Paediatrics Flashcards
(178 cards)
1
Q
Maternal antibodies are present until what age?
A
Approx 6-9 months
2
Q
Differentiate between neonate, infant and child
A
According to WHO: Neonate = from birth til 1 month Infant = 1 month til 2 years Young child = 2-6 years Child = 6-12 years Adolescent = 12-18 years
http://archives.who.int/eml/expcom/children/Items/PositionPaperAgeGroups.pdf
3
Q
Stridor on exertion, high-normal RR and some intercostal recessions would be an example of (mild/ mod/ severe) respiratory distress?
A
Mild resp distress
4
Q
What are the indications for performing neuro obs on a child?
A
Raised ICP Neurosurgical procedure Encephalopathy (metabolic, hepatic) Endocrine disorder (DKA, DI) Seizures Demyelinating neuro disorder (e.g. GBS) Electrolyte disturbance Increased risk of stroke e.g. VAD, abnorm INR
5
Q
What ages are the FLACC, Faces and Numerical pain scales used for assessing pain score in children?
A
FLACC: 2mths - 8yo (or cognitive impairment/ disabled)
Faces scale: >3yo
Numerical scale: >8yo
6
Q
What is the normal reference range for HR and RR for a 6 month-2 year old? A 5-8 year old?
A
6mth-2yo: HR 100-160, RR 25-40
5-8yo: HR 80-130, RR 20-30
7
Q
What does HEADS stand for in assessment of an adolescent (clue: HE2ADS3)
A
Home Education/ employment Activities Drugs/ alcohol Sex/ safety/ suicide
8
Q
At what age do you switch from measuring the child’s length to height?
A
2 years old
9
Q
What does SAVE-A-CHILD stand for plus examples?
A
Skin (colour, mottled, petechiae) Activity level Ventilation (signs of resp distress) Eye contact Abuse (any suspicion) Cry (consolability) Heat (or cold) Immune (underlying immunocompromise) Level of consciousness Dehydration (e.g. skin turgor, mucous membranes, cap refill)
10
Q
Children have [smaller/ larger] diameter airways compared to adults?
A
Smaller diameter -> means even minor injury/ swelling can compromise ventilation
11
Q
What does APGAR stand for, when is it performed and what are normal values?
A
A = Appearance (skin colour)
P = Pulse rate
G = Grimace (reflex irritability)
A = Activity (muscle tone)
R = Respiration
Performed @ 1 & 5mins (±10mins) after birth
Score
≥7 = normal
4-6 = low –> requires medical attention (do a cord gas if ≤5 @ 5mins)
≤3 = critically low –> immediate resuscitation
12
Q
Name 5 of the 9 genetic conditions that are being tested for in a neonatal heel-prick test?
A
1 - Cystic fibrosis 2 - Congenital hypoTH 3 - PKU (phenylketonuria) 4 - Homocystinuria (HCU) 5 - Sickle cell disorders 6 - Maple syrup urine disease (MSUD) 7 - Isovaleric acidaemia (IVA) 8 - Glutaric aciduria 1 (GA1) 9 - Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
13
Q
What are the 4 domains of childhood development?
A
1 - Motor (gross & fine)
2 - Language (speech & written)
3 - Social/ emotional
4 - Cognitive
14
Q
List 4 ‘general’ red flags for childhood development
A
Any of: Strong parental concern Regression in 1+ developmental domain Non-responsive to visual/ verbal stimuli Significant hypo/ hypertonia Lack of eye contact Poor interaction with adults or other children Asymmetry of movement/ strength/ tone bw L & R sides
15
Q
At what ages are most children a) starting to stand with support, b) walking, c) running and d) talking full sentences?
A
a) 5-9months
b) 12 months
c) 18 months
d) 3 years
16
Q
It is a red flag if a child is not smiling by 6 months or cannot walk independently by 2 years or run & jump by 3 years
A
6 months
2 years
3 years
17
Q
What is the difference between global and specific developmental delay?
A
Global is where delay occurs in 2+ developmental domains; specific is only a delay in 1 domain
18
Q
List 4 DDx for respiratory distress in a neonate
A
Any 4 of:
- Sepsis (resp distress in newborn is sepsis til proven otherwise)
- Transient tachypnoea of newborn
- Respiratory distress syndrome aka hyaline membrane disease
- Meconium aspiration syndrome
- Pneumothorax
- Persistent pHTN
- Pneumonia
- Congenital cardiac malformation
- Congenital lung malformation
19
Q
What are the risk factors for transient tachypnoea of the newborn?
A
Pre-term delivery (esp 34-37wks); rapid labour or C/S without labour; maternal asthma or diabetes; SGA or LGA
20
Q
Connect the following causes of neonatal resp distress & underlying pathology/ 'classic' feature: A - Transient tachypnoea of newborn B - Resp distress syndrome C - Persistent pHTN D - Sepsis E - Pneumothorax
1 - increased pulm vasc resistance causing R->L shunt & hypoxia; assoc with congenital diaphragmatic hernia and meconium aspiration; systolic murmur
2 - surfactant deficiency; resp distress appears later & progressively worsens
3 - maternal fever, GBS+, baby has non-specific signs (poor tone, malodour, apnoea, poor feeding, nausea, poor perfusion)
4 - baby required resuscitation and has unequal air entry; higher risk of pulm hypoplasia, pneumonia and meconium aspiration
5 - pulm oedema; onset usually within 2hrs of birth and resolves spontaneously after 12-24hrs
A
A = 5 B = 2 C = 1 D = 3 E = 4
21
Q
List signs of respiratory distress in a neonate/ infant
A
Poor respiratory effort: tachypnoea, grunting, nasal flaring, head bobbing, recessions (intercostal, subcostal, substernal)
Poor respiratory efficacy: reduced chest expansion, added breath sounds, low SpO2
Poor respiratory effect: cyanosis (poor perfusion), tachycardia, impaired mental state
22
Q
What antibiotics are used as empirical therapy for neonatal sepsis?
