Paeds Flashcards
1
Q
does malrotation of the gut present with non-bilious or bilious vomiting?
A
bilious
2
Q
what is a patient education measure that can be advised to prevent gastroenteritis in bottle-fed infants?
A
proper sterilisation for the bottle caps
3
Q
what is a serious complication of gastro-oesophageal reflux?
A
aspiration - chronic cough, pneumonia
4
Q
what are the management steps for GOR?
A
Conservative - positioning tips while feeding, feed thickeners
Medical - prokinetics (erythromycin), antacids, H2 antagonist, PPIs
5
Q
what is recommendation for volume of milk to be taken every day for infants?
A
150 - 180 mL/kg/day
6
Q
what should be counciled and investigated upon discovery of duodenal atresia?
A
Down’s syndrome. 1/3rd of DA have trisomy 21
7
Q
what is the diagnostic test for Meckel’s diverticulum and how does it work?
A
technetium-99m scan
radiolabel only taken up by gastric type mucosa. Meckel’s diverticulum has ectopic gastric and pancreatic tissue, so a signal will alight in the right illiac fossa confirming the diverticular tissue
8
Q
what is the treatment for lead poisoning?
A
ETDA chelation of lead
9
Q
what is missing is Hirschprung disease?
A
the parasympathetic myenteric nervous plexus from a portion of the bowel
10
Q
an infant with CF has not passed stool within 48 hours of birth.
what is the diagnosis and treatment?
A
meconium ileus
gastrograffin enema initially, then the rest of CF treatment under specialist
11
Q
what is the link between temperature and likelihood of fits in febrile convulsions?
A
lowering temperatures does not prevent seizures
HOWEVER still advise to keep temperatures down for wellbeing/comfort of child
12
Q
what safety precautions should be given to parents of children with febrile convulsions?
A
Advise to call 999 if seizure lasts >5 minutes
rescue therapy with rectal diazepam or buccal midazolam can be supplied.
13
Q
what is the relationship between febrile convulsions and epilepsy?
A
same background risk of developing epilepsy (1-2%) but increased if they become complex seizures (4-12%)
14
Q
what are the differential diagnoses to consider with headache in children?
A
migraine, tension, SOL, medication induced, infection (meningitis, encephalitis)
15
Q
what are the red flags for headache?
A
- Sudden onset, severe headache
- Headache lasting several days or progressing in severity
- Weight loss
- Associated with straining, e.g. coughing, or increased by lying down
- Morning headache, especially associated with vomiting
- Seizures or focal neurology
16
Q
define status epilepticus
A
seizure lasting for more than 30 minutes or repeated fits without resolution of post-ictal state for more than 30 minutes
17
Q
what is the prescription for BZDs to terminate a seizure?
A
at 5 mins without spontaneous resolution
PO lorazepam 0.1 mg/kg or buccal midazolam 0.3 mg/kg
18
Q
after how long of a seizure do you move onto phenytoin?
A
15 mins
19
Q
what is a common complication of resolving bacterial meningitis?
A
deafness as pus drains through the auditory meatus and damages CN VIII
20
Q
what is a prophylactic medication given to children with recurrent brochiolitis?
A
pavilizumab, biological anti-RSV
21
Q
what symptoms should you advise parents to look out for as safety net on discharge after bronchiolitis?
A
- ^WOB
- fluid intake 50–75% of normal/no wet nappy for 12 hours
- apnoea or cyanosis
- exhaustion (e.g wakes only with prolonged stimulation)
22
Q
what is the bug implicated in croup?
A
parainfluenza virus
23
Q
- Upper respiratory tract infection (coryza, fever) 2 days before onset of cough
- Characteristic barking cough (‘sea lion’)
- Stridor (subglottic inflammation and oedema)
- Symptoms start, and are worse at night.
what is the diagnosis?
A
croup
24
Q
what are three dangerous differentials to rule out in croup/URTI history?
A
epiglottitis
inhaled foreign body
anaphylaxis
25
what is the management of mild croup?
outpatient, single dose PO dexamethasone 0.15 mg/kg
26
what is the medical management of moderate/severe croup?
PO/IV **dexamethasone** 0.15 mg/kg single dose
*or*
PO **prednisone** 1-2 mg/kg single dose
once arrived at hospital - nebs **budesonide** 2 mg
after 30 mins if further medication required
nebs **adrenaline** 0.4 mg/kg of 1:1000; max 5 mg
27
what steps should be taken if an inhaled foreign body is seen in the back of the oropharynx that causes respiratory distress?
