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Paeds Flashcards

1
Q

Presentation of osgood schlatter disease?

A

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

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2
Q

Presentation of chondromalacia patellae? (also called patellar pain syndrome?

A

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

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3
Q

Immediate management of croup?

A

all children with mild, moderate, or severe croup should receive a single dose of oral dexamethasone (0.15 mg/kg body weight)

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4
Q

Different presentations of septic arthritis vs transient arthritis?

A

Septic arthritis severely restricted joint movement, high temp and complete inability to weight bear

Transient - low grade temp, can weight bear

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5
Q

Presentation of bronchiolitis?

A

coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory crackles (not always present)
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

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6
Q

Management of bronchiolitis?

A

Management is largely supportive
humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
suction is sometimes used for excessive upper airway secretions

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7
Q

Features of (male) fragile X?

A 
learning difficulties
large low set ears, long thin face, high arched palate
macroorchidism
hypotonia
autism is more common
mitral valve prolapse
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8
Q

When to worry about nocturnal enuresis?

A

5 years or older

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9
Q

Characteristics of innocent murmurs in children?

A 
soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
may vary with posture
localised with no radiation
no diastolic component
no thrill
no added sounds (e.g. clicks)
asymptomatic child
no other abnormality
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10
Q

Doses of IM benzylpenicillin for ?meningococcal sepsis?

A

< 1 year 300 mg
1 - 10 years 600 mg
> 10 years 1200 mg

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11
Q

What virus causes croup?

A

Parainfluenza virus

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12
Q

Pertussis treatment?

A

azithromycin or clarithromycin if the onset of cough is within the previous 21 days

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13
Q

What will indomethacin and prostaglandins do to a Patent ductus arteriosus?

A

Prostaglandins will keep open

Indomethacin will close

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14
Q

Fever referral to Paeds ED in under 3 months? ho0w high does the fever need to be?

A

A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness

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15
Q

features of tetralogy of fallot?

A

ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta

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16
Q

If you were to treat bed wetting what is used ?

A

Desmopressin if >7yrs

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17
Q

Methylphenidate side-effects?

A

abdominal pain, nausea and dyspepsia

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18
Q

When and what are the newborn checks?

A

Newborn

  • Clinical examination of newborn
  • Newborn Hearing Screening Programme e.g. oto-acoustic emissions test
  • Give mother Personal Child Health Record

First month
- Heel-prick test day 5-9 - hypothyroidism, PKU, metabolic diseases, cystic fibrosis, medium-chain acyl Co-A dehydrogenase deficiency (MCADD)

Midwife visit up to 4 weeks

Following months

  • Health visitor input
  • GP examination at 6-8 weeks
  • Routine immunisations

Pre school
- National orthoptist-led programme for pre-school vision screening to be introduced

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19
Q

Rule re inheritance of congenital conditions?

A

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

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20
Q

What is genetic anticipation? What disorders are affected?

A

Trinucleotide repeat disorders tend to have earlier onset in subsequent affected generations.

Huntington’s disease and Myotonic dystrophy

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21
Q

Presentation of measles?

A

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

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22
Q

Presentation of mumps?

A

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

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23
Q

Presentation of rubella?

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day

Lymphadenopathy: suboccipital and postauricular

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24
Q

Presentation of Erythema infectiosum?