*Bonus points for doses
A
Penicillin or ampicillin plus gentamicin
Doses:
Penicillin: 60mg/kg BD
Ampicillin: 50mg/kg BD
Gentamicin: 2.5mg/kg OD
23
Q
List 4 aims of the well baby discharge check
A
Any 4 of:
- Identify for congenital abnormalities
- Educate parents & address concerns (e.g. feeding, sleeping, bathing)
- Assess for jaundice
- Assess establishment of feeding, elimination
- Record & assess growth parameters
- Complete infant personal health record
- Arrange appropriate monitoring & follow-up
24
Q
What are the common & not-to-miss DDx for jaundice in a 48hour old baby?
A
Common:
Physiological jaundice
Breastfeeding jaundice (infreq, limited intake -> reabsorption of bilirubin from bowel)
Breakdown of extravasated blood (e.g. cephalohaematoma)
Not-to-miss:
Haemolysis: Rh disease, ABO/ blood group incompatibility
RBC enzyme (G6PD deficiency) or membrane (spherocytosis) defect
Sepsis
Polycythaemia
25
True or false: Jaundice that occurs in the first 24hours of life is not overly concerning
FALSE - never ignore jaundice (of any severity) that presents <24hours --> most likely pathological (haemolysis, rbc enzyme or membrane defect)
26
```
Which of the following is NOT a cause of conjugated hyperbilirubinaemia (e.g. in a 10d old baby with jaundice)?
A - Bile duct stenosis
B - Hyperthyroidism
C - Galactosaemia
D - Alpha-1 antitrypsin deficiency
E - Hepatitis B infection
```
B - hyperthyroidism
| HyPOthyroidism can cause conjugated hyperbilirubinaemia
27
How frequent should breastfeeding be in a neonate with jaundice?
Feeding frequency should be increased to 8-12 feeds per 24hrs (i.e. 2-3 hourly, max 3hrs between feeds)
28
How often should serum bilirubin levels be checked for babies receiving phototherapy? Once phototherapy is ceased?
Every 4-6 hours until rise of bilirubin is controlled, and then 12-24 hourly
Re-check levels 12-24hrs after stopping phototherapy
29
Vit K deficient bleeding in a neonate typically presents with bleeding at which sites? There is a higher risk of occurrence with (breast/ formula) feeding.
GI bleeding; mucosal membranes; umbilicus; circumcision wounds
(intracranial bleeding is rarer, but accounts for ~50% of late presentations and has a mortality rate of 20-50%)
Higher risk with breast feeding (low levels of vit K compared to formula)
30
What is the underlying pathogenesis of hypoglycaemia in a preterm neonate?
Provide 3 other risk factors for hypoglycaemia in a neonate (regardless of gestation)
Preterm hypoglycaemia d/t a) limited glycogen & fat stores; b) impaired gluconeogenesis; c) increased glucose utilization for relatively larger brain size; d) unable to mount counter-regulatory response
Other causes of neonatal hypoglycaemia:
Maternal: diabetes, intrapartum glucose, meds (oral hypoglycaemics, citalopram, ß-blockers, valproate)
Neonatal: IUGR/SGA or macrosomia, resp distress, sepsis, congen cardiac defect, metabolic disorder, hyperinsulinism, hypopituitarism, hypoxic insult, hypothermia, inadequate feeding, Rh haemolytic disease
31
```
Which of the following is NOT a clinical sign of neonatal hypoglycaemia?
A - jitteriness
B - sweating
C - poor feeding
D - bradycardia
E - pallor
```
D - bradycardia
| Neonates with hypoglycaemia more likely present with TACHYCARDIA
32
True or false: the risk of a serious bacterial infection is greatest in the neonatal period?
Why/ why not?
True
Young infants
- Are more likely to present with non-specific signs & can't localise infection due to immature hypothalamic and immune systems
- Are too young to have received vaccines for potential pathogens
- Have declining levels of maternal antibodies & are only beginning to produce their own
- Can deteriorate rapidly
33
```
Classify each of the following clinical signs into the appropriate 'colour' (green, amber or red) of the traffic light system as per the NICE guidelines for assessing an unwell child:
Ashen or mottled colour;
Wakes only with prolonged stimulation;
Grunting;
RR 55;
Moist mucous membranes;
CRT >3 seconds;
Fever <3months old;
Fever for >5 days
```
Green: moist mucous membranes
Amber: wakes only with prolonged stimulation; RR 55, CRT >3 seconds, fever for >5 days
Red: Ashen or mottled colour; grunting; Fever <3months old
34
What are the 4 features of Tetralogy of Fallot?
1. Overriding aorta
2. Membranous VSD
3. Pulm stenosis causing RV outflow obstruction
4. RVH
35
What are the suppurative and non-suppurative complications of group A strep pharyngitis?
Suppurative: peritonsillar or retropharyngeal abscess
| Non-suppurative: acute RF, post-strep GN
36
What are the 3 key supportive treatments for a sore throat?
