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Paediatrics Flashcards

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1
Q

Acute epiglottitis
Common bacterium

Features (5)
Position
Onset
Other

A

H. influenza type B

Features

  1. Tripod position
  2. Rapid onset
  3. Stridor
  4. Drooling of saliva
  5. Temperature
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2
Q

Thumb sign seen in which condition?
Steeple sign - subglottic narrowing seen in which condition?

Dx for epiglottitis
Mx

A

Sign seen on xray epiglottitis
Sign seen on xray croup

Visualisation +/- xray
Mx intubation, oxygen, abx

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3
Q

A sporty teenager presents with knee pain after exercise associated with intermittent swelling and locking

A

Osteochondritis dissecans

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4
Q

a teenage girl presents with medial knee pain following activity. The knee has given way on occasion

A

Patellar subluxation

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5
Q

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

A

Osgood-Schlatter disease

tibial apophysitis

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6
Q

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

A

Patellar tendonitis

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7
Q

Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy

A

Chondromalacia patellae

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8
Q

most common malignancy affecting children

Peak age

A

ALL

2-5yo

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9
Q
  1. Thrombocytopenia - easy bruising
  2. Anaemia - lethargy, pallor
  3. Neutropenia - frequent infections
  4. Fever
  5. Splenomegaly/ hepatomegaly

Name the most likely condition

A

ALL

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10
Q 
ALL poor prognostic factors (5)
Age
WCC number
Surface markers 
Race 
Gender
A 
age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex
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11
Q

Aortic stenosis in children are associated with which three conditions?

Mx (2)

A

William’s syndrome
Coarctation of the aorta
Turner’s syndrome

  1. Valve replacement
  2. If gradient across valve is > 60 mmHg then balloon valvotomy
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12
Q

What is the APGAR score?

A

Score 0,1,2 for each of the below

Pulse: absent, <100, >100
Resp effort: nil, weak irregular, strong/ crying
Colour: blue all over, extremities blue, pink
Tone: flaccid, limb flexion, active movement
Reflex irritability: nil, grimace, cries on stimulation

0-3 very low
4-6 moderate
7-10 good

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13
Q

ADHD

Mx (4)

A

Mx

  1. 10 week watch and wait period
  2. Refer to paeds or CAMHS
  3. Education and training programmes
  4. Drug therapy as last resort and only offered to those >5yo –> first line methylphenidate for 6 weeks

If in adequate response –> lisdexamfetamine

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14
Q

Monitoring methylphenidate + lisdexamfetamine

A

Baseline ECG

Height and weight every 6 months

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15
Q 
What is benign rolandic epilepsy?
Type of seizures
EEG findings?
When do the seizures stop?
Are they aware?
A 
Seizures occur mainly at night 
Partial seizures 
EEG shows centro-temporal spikes
Seizures usually stop by adolescence
Has awareness
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16
Q

Bronchiolitis
Organisim
Age group
Features

Dx

A

RSV
Most common in <1yo

  1. Dry cough
  2. Wheeze
  3. Feeding difficulties

Dx immunofluorescence of nasopharyngeal secretions may show RSV

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17
Q

Bronchiolitis

Rx

A
  1. Oxygen via headbox if <92%
  2. NG feeding
  3. Suction for secretions
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18
Q

Difference between Caput succedaneum and Cephalohaematoma

When does the swelling occur? 
Which crosses suture lines? 
How long to resolve? 
Where is the swelling?
Cause?
A

Caput succedaneum

  • swelling following prolonged/ traumatic delivery
  • vertex and crosses suture lines
  • days to resolve
  • present at birth

Cephalohaematoma

  • develops several hours post delivery
  • usually secondary to bleeding
  • parietal region, does not cross suture lines
  • can develop jaundice
  • can take three months to resolve
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19
Q

Normal RR in newborn

Normal HR in newborn

A

35-60

120-160

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20
Q

Where do threadworms come from?
Name the bacteria

Features

Mx

A

Enterobius vermicularis
Infestation occurs after swallowing eggs that are present in the environment.

perianal itching, particularly at night
Vulval itching

Mx
<6 months - hygiene measures only
>6 months - mebendazole

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21
Q

Causes of snoring (5)

A
  1. obesity
  2. nasal problems
  3. recurrent tonsillitis
  4. Down’s syndrome
  5. hypothyroidism
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22
Q

What is hypospadias?

