Paediatrics Flashcards
1
Q
what are the signs of periorbital cellulitis?
A
acute erythematous swelling of eyelid (unilateral)
2
Q
what are the signs of orbital cellulitis?
A
painful eye movements, diplopia, visual disturbance, fever, lid swelling, PAIN, proptosis
3
Q
how do you investigate a swollen eye?
A
CT orbit
4
Q
what are the two types of squint?
A
esotropia = convergent exotropia = divergent
5
Q
what are the two tests to diagnose a squint?
A
- corneal reflection test
2. cover test
6
Q
how do you manage a squint? (3 Os)
A
OPTICAL
ORTHOPTIC - patching of eye encourages strengthening
OPERATIONS - botox injection/resection of rectus muscle
7
Q
what is Hirschprungs disease?
A
absence of ganglia in the colon segment which leads to a functional GI obstruction
8
Q
how do you manage a patient with hirschprungs?
A
resection of the aganglionic segment/colostomy
9
Q
what is croup? which patients is it common in?
A
acute laryngotracheobronchitis - common in patients <6 years
10
Q
features of croup?
A
stridor, barking cough, hoarseness, virally unwell
11
Q
what causes croup?
A
parainfluenza
12
Q
how do you manage croup?
A
- Dexamethasone
2. Nebulised adrenaline (call anaesthatist)
13
Q
how does epiglottitis present differently to croup?
A
sudden onset, soft continues snorring stridor, drooling scretions, voice muffled
caused by H.Influenza B
14
Q
how do you manage epiglottitis?
A
do not examine throat - call ENT and anaesthetics
IV Abx and steroid
15
Q
what causes bronchiolotis?
A
RSV
16
Q
features of bronchiolitis?
A
cough, coryza, fever, raised RR, wheeze, inspiratory crackles
17
Q
signs of bronchiolitis?
A
reduced feeding, resp distress, hypoxia
18
Q
how do you manage bronchiolitis?
A
O2, NG feed
19
Q
commonest cause of pneumonia? (CAP)
A
strep.pneumoniae
20
Q
signs that a patient has pneumonia?
A
high temperature, malaise, reduced feeding, resp distress, increased RR, reduced SpO2, grunting, intercostal recessions
21
Q
when do you admit a patient with pneumonia?
A
respiratory distress signs or SpO2 <92%
22
Q
how do you manage a viral induced wheeze?
A
SABA + steroids
23
Q
signs of a viral induced wheeze over asthma?
A
virally unwell, no history of atopy/eczema, patient <5 years old
24
Q
Name a DD of a child presenting with an asthma attack?
A
foreign body, pertussis, croup, pneumonia
25
what general measures do we do for asthma patients?
annual review of symptoms/exaccerbations/med use
check inhaler technique and adherence
personalised action plans
26
what drug therapy do we use for day to day management of asthma?
1. SABA (salbutamol)
2. Steroid (beclometasone)
3. <5 = LTRA (monteleukast), >5 = LABA (salmeterol)
4. increasing steroid dose
5. prednisolone
27
how do you manage a child presenting with an acute asthma attack?
1. sit patient up, high flow O2
2. nebulised salbutamol and ipratropium bromide
3. IV hydrocortisone
ESCALATE - MgSO4, aminophylline, IVI salbutamol/ICU
28
name some pitfalls in asthma management?
bad inhaler technique
reduced perception of severe attacks
satisfied with poor control
don't notice diurnal variation
29
how to children present with a UTI?
non-specifically unwell, collapse, sepsis, vomiting, failure to thrive, colic
30
what is vesicoureteric reflux? why is it relevant?
backflow of urine from the bladder into the ureter
- predisposes children to UTIs
- causes renal scarring
- ureters displaced laterally upon entry to the bladder
31
how can you investigate UTIs in children? what do they show?
micturating cystourethogram - shows the VUR
DMSA - shows renal scarring
urine dipstick/clean catch sample - microscopy and culture
US kidney and urinary tract
32
main cause of a UTI?
E.Coli
33
treatment for a UTI in a child?