1. Simple analgesia
2. Maintain hydration
3. Corticosteroids if severe pain despite analgesia: dexamethasone or prednisolone
37
Where antibiotics are indicated in GAS pharyngitis, they are given to prevent [suppurative/ non-suppurative] complications?
Non-suppurative: rheumatic fever/ heart disease, post-strep GN
38
GAS pharyngitis is more likely to affect (<4yo/ >4yo)?
>4yo
| It is uncommon in children <4yo
39
What are the CENTOR criteria for assessing likelihood of strep throat to guide subsequent management?
```
C = Cough ABSENT
E = Exudate present
N = Nodes enlarged (ant cervical LNs)
T = temp >38
OR = young OR old -> 1 point if 3-14yo
```
40
Compare Perthes disease and SUFE (slipped upper femoral epiphysis) in terms of 1) age group affected, 2) pathophysiology, 3) risk factors and 4) treatment
1) Age group
Perthes ~4-8yo
SUFE ~10-15yo
2) Pathophysiology
Perthes: avascular osteonecrosis --> flattened femoral head
SUFE: separation of prox femoral shaft & epiphysis
3) Risk factors
Both: male
Perthes: Caucasian, short stature/ growth delay, FHx (10%)
SUFE: overweight, African-American/ Pacific Islander, renal osteodystrophy, hypoTH or hypopituitarism, gonadal conditions
4) Treatment
Perthes: conservative (rest, avoid weight bearing), bracing/ petrie casting or surgical ('shelf procedure', hip replacement)
SUFE: surgical reduction & internal fixation
41
What are the risk factors for DDH?
```
'BOFFF':
Breech presentation
Oligohydramnios
Female
FHx
First born
```
42
What is the peak age for 1) pyloric stenosis, 2) intussusception and 3) malrotation with volvulus
1) 6-8 weeks
2) 6-12 months
3) 1/3rd present <1mth, 75% <5yo
43
Fluid prescribing in paediatrics: what are the formulas for 1) resuscitation, 2) deficit and 3) maintenance
1) Resuscitation: 20mL/kg bolus
2) Deficit (total): body weight (kg) x % deficit x 10mL
- > usually replace over 4 hours
3) Maintenance: 4mL/kg/hr for first 10kg, 2mL/kg/hr for next 10kg, 1mL/kg/hr thereafter
44
Pyloric stenosis is more common in (males/ females)
Males
45
True or false: rapid IV rehydration should be given to a 8-week old with moderate dehydration?
FALSE
Rapid IV rehydration should only be given to children >6months
Younger children cannot tolerate rapid fluid shifts
46
Which of the following is NOT an indication for delivering a fluid bolus in a child?
A) Signs of circulatory shock (e.g. tachycardia & hypotension)
B) Estimated deficit 7-8%
C) Severe dehydration
D) Significant sodium derangement (hypo or hyper)
B) Estimated deficit 7-8% is moderate dehydration, and is not an indication for a fluid bolus/ resuscitation
47
Which of the following is NOT a requirement for discharging a child with gastroenteritis?
A) Tolerating oral intake
B) Able to be looked after at home
C) No further episodes of vomiting/ diarrhoea
D) Absence of cyanotic heart disease
E) No clinical signs of dehydration
C
| There should be infrequent episodes of vomiting/ diarrhoea, however it needn't be zero
48
(Viral/ bacterial) infections account for 70% of acute gastroenteritis. The most common pathogens are rotavirus & norovirus
Viral infections are most common, with rotavirus & norovirus being the leading causes.
(Bacterial infections account for 15% of cases, most commonly Salmonella or Campylobacter species)
49
What does FLACC stand for in paediatric pain assessment?
Faces Legs Activity Cry Consolability
50
What type of pathology does tenderness suggest and what examination technique is used to best elicit it?
Indicates a degree of peritonism
| Best elicited through percussion
51
What are the most common positions (2) of the appendix?
1) Retrocaecal
| 2) Para-caecal
52
What is the classic triad for intussusception?
Abdominal pain + palpable 'sausage-like' mass on R-side of abdomen + red currant jelly stool
53
True or false: you should examine the groin/ scrotum in all children who present with abdominal pain
True
Need to check for hernias, testicular torsion
But once performed on initial assessment, if low index of suspicion then don't need to repeat
54
```
Which of the following findings is most useful in favouring appendicitis over other causes of abdominal pain in children?
A) Elevated WCC
B) Elevated CRP
C) Pain migrating to RLQ
D) Fever
E) Vomiting
```
D) Fever
55
Intussusception is the telescoping, or invagination, of the (proximal/ distal) loop of bowel into the (proximal/ distal) loop of bowel.
This more often occurs at the ileo-caecal valve
Proximal into the distal
| The Ileo-caecal valve is the most common site for intussusception
56
Match the following conditions to the commonly affected age group
A: Sigmoid volvulus
B: Caecal volvulus
C: Intussusception
1: 2mths-2yo
2: Child/ young adult
3: >60yo
A - 3
B - 2
C - 1
57
At what age does infantile colic peak?
4-6 weeks
58
Contrast the major sites of haematopoiesis in an infant vs adolescent/ adult
Throughout skeleton as a infant (including long bones e.g. tibia/ femur) but then mostly axial skeleton (vertebrae, pelvis) at an older age
59
Bleeding due to platelet deficiency usually occurs in
A) Skin and mucosa
B) Deep tissues
C) Joints
A) Skin & Mucosa
| Bleeding in deep tissues or joints suggests coagulation factor deficiency
60
What ion is particularly important for the coagulation cascade to occur?