Mx

A

Incorrect anatomy of urethral meatus, usually on ventral side of penis

Mx
Refer immediately
Surgery at 1yo
Nil circumcision

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23
Q

Features of CF

A
  1. short stature
  2. delayed puberty
  3. rectal prolapse (due to bulky stools)
  4. nasal polyps
  5. male infertility, female subfertility
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24
Q

CF associated conditions (4)

Genetics

A

Usually picked up at newborn screening programmes

  1. Mec ileus
  2. Recurrent chest infections
  3. Malabsorption/ FTT
  4. DM

AR CFTR gene chrm 7 delta F508

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25
Congenital cyst found in the mouth | Common on hard palate
Epstein's pearl
26
Hand foot mouth disease: Virus:
coxsackie A16
27
At what age is head banging a sign of autism?
``` 3yo = sign of autism 2yo = normal ```
28
Caused by the coxsackie A16 virus Mild systemic upset: sore throat, fever Vesicles in the mouth and on the palms and soles of the feet
Hand foot and mouth disease
29
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci - strep pyogenes Fever, malaise, tonsillitis 'Strawberry' tongue Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Scarlet fever
30
Also known as fifth disease or 'slapped-cheek syndrome' Caused by parvovirus B19 Lethargy, fever, headache 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
Erythema infectiosum
31
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day Lymphadenopathy: suboccipital and postauricular
Rubella
32
Fever, malaise, muscular pain | Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
Mumps
33
Prodrome: irritable, conjunctivitis, fever Koplik spots: white spots ('grain of salt') on buccal mucosa Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Measles
34
Fever initially Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular Systemic upset is usually mild
Chickenpox
35
Abdominal mass Painless haematuria Flank pain Anorexia/ fever =
Wilm's tumour
36
Moderate Severe asthma criteria Life threatening ``` PEFR Sats Clinical signs HR RR ```
Moderate, severe, life threatening PEFR >50%, 33-50%, <33% Sats >92%, <92%, <92% Moderate - no clinical features of asthma Severe: Too breathless to talk Life threateningL silent chest Severe: HR >120 >5yo, >140 1-5yo SevereRR >30 >5yo, >40 1-5yo Life threatening poor resp effort Severe: Use of accessory neck muscles Life threatening: agitation, altered consciousness, cyanosis
37
Acute asthma mx
1. SABA via a spacer 1 puff every 30-60 seconds up to a maximum of 10 puffs If sx not controlled repeat and refer 2. Steroids 3-5 days 2-5yo 20mg OD >5yo 30-40mg
38
Asthma chronic mx >5yo
1. SABA 2. SABA + low dose ICS 3. SABA + low dose ICS + LTRA 4. SABA + low dose ICS + LABA (stop LTRA if not helpful) 5. SABA + MART (low dose ICS) 6. SABA + MART (mod ICS) OR SABA + mod ICS + LABA 7. SABA + MART (high ICS) OR SABA + high ICS + LABA OR Step 6 + theophylline OR Refer
39
Asthma chronic mx <5yo
1. SABA 2. SABA + mod dose ICS 8 week trial After 8 week trial stop the ICS - if symptoms did not improve, consider alternative diagnosis - if symptoms had improved but reoccured within 4 weeks, start SABA and low dose ICS - if symptoms had improved but reoccured after 4 weeks, retrial 8 weeks mod dose ICS + SABA 3. SABA + low dose ICS + LTRA 4. Stop LTRA and refer
40
SIDS protective factors (3)
breastfeeding room sharing the use of dummies
41
``` Features rapid onset unwell, toxic child stridor drooling of saliva ```
acute epiglottitis
42
``` Features are of sudden onset coughing choking vomiting stridor ```
Inhaled foreign body
43
Congenital abnormality of the larynx. Infants typical present at 4 weeks of age with: stridor
Laryngomalacia
44
``` stridor barking cough (worse at night) fever coryzal symptoms 6 months - 3 years =? ```
