogen peroxide 1%
OR Topical antibiotic (2nd line) e.g. Fusidic acid 2% if antiseptic not appropriate.

Oral antibiotics if widespread bullous impetigo or patient is systemically unwell e.g. amoxicillin or cephalexin.

76
Q

Which team must you involve if you suspect orbital cellulitis?

A

ENT review

[concern is brain abscess]

77
Q

What is the treatment for orbital cellulitis?

A

Triple therapy:
Flucloxacillin
Metronidazole
Cefotaxime

[‘Fuck My Cellulitis’]

78
Q

Give a common cause of orbital cellulitis

A

Staph aureus
Strep pneumoniae

[Often results from a sinus infection]

79
Q

What is chemosis?

A

Swollen conjunctiva

80
Q

What investigations would you perform for orbital cellulitis?

A

Blood cultures
FBC
CT/MRI

81
Q

Name a common pathogen responsible for meningitis in neonates and in infants (post 3 months).

A

Neonates: [GEL]

  • Group B strep
  • E. coli
  • Listeria

Infants:

  • Haemophilus Influenzae
  • Neisseria Meningitidis
  • Strep Pneumoniae
82
Q

What antibiotic would you use to treat meningitis in neonates vs infants?

A

Neonates: Cefotaxime + Amoxicillin (for Listeria)
Infants: Ceftriaxone

83
Q

Which antibiotic is used as prophylaxis for meningitis? What else is given to patients at risk?

A

Ciprofloxacin
Rifampicin

Vaccinations:
Men B & ACYW
Hib
Pneumococcal

84
Q

What is another name for laryngotrachealbronchitis?

A

Croup

85
Q

What causes croup?

A

Parainfluenza
Influenza
{Bacteria also]

86
Q

Give two signs of croup

A 
Stridor
Barking cough
Hoarse voice
Worse at night
Otherwise well
87
Q

What sign might you expect to see on CXR of a patient with croup?

A

“Steeple sign”

[pinched trachea]

88
Q

What is the treatment for croup?

A

Dexamethasone
Nebulised adrenaline (if severe)
Supportive

89
Q

What causes Henoch-Schonlein Purpura?

A

IgA vasculitis
[Abnormal immune response]

Cause: unknown
Often follows viral infection.

90
Q

What is the treatment for Henoch-Schonlein Purpura?

A

Analgesia

Corticosteroids

91
Q

Give a cause of Haemolytic Uremic Syndrome (HUS)

A

E. coli [EHEC] 0157:H7
Shigella
Salmonella

92
Q

What is the treatment for HUS?

A

Plasmapheresis
Transfusion
Supportive
Dialysis

93
Q

What is the cause of Rubella?

A

Rubella virus

94
Q

Give two signs of Fragile X syndrome

A 
Large ears
Large testicles
Autistic features
Long face
Intellectual impairment
95
Q

What is the cause of Prader Willi Syndrome? What is the difference between Prader Willi and Angelman?

A

Loss of function mutation of genes on Chromosome 15

Prader Willi = paternal mutation
Angelman = maternal mutation

96
Q

Give two signs of Prader Willi Syndrome

A 
Intellectual impairment
Obesity
Infertile
Hypogonadism
Downward mouth
Almond shaped eyes
Narrow temple distance
97
Q

True or false, Rhett syndrome is mostly inherited?

A

False.

95% is de novo i.e. a germ line mutation

98
Q

Give two signs of Rhett syndrome

A

Repetitive movements (hand wringing)
Intellectual impairment
Seizures
Small head

99
Q

What is the karyotype for Turner’s syndrome?

A

45 XO

[Female missing an X]

100
Q

Give two signs of Turner’s syndrome

A 
Webbed neck
Short stature
Low set ears
Low hairline
Infertile (mostly)
101
Q

What is the karyotype of Kleinfelter’s syndrome?

A

47XXY

[Male with extra X]

102
Q

Give two signs of Kleinfelter’s syndrome

A 
Tall 
Normal intellect
Low libido
Gynaecomastia
Small genitalia
Infertile
103
Q

What is strabismus?

A

Misalignment of the axis of the eyes when focussed on an object

[Aka a squint]

104
Q

What is the most common cause of refractive error in children?

A

Strabismus [Squint]

2% will have a transient squint in first 3 months.

105
Q

What are the 4 types of manifest squints and latent squints?

A 
Manifest - always present. 
Esotropia - inward
Exotropia - outward
Hypertropia - upward
Hypotropia - downward
Latent - present only when eye is covered. 
Esophoria - flicks outwards
Exophoria - flicks inwards
Hyperphoria - flicks down
Hypophoria - flicks up
106
Q

In strabismus surgery what is the difference between recession and resection?

A

Recession = weakens the muscle

Resection = strengthens the muscle

107
Q

For how long and how young must you be to suffer from Juvenile Idiopathic Arthritis?

A

> 6 weeks

Under 16 years of age

108
Q

How many joints are affected in oligoarticular and polyarticular arthritis?

A 
Oligoarticular = 4 or fewer
Polyarticular = 5+
109
Q

An obese 12 year old comes in with a limp, which common fracture do you suspect?

A

Slipped Capital Femoral Epiphysis [SCFE]

Sciffy from too much skippy peanut butter!

110
Q

Give a risk factor for hip dysplasia in an infant

A

Genetic
Breech birth
Swaddling

111
Q

What are the 2 clinical examinations done to investigate hip dysplasia in newborns?

A

Barlow = aDduct + push inferiorly to dislocate.
[‘Barlow is an Addict’]

Ortalani = aBduct to relocate.

[B comes before O]

112
Q

What is hip dysplasia?

A

Where the head of the femur is misaligned with the acetabulum.

This can progress to subluxation where the head of the femur is partially out or full luxation (dislocation).

113
Q

Which hip joint condition is most common in 4-8 year olds?

A

Perthe’s Disease
[Osteochondritis]

Loss of blood supply to the femoral head resulting in avascular necrosis and loss of bone mass.

114
Q

Give two causes of faltering growth in an infant

A

INTAKE:

  • Cleft palate
  • Vomiting
  • Malnutrition
  • Neglect

ABSORPTION:

  • Coeliacs
  • CMPA

ENERGY USE:

  • Cancer
  • Heart disease
115
Q

What is a PEG tube?

A

Percutaneous Endoscopic Gastronomy

Tube inserted into the stomach via the abdominal wall. Indicated if there is a danger of aspiration or for gastric decompression.

116
Q

In cow’s milk protein allergy (CMPA) how do you differentiate between IgE mediated and non-IgE mediated?

A

IgE mediated = reaction is within 2hrs.

Non-IgE mediated = 2-72 hrs.

117
Q

What is the advice for CMPA?

A

Avoid cow’s milk for 12-18 months then start trying to reintroduce it.

118
Q

True or false, cow or goat milk is fine for babies under 1 year old?

A

False. It does not contain a full nutrition profile.

Can drink whole milk from 1-2 years on.

119
Q

What is the test for lactose intolerance?

A

Hydrogen breath test

Nil by mouth for 12 hrs, then baseline taken. Lactose solution given and breath rechecked every 15 minutes for 4 hours.

Paediatrics (P4) (1 decks)

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