Calcium
61
Link the Haemophilia subtypes with their deficient factor & genetic inheritance
Haemophilia A = factor VIII deficiency, X-linked recessive
Haemophilia B = factor IX deficiency, X-linked recessive
Haemophilia C = factor XI deficiency, auto recessive
62
List 4 possible causes of anaemia secondary to blood loss in a neonate
1) Severe fetal-materal haemorrhage e.g. twin-to-twin transfusion syndrome
2) Cephalohaematoma
3) Subgaleal bleed
4) Occult organ trauma
63
What are the recommended volumes for formula/ breast feeding in an infant <3months and 3-6 months?
<3 months: 150mL/kg/d
| 3-6 months: 120mL/kg/d
64
After 4 weeks, how frequently should babies be feeding and how long should this take?
Approx 7-9 times per day (every ~3 hours) for 8-10mins
65
List 4 risk factors for iron deficiency anaemia in children
Any 4 of:
- Prematurity
- Low birth weight
- Cow's milk <6months
- Cow's milk protein allergy
- Exclusive breastfeeding >6mths
- Low iron intake
- Excessive cow's milk intake (>600mL/d): incl bottle > cup feeding in >2yo
- Giardia
- Coeliac
66
Which of the following is NOT a likely clinical manifestation of IDA in a child?
A) Pallor and lethargy
B) Developmental delay
C) Cravings for eating ice
D) Breath-holding spells
E) None of the above (i.e. they are all possible manifestations)
E
All are possible manifestations of iron deficiency, although many children are asymptomatic. Cravings for eating ice refers to pica
67
What are normal amounts of sleep for children 0-2 months, 2-12 months and 12 months to 3 years old?
0-2mths: 16-20 hours per day/night
2-12mths: total 11-16hrs (9-12hrs overnight + 2-4hrs daytime naps)
12mths-3yo: 12-13hrs with 1 daytime nap
68
List 4 physical causes of sleep difficulties in children
Any 4 of:
- GORD
- Hunger
- Cow's milk protein allergy
- Seizures
- OSA
- Cardiac failure, arrhythmia
- Hypoglycaemia
- Eczema, asthma, allergic rhinitis
- Arthritis
- ADHD on stimulants
69
At what age can honey be given to infants/ children and what risk dose it pose before this?
>12mths
| Infant botulinism
70
Select each of the features most consistent with atopic dermatitis (eczema)
Dry vs wet
Pale vs red
Itchy vs painless
Dry, red, itchy
71
What are the five 'principles' for treating eczema?
1) Avoid triggers & irritants: cooler baths, soap-free washes, thin cotton clothing, avoid allergens ± foods if intolerant
2) Regular emollients
3) Topical steroids (cortisone) for flares
4) Control itch: cool towels/ dressings, moisturiser
5) Promptly diagnose & treat super-infection
72
What are the contraindications for a suprapubic aspirate in a child? (4 answers)
1) Bleeding diathesis
2) Overlying soft tissue infection
3) Urogenital or GI abnormality
4) Abdominal distension or massive organomegaly
73
What are the 4 main types of functional gastrointestinal disorders causing abdominal pain?
1. IBS
2. Functional dyspepsia
3. Abdominal migraine
4. Abdominal pain unknown aetiology
74
In a child with abdominal pain, what are 4 red flags that increase the likelihood of an organic cause?
Any 4 of:
- Dysphagia or odynophagia
- Involuntary weight loss or deceleration of linear growth
- GI blood loss
- Severe vomiting incl bilious, protracted, cyclical
- Chronic severe diarrhoea
- Localised mass/ fullness
- Persistent RUQ/RLQ pain or tenderness
- Hepatomegaly or splenomegaly
- Perianal abnormalities
- Tenderness of costovertebral angle or spine
- Associated with arthritis or delayed puberty
- Unexplained fever
75
What are the two antibodies tested for on coeliac serology? What must also be tested to interpret results?
What genetic phenotype is tested?
DGP-IgG = deamidated gliadin peptide IgG
tTG-IgA = transglutaminase IgA
Also need to check total IgA to ensure not deficient and false negative tTG
HLA DQ2/8
76
Regarding Cow's milk protein allergy
True or false
1) CMPA has quite a good prognosis
2) CMPA is always IgE-mediated
1 - True: 50% tolerance by 1yo, >75% by 3yo & >90% by 6yo
2 - False: it can be either IgE-mediated or non-IgE-mediated
77
With regards to coeliac testing and screening, anit-tTG-IgA has a high (negative/ positive) positive predictive value and genetic testing HLA DQ2/8 has a high negative predictive value?
tTG-IgA: high positive predictive value (i.e. if test positive, coeliac likely)
HLA-DQ2/8: high negative predictive value (i.e. if test negative, coeliac unlikely)
78
What are the indications for investigating neonatal jaundice?
1) Onset <24 hours
2) Persisting beyond 2wks (or 3wks if pre-term)
3) Conjugated hyperbilirubinaemia, any age
79
What is the definition of status epilepticus?
30 minutes of continuous fitting or multiple fits with no return to baseline
80
Febrile seizures occur due to a (rapid or gradual) rise in temperature?
Rapid
81
What age group can suffer from febrile seizures?
6 months to 6 years old
82
What are the two sub-classifications of febrile seizures and how are they defined?