Croup
45
What is Plagiocephaly? | What is Craniosynostosis?
parallelogram shaped head | premature fusion of skull bones
46
What is the Kocher criteria? | What is it used for?
Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip. Non weight bearing Temp >38.5 ESR >40 WCC >12 More than 1 criteria 40% chance of septic arthritis
47
Mx unilateral undescended testes Mx bilateral
Refer at 3 months To be seen by 6 months Surgery at 1yo - orchidopexy Reviewed by a senior paediatrician within 24hours
48
Complications of undescended testes (3)
infertility torsion testicular cancer
49
Name x5 cyanotic heart disease in children
1. ToF (presents at 1-2 months) 2. Transposition (presents at birth) 3. Tricuspid atresia
50
Name x5 acyanotic heart disease in children
1. VSD 2. PDA 3. ASD 4. Coarctation 5. Aortic valve stenosis
51
SIDS major RF (5) SIDS other RF (5) Usually what age
``` sleeping prone parental smoking prematurity bed sharing hyperthermia ``` ``` male sex multiple births social classes IV and V maternal drug use incidence increases in winter ``` 1st year of life, commonly at 3 months
52
RF for Surfactant deficient lung disease (5) | CXR findings
1. prematurity 2. male sex 3. diabetic mothers 4. Caesarean section 5. second born of premature twins ground-glass' appearance with an indistinct heart border
53
Hirschsprung's disease Initial ix Gold standard Ix Mx
AXR Rectal biopsy initially: rectal washouts/bowel irrigation definitive management: surgery to affected segment of the colon
54
Umbilical hernia in children mx Which race is more common Common in which condition?
Usually resolves by age 3yo Afro-Caribbean infants Down's syndrome
55
acute hip pain associated with a viral infection 2-10yo commonest cause of hip pain in children
transient synovitis | mx self limiting
56
When is the heel prick test done? | Diseases checked for? (9)
5-9 days of life ``` congenital hypothyroidism cystic fibrosis sickle cell disease phenylketonuria medium chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) ```
57
Most common nephrotic syndrome? | Mx
Minimal change | High dose steroids
58
``` fine, fair hair learning difficulties, seizures downwards (inferonasal) dislocation of lens increased risk of VTE malar flush, livedo reticularis Mx ```
Homocystinuria vitamin B6 (pyridoxine) supplements.
59
What is cradle cap? What age? When does it resolve? Mx
First few weeks of life Erythematous rash with coarse yellow scales on scalp Seborrhoeic dermatitis Usually resolves spontaneously by 8 months mild-moderate: baby shampoo and baby oils severe: mild topical steroids e.g. 1% hydrocortisone
60
What is used to maintain a patent ductus arteriosus?
PGE1
61
What is the nitrogen washout test?
To differentiate cardiac from non-cardiac causes of cyanosis. Give 100% O2 for 10 minutes Take an ABG If pO2 <15kPa = cyanotic congenital heart disease
62
What is Acrocyanosis? | How long will it last?
Normal peripheral cyanosis around mouth and extremities. Occurs immediately after birth Can persist for 24 to 48 hours
63
``` Development milestones When to refer: Not smiling by? Cannot sit unsupported by? Cannot walk by? ```
doesn't smile at 10 weeks cannot sit unsupported at 12 months cannot walk at 18 months
64
Chickenpox infectivity period Features (4)
4 days prior to the rash, 5 days after the rash, or until lesions have crusted over 1. fever initially 2. itchy, rash starting on head/trunk before spreading. 3. Initially macular then papular then vesicular 4. systemic upset is usually mild
65
Chickenpox Name of virus Mx (1)
Varicella zoster 1. Calamine
66
Child development | When is hand preference abnormal?
Before 12 months
67
Constipation mx (2)
1. Movicol Paediatric Plain using an escalating dose regimen | 2. If not effective after 2 weeks add a stimulant laxative e.g lactulose