GENERAL: avoid constipation, increase fluids, full voiding, repeat MSU
ABX
- < 3 months - amoxicillin and gentamycin
- >3 months - trimethoprim
- pyelonephritis - gentomycin
34
name some causes of nephritic syndrome?
post strep
HSP
alport syndrome
SLE
35
presentation of nephritic syndrome?
haematuria, oliguria, HTN, oedema, loin pain
36
signs that nephritic syndrome is caused by post strep? how do you manage this?
7-21 days after a sore throat
| 10 days penicillin
37
signs that nephritic syndrome is caused by HSP? what is HSP? how do you manage this cause?
IgA vasculitis, purpuric rash on buttocks
| steroids and immunosuppressants
38
signs that nephritic syndrome is caused by Alport syndrome? how do you diagnose this?
x linked recessive inheritance
bilateral SN deafness
genetic testing
39
what investigations do you do for nephritic syndrome?
FBC, UE, bicarb, Ca, Ph, complement C3 and C4, dsDNA Abs, ANA Abs, ANCA Abs, blood cultures, throat swab, MSU (red cells/white cells, red cast cells, culture)
Renal US/CXR
40
General management for nephritic syndrome?
sodium restricted diet
diuretic
antihypertensive
41
what is the triad of nephrotic syndrome?
oedema, proteinuria, hypoalbunaemia
42
commonest cause of nephrotic syndrome?
minimal changes
43
signs of nephrotic syndrome in a child?
periorbital/scrotal oedema, anorexia, GI disturbance, frothy urine
44
how do you manage nephrotic syndrome?
restrict fluid and salt
prednisolone
monitor BP
45
name some causes of CKD in children?
congenital dysplastic kidneys
ADPKD
reflux nephropathy
46
what age does nocturnal enuresis normally stop?
age 3/4
47
how can you manage a child with nocturnal enuresis?
1. underlying cause? DM/UTI/constipation
2. advise on fluids/toilet advice/intake
3. reward systems - star charts, enuresis alarm
3. Desmopressin
48
what are the signs of hypospadias?
abnormal penis - ventral urethral meatus, hooded prepuce, chordee
49
what is the triad of haemolytic uraemic syndrome?
AKI, microangiopathic anaemia, thrombocytopenia
50
how does a Wilm's tumour present?
abdo mass, painless haematuria, flank pain, anorexia
51
features of a retinoblastoma
loss of red reflex, strabismus, visual problems
52
how can you manage a retinoblastoma?
external beam radiotherapy, photocoagulation
53
name 2 common bone tumours in children?
osteosarcoma
| ewing's sarcoma
54
what are the X ray changes on an osteosarcoma?
Codman's triangle - periosteal elevation and sunburst pattern
55
what are the X ray changes on ewing's sarcoma?
Onion ring lesions
56
where do neuroblastoma's arise from?
arise from neural crest tissue of the adrenal medulla and the sympathetic nervous system
57
what are the features of neuroblastomas?
abdo mass, pallor, weight loss, bone pain, limp
58
name some complications of undescended testes?
infertility, torsion, cancer
59
what increases the risk of undescended testes?
pre-term delivery
60
what are the signs of testicular torsion (twisting of the spermetic cord)?
pain severe, lower abdo pain, N&V
61
which reflex is lost in testicular torsion?
cremasteric reflex
62
how do you manage testicular torsion?
urgent surgical exploration
63
signs that a child is being affected by GORD?
child is WELL
recurrent regurgitation after eating (not projectile)
still thriving
64
Ix for GORD in children?
24hr pH test in the oesophagus
65
how do you manage a child with GORD?
ADVISE: normally improves by 1 year of age as the LOS matures
avoid overfeeding/lying down to eat
medication: Omeprazole, gaviscon, ranitidine
66
when does pyloric stenosis present and why?
presents at 2-8 weeks of age
| pyloric muscle hypertrophy which causes a gastric outlet obstruction
67
what are the electrolyte disturbances in pyloric stenosis?
hypokalaemia
hypochloridaemia
metabolic alkalosis
68
how can you investigate a child for pyloric stenosis?
feed child --> relax stomach --> visible gastric peristalsis and an olive mass
US the stomach
69
Mx for pyloric stenosis?
correct UEs, fluids
| pyloromyomectomy
70
name some common causes for gastroenteritis?
rotavirus, norovirus, E.Coli, salmonella
71
what do you need to assess in a child presenting with gastroenteritis?