1) Simple: <15mins, no focal signs (usually generalised tonic-clonic), ≤1 seizure in 24hrs, rapid recovery
2) Complex: >15mins, focal signs, >1 seizure in 24hrs, prolonged recovery >1hr or background of neurodevelopment problems
83
Describe Kernig's and Brudzinski's tests and what are they looking for?
Kernig's: pain inhibition/ resistance to straightening knee when hip is flexed to 90 degrees
Brudzinski's: child's hips & knees flex when their neck is actively flexed
Both are tests for meningism
84
What are the two main metabolic disorders that can cause seizures?
Hypoglycaemia
| Hyponatraemia
85
Under what gestation and birth weight would you admit a baby at risk of hypoglycaemia to the neonatal unit?
<35 weeks gestation
| <2500g birth weight
86
Contrast the initial treatment(s) recommended as per the guidelines for non-severe (BGL 1.5-2.5) and severe (BGL <1.5) neonatal hypoglycaemia
BGL 1.5-2.5:
> 40% glucose gel buccally
> regular feeds (breast/ EBM/ formula/ NGT)
```
BGL <1.5
> confirm BGL via blood gas/ PoC test
> Admit to SCN & notify medical team
> IV glucose 10% infusion (1-2mL/kg bolus then 60mL/kg/day)
± IV glucagon 200mcg/kg
```
87
Categorise these drugs into 1st, 2nd or 3rd line for treatment of convulsive status epilepticus
IV phenytoin; IV/ IO midazolam; IV phenobarbitone; IM/ IN/ buccal midazolam; PR/ IV/ IO diazepam; midazolam infusion IV; PR paraldehyde; IV thiopentone
1st: IV/ IO/ IN/ IM/ buccal midazolam; IV/ IO/ PR diazepam
2nd: IV phenytoin, PR paraldehyde, IV phenobarbitone
3rd: IV midazolam infusion; IV thiopentone
88
Under what level of platelets is a lumbar puncture contraindicated?
PLT<50 (50 000/µL)
89
EEG has a (high/ low) low sensitivity and (high/low) high specificity for diagnosing epilepsy
```
Low sensitivity (40-50%)
High specificity (96%)
```
90
What is the minimum recommended duration of seizure-free anti-epileptic treatment?
Anti-epileptic medication should be continued until the child has been seizure free for at least 2 (TWO) years
91
What are the common causes of wheeze vs stridor in an infant-young child?
Wheeze: viral-induced wheeze, bronchiolitis
Stridor: croup, laryngomalacia
92
```
For each of the following serious respiratory conditions, match it with the more likely presentation (wheeze or stridor):
Epiglottitis
Cardiac failure
Peritonsillar abscess
Laryngeal web
Bacterial Tracheitis
Suppurative lung failure
```
Epiglottitis, peritonsillar abscess, laryngeal web & bacterial tracheitis --> stridor
Cardiac failure, suppurative lung failure --> wheeze
93
A history of developmental delay makes which of the following diagnoses more likely for wheeze?
1) Asthma
2) Anaphylaxis
3) Cardiac failure
4) Aspiration
5) Bronchiolitis
4) Aspiration - may be associated with underlying predisposing factor
94
What is laryngomalacia and before what age does it become apparent?
Congenital softening of laryngeal tissues, making them floppy & prone to obstructing airway. Usually presents as stridor by 6wks
95
A barking cough is more typical of asthma/ bronchiolitis/ croup?
Croup
96
What are the discharge criteria for asthma/ viral-induced wheeze?
```
O2 Sats >94% RA
Stable on q3h salbutamol
No tachypnoea
No accessory muscle use, no/mild WOB
Good air entry with minimal wheeze
Tolerating diet/ fluids
```
97
What are 3 reliever medications (puffers, including brand names) used for children with asthma/ wheeze?
What are the first line preventers (incl brand names)?
Relievers: Salbutamol [Ventolin(R), Asmol(R)], Terbutaline [Bricanyl(R)]
Preventers: montelukast [Singulair(R)], fluticasone propionate [Flixotide(R)]
98
Which of the following would be more concerning?
| An end-expiratory wheeze; inspiratory stridor; biphasic wheeze/ stridor
Biphasic wheeze/ stridor
| Suggests fixed lesion obstructing airway --> always pathological
99
List possible triggers for multi-trigger wheeze
Viral illness, exercise, tobacco smoke, laughter/ crying, cold air or night, mist, dust, plants
100
What clinical features make an asthma/ pre-school wheeze life-threatening?
Altered level of consciousness, exhaustion, cyanosis, excessive accessory muscle use, agonal breathing, unable to talk, reduced RR or HR, soft or absent breath sounds
101
What is the pathological mechanism of a wheeze and what are the DDx?
```
Mechanism: obstruction of intrathoracic airways
DDx:
Common:
Viral-induced/ multi-trigger wheeze or asthma;
Bronchiolitis
Tracheomalacia/ bronchomalacia
Bronchopneumonia
Less common, serious:
Anaphylaxis
Inhaled foreign body
Aspiration
Cardiac failure, vascular rings
Chronic suppurative lung disease e.g. CF bronchiectasis
Bronchiolitis obliterans
```
102
Compare & contrast bronchiolitis and croup in relation to most common aetiology, age group affected, typical symptoms and natural history
Bronchiolitis
Aetiology: RSV (80%)
Age group: <1yo (peaks 2-6mths)
Sx: dry wheezy cough, fine end-inspiratory crackles, ± WOB, ± apnoeas
Natural Hx: ~3 days incubation, ~3 days sickness (peaks day 2-3), self-resolves in 1-3 weeks
Croup = laryngotracheobronchitis
Aetiology: parainfluenza & influenza
Age group: 1-6yo (peaks 1-2yo)
Sx: stridor, barking cough, ± WOB
Natural Hx: incubation 2-7 days, Sx usually last 1-2 days (up to 7), self-limited unless severe
103
True or false: chest physiotherapy IS routinely recommended in bronchiolitis
```
False!! The following treatments are NOT indicated:
Chest physio
Corticosteroids
ß-agonists/ bronchodilators
Antibiotics/ anti-virals
Adrenaline
Deep suction
```
104
What are the 4 common causes of loss of consciousness in a child?