68
Cow's milk protein intolerance (CMPI) Presentation Features (5)
Within first 3 months of life in formula fed babies 1. regurgitation 2. diarrhoea 3. urticaria, atopic eczema 4. 'colic' symptoms: irritability, crying 5. vomiting
69
Cow's milk protein intolerance (CMPI) Mx (2) If breastfeeding? Mx
Mild-moderate sx 1. extensive hydrolysed formula (eHF) milk Severe sx 2. amino acid-based formula (AAF) If breastfeeding Continue breastfeeding Eliminate cow's milk protein from mum's diet Calcium supplements Usually resolves in children by age 3-5
70
Croup Caused by? Age
Parainfluenza | 6 months - 3years
71
Croup When to admit? (4) Mx (2) Acute (2)
1. <6 months 2. Upper airway abnormalities 3. Moderate or severe croup 4. Uncertain diagnosis Mx Single dose dexamethasone to all children regardless of severity OR Pred Acute High flow oxygen Nebulised adrenaline
72
RF development dysplasia of the hip (6)
1. female sex: 6 times greater risk 2. breech presentation 3. positive family history 4. firstborn children 5. oligohydramnios 6. birth weight > 5 kg
73
Who gets screening for development dysplasia of the hip? (3) Dx investigation Mx (3)
USS 1. 1st degree relative with hip problems early in life 2. Breech from K36 3. Multiple pregnancy Barlow (dislocate) and Ortolani (relocate) All babies newborn and at 6 week check USS unless >4.5months - xray Mx most will resolve by 3-6 weeks of age Otherwise Pavlik harness if <4 months Otherwise surgery
74
Most common cause of acute diarrhoea in children? | Chronic diarrhoea
Rotavirus | Cows milk protein intolerance
75
Eczema Locations commonly affected? Age of onset Age it normally resolves Mx
Face and trunk, younger children is extensor surfaces Older children flexor surfaces, creases of face and neck Normally onset <6months, resolves by age 5 Mx 1. simple emolients 2. topical steroids
76
What age to refer kids with epistaxis?
Age <2yo
77
Pneumonia Most common organism Mx Mx myoplasma or chlamydia Mx pneumonia associated with influenza
Strep pneum Amoxicillin Macrolides should be used if mycoplasma or chlamydia is suspected In pneumonia associated with influenza, co-amoxiclav is recommended
78
'projectile' vomiting, typically 30 minutes after a feed constipation dehydration palpable mass may be present in the upper abdomen hypochloraemic, hypokalaemic alkalosis due to persistent vomiting = age of onset dx mx
pyloric stenosis second to fourth weeks of life USS Surgery: Ramstedt pyloromyotomy
79
``` School exclusion No exclusion (7) ```
``` Conjunctivitis Slapped cheek/ fifth disease Roseola Infectious mononucleosis Head lice Threadworms Hand, foot and mouth ```
80
``` School exclusion Scarlet fever Whooping cough Measles Rubella Chickenpox + impetigo Mumps Scabies+ influenza ```
``` Days 24 hours after starting abx 2 days after starting abx 4 days of onset of rash 5 days of onset of rash all lesions crusted over 5 days of onset of swollen glands Until recovered ```
81
Measles Infective period Features (3) including location of rash Ix Mx What to do if has not taken MMR but has been exposed to measles?
infective from prodrome until 4 days after rash starts 1. Prodrome - irritable, conjunctivitis, fever 2. Koplik spots - white spots on buccal mucosa before rash 3. rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent Ix IgM antibodies Mx supportive Give MMR within 72 hours
82
Measles | Top two complications
1. Otitis media | 2. Pneumonia
83
Whooping cough AKA Bacterium Gram +ve/-ve Features (5) How long can symptoms last for?
Pertussis Bordetella pertussis Gram negative Features 1. 2-3 days of coryzal sx .. then 2. Coughing bouts, worse at night 3. Vomiting +/- cyanosis 4. Inspiratory whoop 5. Apnoea 10-14 weeks
84