DEHYDRATION STATUS
72
what is meckels diverticulum?
ileal remenant of vitello-intestinal duct
73
how can meckels diverticulum present?
painless rectal bleeding, volvulus, intesussuption
74
what is intessusuption?
bowel invaginating on itself proximally
75
how does intessusuption present?
periods of intense paina nd drawing up the knees
redcurrent jelly stool
shock
sausage mass
76
management of intessusuption?
1st line = air enema
| 2nd line = reduction via laparotomy
77
what is constipation?
hard stool, reduced frequency of defacation
pain
overflow diarrhoea
78
name some causes of dehydration?
```
dehydration
reduced fibre intake
hirschprungs disease
hypothyroid
anorectal abnormalities
```
79
how does constipation lead to incontinence?
1. longstanding constipation
2. rectum overdistends
3. reduced rectal sensation
4. involuntary soiling
80
how can you manage constipation in children?
explain to parents
stool softener e.g. Movicol (escalating regime)
senna - stimulant laxative
81
what is the commonest hernia in children?
Inguinal - due to patent processus vaginalis - bulge appears when crying
82
how do you manage a hernia? (2/6 rule)
<6 weeks - operate in 2 days
<6 months - operate in 2 weeks
<6 years - operate in 2 months
83
what is kawasaki disease and what are the signs?
inflammatory vasculitis
| fever > 5 days, cervical lymphadenopathy, cracked lips, peeling fingers, conjunctivitis, coronary artery aneurysms
84
Ix kawasaki disease?
ESR/CRP, ECHO
85
Mx for kawasaki disease?
aspirin
IVIG
follow up ECHO
86
Signs of measles?
cough, coryza, conjunctivitis, cranky, high temperature, maculopapular rash behind ears which spreads down body, koplik spots
87
Ix for measles?
IgG/IgM, PCR
88
name some complications of measles?
croup
pneumonia
subacute sclerosing paraencephalitis
89
what are the signs of rubella? when is it infectious?
mild illness
macular rash starting on face
infectious 5 days before rash to 5 days after rash started
90
effects of rubella on a foetus?
deafness
cataracts
CHD
91
how do the skin lesions develop in chicken pox?
2 day temp --> macular --> papular --> pustules --> crust
| lesions tend to occur on the trunk
92
complications of chicken pox?
pneumonia
secondary infection
meningitis
93
how can you manage the symptoms of chicken pox?
calamine lotion
| trim nails
94
name some meningial signs?
stiff neck, positive kernig and bruduski, photophobia
95
name some septic signs?
raised heart rate and resp rate, reduced BP, mottled and cold peripheries
96
name a sign of meningococcal disease?
non-blanching purpuric/petichial rash
97
how do you manage meningococcal disease?
1. IMMEDIATE BENPEN before hospital (IM)
| 2. Hospital - ABCDE, IV cefotaxime + dexamethasone
98
how do you Ix acute bacterial meningitis?
throat swab PCR
blood/urine/stool culture
head CT
LP
99
what are the signs of encephalitis?
flu-like illness, low GCS, raised temperature
100
what is the main cause of viral encephalitis?
HSV
101
what are the 3 main features of ADHD?
1. impulsivity
2. inattention
3. hyperactive
102
how do you investigate ADHD?
school reports, conners scale, observe in school, screen for an organic cause
103
how do you manage ADHD?
parenting lessons, positive parenting
education programmes
methylphenidate
104
name the 3 features of autism?
1. impaired social interaction - unaware of others/no empathy/solitary play
2. impaired imagination - less babbling/no facial expressions/no fantasy play
3. poor range of activities - object pre-occupation
105
how can you manage autism?
intensive early speech and social therapy
national autism society
social training
risperidone
106
what is cerebral palsy?
disorder of movement/posture caused by a non-progressive lesion to the brain occuring < 2 years
107
name some features of cerebral palsy?
epilepsy
delayed motor milestones
learning disability
language/speech problems
108
how can you manage a patient with cerebral palsy?
physio/OT/ortho surgeons
botox
baclofen injections
109
what is klinefelter syndrome? signs?