1) Head injury
2) Seizure
3) Syncope
4) Breath-holding spell
105
What is the peak age for breath holding spells?
2-3yo
106
What are the 3 clinical decision rules used to determine if a CT head is required in a child with a head injury?
CHALICE
PECARN
CATCH
107
What are the two treatment mainstays for nocturnal enuresis?
1) Bed alarms & behavioural training
| 2) Desmopressin (Minirin) medication
108
What is the ROME IV criteria for constipation and what are the 6 criteria?
```
Used to diagnose functional constipation
Need 2+ for >1mth duration of
≤2 stools/ wk
Faecal incontinence/ soiling at least once per week (in a toilet trained child)
History of voluntary stool retention
Painful/ hard bowel motions
Large-diameter stools
Large faecal rectal mass
```
109
Compare and contrast acute vs chronic malnutrition in terms of consequences, diagnosis/ measurement and management
Acute
Consequence: 'wasting' (sudden weight loss, oedema)
Measurement: weight-for-height (WFH) <80% (severe if <70% OR bipedal oedema)
Mx: feeding, therapeutic milk
Chronic
Consequence: 'Stunting'
Measurement: height-for-age (HFA) >2 SDs below mean
Mx: no response to feeding; ensure no further stunting depending on age
110
What are the criteria for failure to thrive?
1) Below 5th percentile weight-for-age on multiple occasions
2) Weight deceleration crossing 2 major percentile lines
3) <80% median weight-for-height
111
What is the most common cause of nephrotic syndrome in children?
Minimal change disease (MCD)
112
____ is the most common congenital cardiac defect/ disease?
Ventricular septal defects (VSD) occur in 2-7% of all live births; They account for ~20% of congenital heart defects
113
What drug class is used to treat PDA in pre-term infants? List 3 examples of specific medications
COX inhibitor/ NSAID
Indomethacin
Ibuprofen
Paracetamol
114
Truncus arteriosus needs to be surgically repaired within six (6) months of birth
six (6)
115
Cerebral palsy (CP) is a) _____ disorder characterised by impaired b) ____ (3). Most commonly brain injury occurs (time period) c)____. The most common subtype of CP is d) ____.
a) a non-progressive neurodevelopmental
b) motor function, tone and posture
c) antenatally
d) spastic
CP is an umbrella term for permanent movement/ posture disorders, often associated with cognitive, communicative and sensory impairment.
80% of cases develop in the antenatal period: risk factors include radiation exposure, infection, cerebrovascular haemorrhage or ischaemia, genetic syndromes.
~90% is classified as spastic, 6% dyskinetic and 4% ataxic
116
What does GMFCS stand for and what condition is it used for?
Gross Motor Function Classification System
| Used to classify cerebral palsy
117
With regards to cerebral palsy
Spastic subtype is due to damage of upper motor neurones/ corticospinal and pyramidal tracts
Dyskinetic subtype is due to damage of the basal ganglia/ extra-pyramidal tracts
Ataxic subtype is due to damage of the cerebellum
Cerebral palsy can be classified as
Spastic (90%): UMN lesion --> hypertonia
Dyskinetic (6%): basal ganglia lesion --> involuntary movements
Ataxic (4%): cerebellar lesion --> uncoordinated, poor balance, hypotonia
118
What categories (8) are used to assess the severity of acute bronchiolitis?
```
Behaviour: level of lethargy/ irritability
Feeding
Hydration
Circulation: CRT, perfusion, pulses
O2 saturation
Respiratory rate
Accessory muscle use/ other signs WOB
Apnoeas
```
119
Mild to severe croup is treated with steroids, either dexamethasone or prednisolone.
```
Mild-mod
Dexamethasone 0.15mg/kg PO single dose
Prednisolone 1mg/kg PO + 2nd dose the following evening
Severe
Dexamethasone 0.6mg/kg IM/IV/ PO
```
120
30 % of children have 1 episode of wheeze by 3 years old. 60 % stop wheezing by 6 years old
30%, 3yo
| 60%, 6yo
121
The risk factors for asthma are _____
personal or FHx of atopy/allergy, tobacco smoke exposure, low SES, high BMI or low physical activity
122
```
Match the asthma medications generic name to brand name (there may be overlap)
Brand name:
Ventolin
Bricanyl
Flixotide
Singulair
Symbicort
Asmol
Seretide
Pulmicort
Generic name:
Fluticasone propionate
Fluticasone/ salmeterol
Salbutamol
Budesonide
Terbutaline sulfate
Budesonide/ eformoterol
Montelukast
```
Ventolin, Asmol = Salbutamol
Bricanyl = Terbutaline sulfate
Flixotide = Fluticasone propionate
Seretide = Fluticasone/ salmeterol (combo ICS/LABA should be avoided unless severe asthma w poor control)
Pulmicort = Budesonide
Symbicort = Budesonide/ eformoterol (combo ICS/LABA should be avoided unless severe asthma w poor control)
Singulair = Montelukast
123
Swollen turbinates, dark circles under the eyes and a transverse nasal crease (allergic salute) are signs of ____
allergic rhinitis
124
When classifying an asthma attack, oxygen saturates of 90-94% are ____ and <90% are ____
moderate
| severe or life-threatening
125
When assessing whether to 'stretch' the salbutamol for a child with asthma, you look for signs of _____. If none of these are present, stretching is appropriate
respiratory distress, reduced air entry and prolonged expiratory phase
126
What are the side effects of salbutamol and what metabolic changes do you get with toxicity?