A

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

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25
Presentation of scarlet fever?
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci Fever, malaise, tonsillitis 'Strawberry' tongue Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
26
Presentation of hand foot and mouth disease?
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
27
What does parovirus case?
Erythema infectiosum
28
What does coxsackie virus cause?
Hand foot and mouth
29
Is head banging normal in children?
<3yrs yes if above - should have ASD assessment
30
Hand preference abnormal below what age?
Abnormal below 12 months
31
Patau syndrome presentation?
Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions
32
Edwards syndrome presentation?
Micrognathia Low-set ears Rocker bottom feet Overlapping of fingers
33
Fragile X presentation?
``` Learning difficulties Macrocephaly Long face Large ears Macro-orchidism ```
34
Noonan syndrome presentation?
Webbed neck Pectus excavatum Short stature Pulmonary stenosis
35
Pierre robin syndrome presentation?
Micrognathia Posterior displacement of the tongue (may result in upper airway obstruction) Cleft palate
36
Prader willi syndrome presentation?
Hypotonia Hypogonadism Obesity
37
Williams syndrome presentation?
``` Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis ```
38
Cri du chat syndrome (chromosome 5p deletion syndrome) Presentation?
Characteristic cry (hence the name) due to larynx and neurological problems Feeding difficulties and poor weight gain Learning difficulties Microcephaly and micrognathism Hypertelorism
39
Most common congenital heart disease for cyanotic and acynaotic (separately)?
Cyanotic: TGA most common at birth, Fallot's most common overall Acyanotic: VSD
40
Most common presentations of wilms tumour?
abdo mass
41
When do you get physiological jaundice?
Physiological jaundice develops 2-3 days post-delivery and should resolve by 14 days Within the first 24 hours is always pathological
42
Levels of bilirubin in physiological jaundice?
<100
43
Features of kawasaki's disease?
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics conjunctival injection bright red, cracked lips strawberry tongue cervical lymphadenopathy red palms of the hands and the soles of the feet which later peel
44
How to calculate down syndrome risk in increasing age?
1/1,000 at 30 years then divide by 3 for every 5 years
45
When are women offered the pertussis vaccine in pregnancy?
16-32 weeks
46
What does the heel spot test test for?
``` congenital hypothyroidism cystic fibrosis sickle cell disease phenylketonuria medium chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria (pyridoxine unresponsive) (HCU) ```
47
If a baby didn't have the heel spot test then what test would you use for CF?
Sweat test
48
Risks of undescended testes?
increased risk of infertility, torsion and testicular cancer
49
Management of undescended testes
Unilateral undescended testis NICE CKS now recommend referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age Orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age Bilateral undescended testes Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
50
What is the most common cardiac abnormality associated with downs?
AVSD
51
How would a PDA present ?
``` left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat ```
52
In terms of brisk stacking what ages should you be able to do what?
15 months Tower of 2 18 months Tower of 3 2 years Tower of 6 3 years Tower of 9
53
What age should a baby have a palmar grasp?
5-6 months
54
What age do you correct hypospadius?
12 months
55
What babies are at risk of Vit K deficiency?
Breast-fed babies are particularly at risk as breast milk is a poor source of vitamin K. Maternal use of antiepileptics also increases the risk
56
R/F for surfactant lung disease? (RDS)
male sex diabetic mothers Caesarean section second born of premature twins
57
What drug for threadworm?
mebendazole Treat whole household
58
When should kids be able to sit without support?
7-8 months
59
What is Kallman's syndrome?
Kallman's syndrome is a cause of delayed puberty secondary to hypogonadotrophic hypogonadism
60
Inheritance pattern of haemophilia A?
X linked recessive
61
What are the common causative organisms of meningitis in newborns (or recently born)?
Group b strep - usually acquired from mother
62
What is trisomy 18?
Edwards (rocker bottom feet)
63
What is trisomy 21?
Downs
64
What is trisomy 13?
Patau
65
Xray finding in Transient tachypnoea of the newborn?
hyperinflation and fluid in the horizontal fissure
66
How does Osteochondritis dissecans present>
Pain after running intermittent swelling and locking
67
How does Patellar subluxation present?
Medial knee pain due to lateral subluxation of the patella | Knee may give way
68
How does patellar tendonitis present?
More common in athletic teenage boys Chronic anterior knee pain that worsens after running Tender below the patella on examination
69
Difference in exomphalos and gastroschisis?
Exomphalos - the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum. Gastroschisis - a congenital defect in the anterior abdominal wall just lateral to the umbilical cord. gastroschisis tends to be a stand alone bowel condition, exomphalos is associated with cardiac and kidney diseases
70
Advice for fluids in enuresis?
Do not restrict fluids. The child should have about eight drinks a day, spaced out throughout the day, the last one about 1 hour before bed.
71
Carrier rate for CF gene in UK?
carrier rate is 1 in 25
72
First sign of puberty in boys and girls?
Boys: first sign is testicular growth at around 12 years of age (range = 10-15 years) testicular volume > 4 ml indicates onset of puberty Girls: first sign is breast development at around 11.5 years of age (range = 9-13 years)
73
Normal changes in puberty (that may seem pathological?)
gynaecomastia may develop in boys asymmetrical breast growth may occur in girls diffuse enlargement of the thyroid gland may be seen
74
What do APGAR scores represent?
A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state
75
Comression to breaths ratio in PLS?
15:2
76
Management of kawasaki disease?
1. high-dose aspirin 2. intravenous immunoglobulin 3. echocardiogram is used as the initial screening test for coronary artery aneurysms
77
When do umbilical hernias resolve?
By 3, refer after this
78
At what age do the majority of children achieve day and night time urinary continence?
3-4
79
RF for DDH?
``` female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity ```
80
When should a child be able to hop on one foot?
4 years
81
When should a child be able to squat to pick up a ball
18 months
82
When should a child be able to pull to stand?
9 months
83
How long off school for mumps?
excluded from school for 5 days from the onset of swollen glands
84
Inheritance pattern of CF?
x linked recessive
85
Most common cause of hypothyroidism in children?
autoimmune thyroiditis.
86
Example of a mild steroid?
Hydrocortisone 1%
87
What is in dermovate, is it potent or mild?
Clobetasone and it is potent
88
Most common cause of primary headaches in children?
Migraine
89
First line treatment for paediatric migraines?
Ibuprofen
90
How would CCF present in Neonates?
poor feeding, shortness of breath, hepatomegaly
91
What organism causes acute epiglottitis?
Haemophilus influenzae
92
Common referral ages for different issues in development?
doesn't smile at 10 weeks cannot sit unsupported at 12 months cannot walk at 18 months
93
What is the triad of haemolytic uraemic syndrome?
acute kidney injury microangiopathic haemolytic anaemia thrombocytopenia
94
What is the most common cause of HUS in children?
E.coli - enterotoxins

MSRA (22 decks)

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