47XXY
| infertility, hypogonadism, gynocomastia
110
what is pattau syndrome? signs?
trisomy 13
| cardiac and renal impairment, cerebral malformation, polydactyl, neural tube defect, cleft palate, micropthalmia, SGA
111
what is edwards syndrome? signs?
trisomy 18
rockerbottom feet, SGA, overlapping fingers, renal and cardiac malformation, cerebral malformation, low set ears, prominant occiput
112
what is turners syndrome? signs?
45X
wide and spade shaped chest, wide nipples, coarction of aorta, horseshoe kidney, recurrent OM, primary amenorrhea, short stature
113
what is prader willi? signs?
loss of paternal genes on chromosoem 15. hypotonia, poor feeding - obesity and social problems
114
what is angelman syndrome? signs?
loss of maternal genes on chromosome 15. laughing fits, physical and intellectual disability
115
what is a sign of noonan's syndrome?
ptosis and down turned eyes
116
what is downs syndrome and what are the signs?
trisomy 21
flat occiput, low set ears, small eyes and mouth, large tongue, round face, short stature, epicanthal fold, single palmar crease
117
what diseases are associated with downs syndrome?
coeliac disease, hirschprung, duodenal atresia, AD, leukaemia
118
what is the 3 ways that downs syndrome is inherited?
non-meiotic dysfunction
robertsman translocation
mosaicism
119
what is the defintion of precocious puberty?
<8 in girls, and <9 in boys
120
name some gonadotropin dependant causes of precocious puberty (raised LH/FSH)
pituitary tumours
121
name some gonadotropin independant causes of precocious puberty (low FSH/LH)
tumours in the gonads
122
what do we use to stage puberty?
tanner's chart
123
Ix for precocious puberty?
```
stage the puberty
CT/MRI head
bone age (skeletal Xray)
T4/TSH/LH/FSH/HCG/AFP/GH
US ovaries and adrenals
```
124
what are some risk factors for nectrotizing enterocolitis?
premature, cows milk
125
what are the signs of nectrotizing enterocolitis?
rectal bleeding, abdo distension, mucus PR, tender, shock
126
what is the classic XRay sign of nectrotizing enterocolitis?
pneumonitis intestinalis (gas in the bowel wall)
127
how do you manage nectrotizing enterocolitis?
stop feed, culture faeces, cross match blood
| Abx (cefotaxime + vancomycin)
128
what increases the risk of meconium aspiration?
increasing gestational age
| distressed foetus
129
what does aspiration of meconium cause?
chemical pneumonitis
obstruction
surfactant dysfunction
130
how do you manage meconium aspiration?
ventilation
ABx
NO
surfactant
131
what causes respiratory distress syndrome?
surfactant deficiency (RF = prematurity)
132
which cells secrete surfactant?
type 2 pneumocytes
133
How can you prevent RDS?
antenatal corticosteroids - stimulates surfactant production
134
Features of RDS? on XRay?
raised RR, chest wall recessions, grunting, nasal flaring
| ground glass appearance
135
what is the DD of RDS?
meconium aspiration, transient tachypnoea of the new born
136
how do you manage RDS?
Ventilate (21% O2)
| ET surfactant therapy
137
what is a side effect of ventilation for RDS?
bronchopulmonary dysplasia - caused by barotrauma and O2 toxicity
138
what are the features of bronchopulmonary dysplasia?
O2 desaturations during feeding
leads to;
- low IQ
- cerebral palsy
- asthma
- exercise intolerance
139
what are the signs of toxoplasmosis infection?
retinopathy, cerebral calcifications, hydrocephalus
140
what are the signs of a parovirus B19 infection?
fetal hydrops
141
what are the signs of a rubella infection?
deafness, CHD, cataracts
142
what are the signs of a CMV infection?
SN deafness, liver dysfunction, SGA
143
signs of a listeria infection?
sepsis
144
name some causes of hypoxic ischaemic encepalopathy?
cord prolapse
placenta abruption
maternal hypoxia
inadequate post natal circulation
145
how do you manage HIE?
treat seizures
| therapeutic hypothermia
146
what are the physiological reasons for jaundice in a newborn?
increased production (short RBC lifespan)
hepatic immaturity
breast feeding can cause dehydration and reduced bilirubin elimination
147
causes of jaundice in a baby <24 hours old?
RhD, ABO incompatibility, sepsis, G6PD/spherocytosis
148
how do you investigate jaundice within 24 hours of birth?