Side effects: tachycardia, tremor, agitation, HTN (rare)
| Toxicity: high lactate, hyperglycaemia, hypokalaemia, metabolic acidosis
127
In an acute asthma attack, a dose of salbutamol is __ puffs in >6yo and ___ puffs in >6yo via MDI + spacer
6 puffs
| 12 puffs
128
The atopic march describes what 4 conditions?
Eczema (atopic dermatitis), food allergies, asthma and allergic rhinitis
129
A skin prick test > __ mm is considered a positive test
>3mm
130
The most effective treatment for allergic rhinitis is _____
intranasal corticosteroids
131
What conditions are immunised against in the Infanrix(R) hexa vaccine? A dose is given at ____ of age
2, 4 and 6 months
DTPa i.e. Diphtheria, tetanus, pertussis
Hepatitis B
Haemophilus influenzae type B
Polio
132
The quadrivalent meningococcal vaccine covers which serogroups?
A, C, W, Y
| The brand name is Nimenrix(R)
133
What is the most concerning complication of Kawasaki disease?
Coronary artery aneurysm
| Kawasaki disease is vasculitis of medium-sized arteries, with a predilection for the coronary arteries.
134
Prolonged fever, polymorphous rash, lymphadenopathy and bilateral bulbar conjunctival injection are classic features of _____
Kawasaki disease
135
What is the dose of IM adrenaline for anaphylaxis management in children?
10mcg/kg (max 0.5mg)
| aka 0.01mL/kg (max 0.5mL) of 1:1000 solution
136
A(n) _____ thermometer should be used in neonates (<1mth)
axillary
Tympanic thermometers are inaccurate in infants and forehead thermometers are unreliable
137
Crops of skin lesions in different stages (papules, vesicles and crusted lesions) is characteristic of (infection) _____
chickenpox
138
The prodromal phase of measles illness is characterised by______
cough, coryza and conjunctivitis
139
____ virus has a predilection for the parotid glands, brain and testicles/ epididymis
Mumps
140
A Kasai procedure is performed for neonatal jaundice secondary to ____
biliary atresia
141
____kg is considered a normal birth weight. Macrosomia is birth weight >___
2.5-4
| >4.5kg
142
Weight loss of ____% is considered normal in the first week after birth
5-10% is normal. Weight loss >10% is abnormal and investigation is indicated
143
(neonatal haematomas) a) _____ can cross suture lines whereas b) _____ do not cross suture lines
a) Caput succedaneum and subgaleal haematomas
| b) cephalohaematomas
144
____ jaundice causes clay-coloured pale stools and dark urine
Obstructive
Jaundice from post-hepatic obstruction e.g. biliary atresia, choledochal cyst. It will be a conjugated hyperbilirubinaemia, which cannot be excreted in the faeces (hence, pale clay-coloured stools) and instead accumulates in the bloodstream and is excreted in the urine (hence, dark urine)
145
Air bronchograms and ground glass appearance on a newborn's chest x-ray are characteristic of _____
respiratory distress syndrome
146
Congenital diaphragmatic hernias usually occur on the ____ side
Left
147
The most common cause of early-onset neonatal sepsis is___
GBS
Other pathogens are Listeria, E.coli, Klebsiella and enterobacter
148
The high-risk maternal antibodies for haemolytic disease of the newborn are ____
anti-C, anti-D and anti-K (Kell)
149
G6PD deficiency is a(n) (genetics) a) _____ condition that is triggered by oxidative stress, which may be precipitated by b) ____. The classic features on a blood film are c) ______
a) X-linked recessive
b) fava beans, sulphonamides, rifampicin and nitrofurantoin
c) Heinz bodies and bite cells
150
What is the Parkland Formula for burns?
The formula to guide fluid resuscitation:
% TBSA x weight (kg) x 3-4mL
Warm Hartmann's solution, 50% given over first 8hrs then 50% over next 16hrs
If the burn is large (TBSA >20%) add 4% albumin to the 2nd half of IV fluids
151
____ (3) are the most reliable individual signs of dehydration in a young child
Capillary refill time, skin turgor and respiratory pattern
152
What is the formula for prescribing fluids for deficit in children and what type of fluid is given?
```
Body weight (kg) x % deficit x 10mL
Usually normal saline + 5% dextrose
```
153
GORD (gastro-oesophageal reflux disease) is reflux PLUS which features?
oesophagitis or nutritional compromise (poor weight gain, feed refusal) or extra-oesophageal symptoms (choking, gagging, coughing)
GORD is a clinical diagnosis
154
A metabolic complication of pyloric stenosis is ______
hypochloraemic alkalosis
155
FPIES (Food protein induced enterocolitis syndrome) is usually due to a)_____. It presents with b) ____ approximately 1-3 hours after exposure.
a) cow's milk protein
| b) profuse vomiting and diarrhoea
156
The anti-emetic of choice for gastroenteritis is (medication & dose) _____ for children >6 months old and >8kg.
ondansetron 2-8mg
157
What are 4 clinical signs of appendicitis?