CALL FOR SENIOR HELP IMMEDIATELY and prepare instruments for cricothyroidotomy. Do not put your fingers in their mouth.
28
what are the PEF thresholds for moderate, severe, life threatening asthma exacerbations?
\>50 % - moderate
\<50 % - severe
\<33 % - life threatening
29
in under 5 year olds with SpO2 \<92 %, what clinical features suggest life threatening asthma exacerbation?
* silent chest
* poor respiratory effort
* agitation
* altered consciousness
* cyanosis
30
what is the medical therapy for asthma exacerbation?
* Nebulised **salbutamol** back to back
* Consider **ipratropium** bromide if unresponsive
* Consider **malgnesium** sulfate if presenting with sats \<92%
* **Steroid** therapy for 3 days
* Consider **IV salbutamol** in severe asthma if no response
* Consider **aminophylline** in severe to life threatening if unresponsive
* Discharge when stable, PEF \>75% and sats \>99%
31
what is the management of dehydration following diarrhoea or vomiting?
## Footnote
*not shock*
\<5yrs give 50 ml/kg low osmolarity ORS over 4 hours, + ORS solution for maintenance
\>5yrs 200ml ORS after each loose stool + Normal fluid intake
32
what cheap stool test will inform you about post-gastroenteritis lactose intolerance?
stool pH \<6.0
*or*
reducing sugars
33
what differentials should be considered in a child with metabolic acidosis?
1. DKA
2. HONK/HHS
3. lactic acidosis
4. starvation ketosis
5. uraemic acidosis
6. ethylene glycol/methanol poisoning
7. salicylate poisoning
34
what is the bolus fluid challenge given for children with DKA?
IV 0.9 % saline 10 ml/kg
up to 3x as directed by specialist
35
what is the equation for fluid requirement in children?
Fluid req = maintenance + estimated deficit - bolus given
(100/50/20 ml/kg in 24hrs) + (% dehydration x weight)\*1000 - (20/10 mg/kg)
36
what is the potassium chloride requirement for normal fluid maintenance?
20 mL KCl in 500 mL fluids
37
what is the insulin requirement IV for a patient in DKA until stable?
when do you start and stop IV insulin?
0.1 U/kg/hr
## Footnote
Start after 1 hour of IV fluids have run
Do not stop until 1 hour after subcut insulin begins
38
what is the electrolyte abnormality from vomiting you would expect?
hypochloraemic, hypokalaemic metabolic alkalosis
39
what is the diagnostic, supportive and definitive management of pyloric stenosis
Diagnosis is made on **USS**
Initially correct **dehydration**
Definitive treatment with **Ramstedt’s pyloromyotomy**
40
what are the common causes of constipation in children (\>6 months)
* Simple constipation
* Short-segment Hirschprung’s diseae (can present late)
* Neuromuscular disorders (e.g. cerebral palsy)
* Hypothyroidism
* Coeliac disease
* Food allergies (non-IgE mediated)
* Anal fissure
41
what are the red flag symptoms of constipation?
* Symptoms started within first few weeks of life
* Passage of meconium \>24h
* Faltering growth
* Delayed walking or lower limb abnormal neurology (cerebral palsy)
* Distension of abdomen and or vomiting
* Child protection concerns
42
what are the steps in acute management of constipation?
1. osmotic laxative - movicol//lactulose/docusate
2. stimulant laxative - senna
3. phosphate enema - traumatic, avoid in under 2 y/o
4. super specialist surgical referral
43
what are the differentials for a slow walker? (20 months)
constitutional delay
global delay
motor cortex injury
neuromuscular disorder
spinal cord lesions (spina bifida)
44
what causes for limp are considered between 0 - 3 years?
trauma
infection: septic and reactive, osteomyelitis, discitis
malignancy
developmental dysplasia of the hip
NMD
45
what causes for limp are considered between 4 - 10 years?
Trauma
specials: transient synovitis, Perthe's disease, JIA
infection: septic and reactive, osteomyelitis, discitis
malignancy: Ewing, osteosarcoma, lymphoma
NMD
46
what causes for limp are considered between 10-18 years?