COOMBS test, FBC plus film
149
what does coombs test show?
presence of antibodies on a babies RBCs
150
what is a cause of jaundice in a baby > 2 weeks?
sepsis, TORCH infection, breast milk, biliary atresia
151
how do you investigate jaundice >2 weeks?
TORCH screen, sepsis 6, US liver
152
what is biliary atresia?
congenital malformation of the bile duct causing accumulation of bile
153
what is Kernicteris?
acute bilirubin encepalopathy
154
signs of Kernicteris?
shrill cry, lethargy, poor feeding
155
how do you manage Kernicteris?
phototherapy, exchange transfusion
156
what are the long term effect of Kernicteris?
akethoid dyskinetic cerebral palsy
157
what is the presentation of transient synovitis?
follows a viral infection - limp and pain, comfortable at rest, no temperature or toxic signs
158
what Ix do you do for transient synovitis? what do these show?
US hip - effusion
159
what is the criteria for septic arthritis?
KOCHER CRITERIA
- not weight bearing
- temperature
- raised ESR/CRP/WCC
160
common cause of septic arthritis?
S.Aureus
161
how do you IX septic arthritis?
FBC, UE, LFT, blood cultures, ESR, CRP, aspirate joint
162
what is osteomyelitis and what bacteria commonly causes it?
Infections of the metaphysis of bone (normally the long bones in children)
S.Aureus
163
how do you investigate osteomyelitis?
WCC/ESR/CRP/bone biopsy - gold standard
164
what are the XRay changes shown early and late in osteomyelitis?
```
EARLY - cloccae (erosions in the bone)
LATE -
- involcurum (elevated periosteum)
- sequestrum (dead bone)
- sinuses (discharging pus)
```
165
Mx for osteomyelitis?
6 weeks of Cefotaxime and Vancomycin
166
what is DDH?
stable acetabular dysplasia through to total dislocation
167
what increases the risk of DDH?
breech, oligohydramnios, twin, sibling with DDH
168
when and how do we screen childrens hips?
at 1 day and at 6 weeks
ORTOLANI - flex hips and abduct to try and lift femoral head to relocate hips
BARLOW - flexed hips and adduct the apply axial load
169
what do you do of ortolani and barlow comes back as abnormal?
US hips
170
how do you manage DDH?
Pavlik harness, surgery
171
definition of JIA?
>6 weeks of joint swelling and stiffness in a child <16
172
what types of JIA are there?
```
polyarthritis = >4 joints
oligoarthritis = <4 joints
systemic = fever and salmon rash
```
173
features of JIA?
morning stiffness, joint swelling, can't participate in hobbies, reduced growth, joint deformity
174
name some complications of JIA?
uveitis, reduced growth, osteoporosis, anaemia
175
how do you manage JIA?
```
involve paeds rheumatology
NSAIDS/paracetamol
corticosteroids - in the joint or systemic
MTX
infliximab
```
176
what is rickets?
failed mineralisation of growing bone
177
what increases your risk of rickets?
dark skin, low UV exposure, malabsorption, vegan diet, CF, coeliac disease, maternal vitamin D deficiency
178
name some signs of rickets
```
harrison's sulcus
palpable costo-chondral joint
ping pong sensation on the head
widened wrists
delayed fontanelle closure
```
179
how do you investigate rickets?
Vit D and calcium levels
| X ray wrist
180
what is congenital adrenal hyperplasia (CAH)?
autosomal recessive disorder. Deficiency of the 21a hydroxylase enzyme. Reduced gut cortisol results in negative feedback and increased ACTH and increased testosterone levels
Reduced mineralcorticoid synthesis (low Na and high K)
181
features of a patient with CAH?
```
clitoris hypertrophy
fused labia
enlarged penis
salt losing crisis
tall
```
182
what do you find on Ix with a patient with CAH?
low Na, high K, low glucose, metabolic acidosis
high testosterone
US female - ovaries?
183
how do you manage a patient with CAH?
genital surgery for females
fludrocortisone/hydrocortisone
monitor growth
184
Name the features of a L --> R shunt (breathless)?