McBurney's point tenderness
Rovsing's sign (cross-tenderness)
Obturator sign
Psoas sign
158
____ % of children experience functional abdominal pain.
10-15%
159
(hypo/hyper)chloraemic, (hypo/hyper)kalaemic metabolic alkalosis is the classic electrolyte & acid imbalance in pyloric stenosis
Hypochloraemic, hypokalaemia metabolic alkalosis
Due to loss of Cl-, H+ and K+ in the vomitus + RAAS activation leads to extra losses of K+ in the urine and subsequent exchange with H+ in distal tubule -> urine H+ loss -> worse alkalosis
160
According to the US-CDC growth charts, a BMI of ___% is considered "overweight" and a BMI >___% is considered "obese"
85-95%
| >95%
161
What are the DDx for an organic cause of overweight/ obesity?
```
Medications: antipsychotics, steroids
Hypothyroidism
Cushing Syndrome
Growth hormone deficiency
Genetic syndromes: Beckwith-Wiedemann, Prader-Willi
```
162
Nephrotic syndrome classically manifests as _____
proteinuria, oedema and hypoalbuminaemia
Proteinuria: 3-4 + on dipstick or >200mg/mmol
Oedema: periorbital, sacral, scrotal/ vulval, leg & anke oedema, SOB, ascites & abdominal distension
Hypoalbuminaemia: contributes to proteinuria & oedema
163
What are the complications of nephrotic syndrome?
Hypovolaemia (due to intravascular volume depletion)
Thrombosis (due to hypercoagulable state)
Infection (due to urinary loss of immunoglobulins), esp capsulated organisms (e.g. pneumococcus)
Hypercholesterolaemia
164
A head injury with brief loss of consciousness, 2 vomits, persistent headache and normal neurological exam would be classified as ___
Moderate
Mild - no loss of consciousness, ≤1 vomit (and normal neuro exam)
Severe - prolonged loss of consciousness of decreased/ deteriorating LOC, abnormal neurological findings (e.g. CSF leak, signs of raised ICP)
165
Cushing's triad is (3 signs) ____
bradycardia plus HTN plus abnormal respiratory pattern
166
C-spine immobilisation is indicated if there is a suspected head/ neck injury PLUS either
paraesthesia of the extremities, GCS <15, neck pain/ tenderness, torticollis, focal neurological deficit
167
What are the 4 main types of paediatric fractures?
1. Greenstick
2. Buckle (torus)
3. Bowing plastic deformity
4. Salter Harris Types I-V
168
What are the red flags for non-accidental injury or child abuse?
Delayed presentation, multiple injuries at different stages of healing, unusual bruising (head, buttocks, torso, hands/ feet, round cigarette burns), carer is distant or child unsettled with them, signs of neglect (poor hygiene, underweight)
169
Normal vision has developed by approximately (age) ____ years old
4-5 yrs
As defined by 6:6 (20:20) vision
The critical period for visual development is 0-4mths (up to 12mths)
170
Strabismus is also known as ___
squint
171
Strabismus can be classified as horizontal or vertical. Horizontal strabismus includes a) ____, where the eye turns inwards, and b) ____, where the eye turns outwards
a) esotropia (convergent)
b) extropia (divergent)
Horizontal strabismus
Esotropia (convergent squint): eye[s] turn inward
Exotropia (divergent squint): eye[s] turn outward
Vertical strabismus
Hypertropia: eye[s] turn upward
Hypotropia: eye[s] turn downward
172
Blanching, sandpaper-like, flushed face and cheeks with perioral sparing describes the 'classical' rash of ___
scarlet fever
173
The complications of acute otitis media are (4) ____
tympanic membrane perforation, recurrent/ chronic OM with effusion (glue ear), acute mastoiditis, intracerebral infection
OM + effusion can lead to conductive hearing loss, speech & learning impairment
Acute mastoiditis occurs when infection spreads to the mastoid bone, causing suppurative bony necrosis. This can progress to intracerebral abscess or meningitis, however this is rare.
174
True or false: antibiotics are routinely needed in acute otitis media
False! Routine use should be avoided
Indications for antibiotics are no symptom resolution after 2-3 days or red flags (AOM in only hearing ear, cochlear implant, Indigenous ethnicity or immunodeficiency)
The antibiotic of choice is amoxicillin 30-45mg/kg BD
175
What are the differentials for an acute red eye? Painful vs painless
```
Painful
Foreign body
Corneal ulceration: traumatic or herpetic
Acute glaucoma
Iritis
[Epi]scleritis
Painless
Subconjunctival haemorrhage
Conjunctivitis: allergic, bacterial or viral
```
176
____ (location) fractures are the most common fractures in children
Elbow
177
An ophthalmology referral for nasolacrimal duct obstruction (dacryostenosis) should be delayed until ___ of age.
12 months
Initial management should be conservative, with warm compress (2-5 times per day), and lacrimal sac massage. 90% of cases resolve spontaneously by 6 months, and even higher resolution by 12 months.
178
An omega-shaped epiglottis on laryngoscopy of an infant is classic of ____
laryngomalacia.
Laryngomalacia is congenital softening of the laryngeal tissues above the vocal cords. This causes the epiglottis to 'flop' down, producing the classic 'omega' shape. It causes noisy breathing and stridor, but usually self resolves by 18-20 months.