Trauma
specials: SUFE, JIA
malignancy: Ewing, osteogenic sarcoma
infection: septic and reactive, osteomyelitis, discitis
47
when is Perthes disease most common?
4-8 years old
48
monoarthralgia + fever and severely reduced ROM
septic arthritis
49
monoarthralgia + recent cold
reactive arthritis
50
monoarthralgia + easy bruising
haemophilia
51
monoarthralgia + chronic pain and swelling
juvenile idiopathic arthritis
52
53
what skin condition is associated with COCP use?
erythema nodosum
54
what is the most common aetiology for erythema multiforme?
infection
mycoplasma, coxsackievirus, echovirus, , adenovirus, herpes (HSV-1/2, VZV, EBV, CMV) viral hepatitis, HIV, salmonella, TB, typhoid, dermatophytes
55
how do you best tell Noonan syndrome from Turner syndrome?
pulmonary stenosis and mental retardation (present in Noonan)
56
egg hypersensitivity is a contraindicaiton to what vaccines?
influenza and yellow fever
## Footnote
**MMR may still be given**
57
what is the minimum CD4+ count for children with HIV to receive live attenuated MMR vaccine?
\<6 years old and \>6 years old
\<6 = 500/mcL
\>6 = 200/mcL
58
what is the diagnostic criteria for Kawasaki disease?
\>5 days fever
+ at least four of:
1. conjunctivitis
2. orocutaneous erythema
3. peripheral skin involvement (palms and soles)
4. cervical lymphadenopathy
5. polymorphous rash
+ absence of another diagnosis that *could* explain findings
59
jaundice does not have to be investigated when what criteria are met?
1. no jaundice in the first 24 hours of life
2. baby is clinically well
3. bilirubin remains under treatment level
4. jaundice resolves by 14 days
60
what investigation is needed following a non-febrile seizure in a child?
12-lead ECG
MRI only indicated in repeat seizures, refractory epilepsy or evidence of focal neurology
61
what are the first line treatments for absence seizures in the UK?
valproate and lamotrigine
62
what are the causal organisms of septic arthritis in children?
staph aureus, strep spp. HiB
63
what are some factors that increase or decrease the likelihood of surfactant deficiency in preterm babies?
**increases** the likelihood
* male gender
* maternal diabetes
* second twin
* elective CS
**Decreases** the likelihood
* female gender
* prolonged ROM
* maternal opiate use
* IUGR
* antenatal steroids
64
which vaccines should and should not be given in HIV?
SHOULD give - MMR, 5 in 1
SHOULD NOT give - yellow fever, BCG
65
what vaccinations are given at 8 weeks?
5 in 1
PCV
Men B
Rotavirus
66
what vaccinations are given at 12 weeks?
5 in 1
Rotavirus
67
what vaccines are given at 16 weeks?
5 in 1
PCV
MenB
68
what vaccines are given at 1 year?
MMR
Hib booster
PCV booster
MenB/C
69
what vaccines are given at 3 years 4 months?
MMR
DTaP/IPV
70
what vaccines are given at 12-13 years old?
HPV quadravalent
repeated 6-24 months apart
71
what vaccines are given at 14 years?
tetanus, diptheria and polio (Td/IPV)
MenAWCY
72
what is the timeline for undescended testicle management?
\<3 months old - review at 3 months old
3 months old - if undescended, refer to paediatric surgeon
must be reviewed by specialist before 6 months old
73
what are the first steps in management of nocturnal enuresis for all children?
* look for possible **underlying causes/triggers** (e.g. Constipation, diabetes mellitus, UTI if recent onset)
* advise on **fluid intake, diet and toileting behaviour**
* **reward systems** (e.g. Star charts). NICE recommend these 'should be given for agreed behaviour rather than dry nights' e.g. Using the toilet to pass urine before sleep
74
following initial management, what is the next step for nocturnal enuresis in children younger than 7 years old?
always try enuresis alarm
75
at what age is nocturnal enuresis supposed to be normal until?
5 years old
76
episodic crying and drawing of the legs towards the chest
suggests what?
intussusception
77
what is the natural history of HHV-6, roseola infantum?
3-5 days high fever
2 days maculopapular rash
rash starts on chest and spreads to arms and legs
78
risk factors for NRDS besides prematurity
(4)
* male sex
* diabetic mothers
* Caesarean section
* second born of premature twins
79
what are the signs of 'moderate croup' that would prompt admission for observation?