PDA
ASD
VSD
185
How do you investigate cardiology in children?
antenatal ECHO, ECHO/ECG/CXR
186
Features of PDA? Mx?
ductus arteriosus remains open - continuous murmer.
| need to shut with a coil
187
features of ASD? what murmur do you hear?
recurrent chest infections and wheeze
| Left upper sternal edge ejection systolic murmer
188
features of VSD?
left lower sternal edge pansystolic murmer
189
Name the causes of a R --> L shunt (cyanotic)?
Tetralogy of Fallot
| transposition of the arteries
190
what are the features of ToF?
overriding aorta
VSD
pulmonary stenosis
RVH
191
what symptoms do you get with ToF?
| what sort of murmer do you get?
symptoms of cyanosis and hypercyanosis on defacation/exercise
Harsh ejection systolic murmer
192
what is the transposition of arteries and what symptoms do you get?
arteries are switched over - severe cyanosis at day 2 as the ductus arteriosus closes. NO MURMER
193
how do you manage transposition of the arteries?
give prostaglandin and a atrial septoplasty - to allow for mixing of blood
surgical repair
194
name the causes of an outflow obstruction in a well child?
pulmonary stenosis
| aortic stenosis
195
name the causes of an outflow obstruction in an unwell child?
coarction of the aorta
196
what murmer is there in pulmonary stenosis?
soft ejection systolic murmer in the Left upper sternal edge
197
what murmer is there in aortic stenosis?
ejection systolic murmer in the right upper sternal edge
198
what are the features of coarction of the aorta?
restriction around ductus arteriosus
Radiofemoral delay
ejection systolic murmer
LV hypertrophy
199
what causes Kwashiokor?
reduced protein intake
200
what causes Marasmus?
lack of calories
201
signs of diptheria?
muffled voice, dysphagia, bronchopneumonia, airway obstruction, tonisillitis with false membrane over the fauces
202
how do you manage a patient with diptheria?
diptheria antitoxin and erythromycin
203
features of Kallman syndrome?
```
X linked recessive disorder
LACK OF SMELL
delayed puberty
hypogonadotropic hypogonadism
low sex hormones (FSH and LH)
```
204
what is osteogenesis imperfecta?
brittle bone disease due to a disorder of collagen metabolism which results in fragility and fractures
205
features of osteogenesis imperfecta?
childhood presentation
fractures after minor trauma
blue sclera
deafness secondary to osteosclerosis
206
how do you investigate osteogenesis imperfecta?
Ca/Ph/PTH/ALP all NORMAL
207
What is perthes disease?
avascular necrosis of the femoral head. Impaired blood supply and bone infarction.
208
features of perthes disease?
10% bilateral
hip pain over a few weeks and a limp
stiffnes
reduced RoM
209
Xray changes in perthes disease?
early - widened joint space
| late - reduced femoral head size
210
how do you investigate perthes disease?
Xray/bone scan - CATTERALL STAGING
211
how do you manage perthes disease?
cast/brace, surgery
212
which bone does Kohler disease affect?
Navicular bone
213
presentation of Kohler disease and features on X ray?
pain in mid-tarsal region and a limp
| X Ray - dense and deformed bone
214
what is Osgood Schlatter disease?
inflammation of the tibial tuberosity in association with physical overuse - the pain occurs on strenuous activity and contraction of the quadricep
215
what does an X ray show in osgood schlatter disease?
tibial tuberosity enlarged
216
how do you manage osgood schlatter disease?
ice, oral anti-inflammatories, physio
217
what is a slipped femoral epiphysis?
displacement through the growth plate - the epiphysis slips down
218
presentation of a slipped femoral epiphysis?
50% patients obese
follows minor trauma - limp and groin pain
LIMITED flexion/abduction/medial rotation
219
how do you investigate a slipped femoral epiphysis?
AP X ray of the hip
| frog leg X ray
220
how do you approach newborn resuscitation?
1. Dry baby and keep warm
2. Assess tone/RR/HR
3. if gasping/not breathing --> 5 inflation breaths
4. reassess chest movements
5. If HR < 60bpm --> start compressions and ventilation breaths at a ratio of 3:1
221
features of a febrile convulsion?
viral infection and raised temperature
seizure lasting <5 mins
tonic-clonic
222
Mx of a febrile convulsion?
rectal diazepam, antipyretic
223
what are the 4 areas of development that we assess?
social
gross motor
fine motor and vision
speech and hearing