Whooping cough When to admit? Mx (2) School exclusion Complications (4)
<6 months Mx 1. Macrolide if cough within 21 days of onset of cough 2. Household contacts should be offered abx 48 hours of onset of abx 1. Subconjunctival haemorrhage 2. Pneumonia 3. Bronchiectasis 4. Seizures
85
UTI in children When to do an USS? Other Ix (3)
< 6 months + first UTI which responds to treatment USS within 6 weeks > 6 months with atypical infection or recurrent infection Ix 1. MSU - for culture 2. DMSA 4-6 months post infection - to check for scarring 3. MCUG if <6 months and atypical/ recurrent infection - to identify vesicoureteric reflux
86
What is the most common cause of cyanotic congenital heart disease? Age of presentation? Features (4) CXR finding ECG finding What medication can be given for cyanotic episodes?
ToF 1-2 months 1. VSD 2. right ventricular hypertrophy 3. pulmonary stenosis 4. overriding aorta CXR: 'boot-shaped' heart ECG right ventricular hypertrophy BBs
87
Scarlet fever caused by? | Features (6)
Group A haemolytic strep Strep pyogenes 1. 'strawberry' tongue 2. . sand paper rash obvious in flexures 3. rash: fine punctate erythema ('pinhead') on the torso and spares the palms and soles
88
Scarlet fever Dx Mx (2) School exclusion Complications
1. Throat swab Mx treat before results 1. Penicillin V for 10 days 2. Azithro if pen allergic 24 hours after commencing antibiotics Complications 1. Otitis media 2. Glomerulonephritis 3. RhF
89
Roseola infantum AKA | Caused by?
Sixth disease | HHV6
90
high fever: lasting a few days, followed later by a maculopapular rash Nagayama spots: papular enanthem on the uvula and soft palate febrile convulsions occur in around 10-15% diarrhoea and cough are also commonly seen =
Roseola infantum
91
Name the condition absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom strabismus visual problems AD/AR Chrm Age of diagnosis Mx
Retinoblastoma AD Chrm 13 18 months Mx Enucleation/ RT/ chemo/ photocoagulation
92
Food allergy Mx If the history is suggestive of an IgE-mediated allergy what would you offer? If the history is suggestive of an non-IgE-mediated allergy how would you manage the patient?
offer a skin prick test or blood tests for specific IgE antibodies to the suspected foods eliminate the suspected allergen for 2-6 weeks, then reintroduce.
93
Gastroschisis Mx (1) MOD Exomphalos MOD Associated with which three conditions? Mx
Can have vaginal delivery Theatre straight away ``` CS Beckwith-Wiedemann syndrome Down's syndrome cardiac and kidney malformations Mx can have surgery later as infant may need to grow a little so it can fit back in ```
94
``` Vaccinations At birth 2 months 3 months 4 months 12-13 months 2-8yo 3-4yo 12-13yo 13-18yo ```
At birth: BCG 2 months: '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), PO rotavirus, Men B 3 months: '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), PO rotavirus, PCV 4 months: '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), Men B 12-13 months Hib/Men C, MMR, PCV, Men B 2-8 years Flu vaccine (annual) 3-4 years '4-in-1 pre-school booster' (diphtheria, tetanus, whooping cough and polio), MMR 12-13 years HPV vaccination 13-18 years '3-in-1 teenage booster' (tetanus, diphtheria and polio), Men ACWY
95
Low-pitched sound heard at the lower left sternal edge =
Still's murmur - normal
96
paroxysmal abdominal colic pain during paroxysm the infant will characteristically draw their knees up and turn pale vomiting bloodstained stool - 'red-currant jelly' - is a late sign sausage-shaped mass in the right upper quadrant = which condition? Age Gender Ix + finding Mx
Intussusception 6-18months M>F USS - target-like mass Mx reduction by air insufflation under radiological control

MSRA (22 decks)

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