* Frequent barking cough
* Easily audible stridor at rest
* Suprasternal and sternal wall retraction at rest
80
what layer is filled with fluid in a hydrocele?
tunica vaginalis
81
what investigation is indicated in hydrocele?
USS testicle to make sure the hydrocele isn't secondary to any underlying pathology
82
how do you diagnose varicocele?
USS - venous dilatation of pampiniform plexus \>2 mm
83
what is the treatment of varicocele?
conservative - supportive underwear
interventional - radiological ablation of testicular vein
surgical - ligation and division of testicular veins
84
what is Prehn sign?
relief of pain on elevation of the testes - clinical diagnosis of epididymo-orchitis
85
what is the treatment of epididymo-orchitis
abx - oral ciprofloxacin for 6 weeks
86
pitted teeth and metabolic alkalosis...
diagnosis?
bulimia
87
what is the treatment of quincy?
peritonsillar abscess caused after tonsilitis
abx - penicillin
6 weeks after resolution should perform tonsillectomy
88
what antifungals can you use to treat oral/oesophageal candidiasis?
fluconazole, nystatin or amphotericin
89
what are the skin lesions of TB?
erythema nodosum
lupus vulgaris (nodular, painful, disfiguring lesions, primarily on the face)
90
what is the treatment of pyelonephritis in children?
sepsis six, sending blood cultures **before** beginning treatment
7-10 days **oral cephalosporin** if they are able to take oral meds
if not, start on IV meds then switch to oral when possible
91
what is the treatment of cysitis in a child?
MSU MC&S
Urine dip
3 days of oral cephalosporin, trimethoprim, co-amoxiclav
92
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
chickenpox
93
Prodrome: irritable, conjunctivitis, fever
white spots ('grain of salt') on buccal mucosa
Rash starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
measles
94
Fever, malaise, muscular pain
'earache', 'pain on eating': unilateral initially then becomes bilateral in 70%
mumps
'earache' is actually parotitis
95
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
rubella
96
Lethargy, fever, headache
facial rash spreading to proximal arms and extensor surfaces
parvovirus B19 - fifth disease - erythema infectiosum
97
Fever, malaise, tonsillitis
'Strawberry' tongue
fine punctate erythema sparing face
scarlet fever
98
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
coxsackie A16 - hand, foot and mouth
99
what are the centor criteria?
1. exudate
2. no cough
3. fever
4. tender cervical lymphadenopathy/lymphadenitis
if 3-4 is scored, 50% chance of GABHS tonsilitis. treat
100
what are the antibiotic treatment options for GABHS tonsilitis?
analgesia with paracetamol regular
abx **phenoxymethylpenicillin**/**clarithromycin** if pen-allergic
101
what are the infection control steps of scarlet fever?
notifiable disease
children should return to school 24 hours after starting abx
102
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
Pierre Robin syndrome
103
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Noonan syndrome
104
Hypotonia
Hypogonadism
Obesity
Prader-Willi syndrome
105
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
William's syndrome
106
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Cutis aplasia
Patau syndrome
107
what is the ratio of compressions to ventilation in neonatal resus?
give 5 ventilation breaths at first then reasses
if heartrate is not picking up/spontaneous return of breathing...
3 to 1 (compressions to ventilation)
108
what are the components of Apgar score?
pulse, respiratory effort, colour, muscle tone, reflex irritability
109
apgar score
pulse breakdown
\>100 = 2
\<100 = 1
pulseless = 0
110
apgar score
respiratory effort breakdown
strong, crying = 2
weak, irregular = 1
nil = 0
111
apgar score
colour breakdown
pink all over = 2
body pink, extremities blue = 1
blue all over = 0
112
apgar score
muscle tone breakdown
active movement = 2
limb flexion = 1
flaccid = 0
113
apgar score
reflex irritability breakdown
cries/sneezes/coughs on stimulation = 2
grimace = 1
nil = 0
114
what is the most common age to get croup?
6 months - 3 years
115
what should always be done for an infant younger than 3 months old with a fever?
* refer to specialist
* blood culture
* FBC
* CRP
* urine dip, MC&S
* CXR if chest signs
* stool culture if diarrhoea
116
what are the different antibiotic options for hospital aquired pneumonia?
Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
117
what is the visual field defect in craniopharyngioma?
bitemporal inferior quadrantanopia
118
what is the finding for NEC on AXR?
gas cysts in bowel wall
119
3 main differences between mild and moderate croup
stridor at rest
little distress but can be placated with toys
suprasternal/intercostal recessions
120
what is the difference in management between mild or moderate croup?
none - all children get single dose 0.15 mg/kg dexamethasone PO regardless of severity
121
what is the treatment for nephrogenic DI?
thiazide diuretic
122
what are the admission criteria for bronchiolitis?
apnoea (witnessed or reported)
off oral fluid intake \>50%
RR \>60
SpO2 \<92%
123
allergy to neomycin is a contraindication to which vaccines?
MMR
124
what type of bilirubin can cause kernicterus?
what are the consequences of kernicterus?
only unconjugated
deafness, chorioathetoid cerebral palsy
125
what is Kasai procedure?
indicated in biliary atresia
protoenterostomy - joining CBD/hepatic duct to the duodenum allowing drainage of bile
126
neonatal intraventricular haemorrhage is most associated with which type of cerebral palsy?
spastic diplegic
127
managing UTI
infant \<3/12
refer to hospital immediately
128
managing UTI
upper UTI, child \>3/12
consider admission
if not, oral abx such as cephalosporin or co-amoxiclav for 7-10 days
129
managing UTI
child \>3/12, lower tract UTI
oral antibiotics such as trimethoprim, nitrofurantoin, cephalosporin or amoxicillin for 3 days
safety net by telling parents to retun in 24-48 hours if the child doesn't feel better
130
after how many childhood UTIs do you consider giving antibiotic prophylaxis?
after the 2nd
131
what dietary advice would you give to help in uncontrollable childhood epilepsy?
Ketogenic diet
low carb, high protein, high fat
132
what other conditions are linked to epilepsy?
cerebral palsy (30% will have epilepsy)
mitochondrial disorders
tuberous sclerosis
133
A 2-month-old baby girl is admitted to hospital with suspected meningitis. Her parents describe her becoming pyrexial and drowsy over the past 24 hours. On examination her temperature is 39.2ºC, heart rate is 160/min and respiratory rate is 50.min. Her anterior fontanelle is bulging. No petechial rash is seen. In addition to cefotaxime, what antibiotic should be given intravenously?
amoxicillin to cover *Listeria*
134
what are the antibiotics are indicated for *bordetella pertussis*?
macrolides (clarithromycin, azithromycin)
135
what is the does of IM adrenaline to give to children of different ages in anaphylaxis?
0-6 months = **0.15 mL** of 1 in 1,000
6 mo-6 years = **0.15 mL** of 1 in 1,000
6-12 years = **0.3 mL** of 1 in 1,000
adult and \>12 years = **0.5mL** of 1 in 1,000
136
what is the name for a low-pitched murmur heard at the lower left sternal border in children?
still's murmur
137
what is the name for the continuous blowing sounds heard below the clavicles in children on auscultation?
venous hums
138
at what age do you usually get Perthe's disease?
4-8 years old
139
what diseases are screened for on the heel-prick test?
when does this happen?
5-9 days old
PKU, hypothyroidism, MCADD, cystic fibrosis, inherited metabolic diseases
140
IgA nephropathy (Berger's disease) is nephritic or nephrotic syndrome?
nephritic, similar presentation to RPGN/alport syndrome
141
which are the live attenuated vaccines?
MMR
BCG
oral polio
yellow fever
oral typhoid
142
what is laryngomalacia?
congenital malformaiton of the epiglottis
presents at 2-4 weeks old with stridor and poor feeding
should resolve on its own but if stridor is bad and breathing difficult then surgery may be performed to improve the airway
143
a mother is given labetalol for high BP
what should be monitored in the baby after it is born?
measure BM, baby at increased risk for neonatal hypoglycaemia
144
at what age do children start to respond to their own name when called?
12-15 months
145
at what age to children begin to talk in full sentances (3-6 words)?
3 years old
146
what is the treatment for mesenteric adenitis?
reassurance and discharge
147
what are the causative organisms for bacterial conjunctivitis in children?
* haemophilus influenzae*
* streptococcus pneumoniae*
148
what advice do you give for staying off school for children with hand, foot and mouth disease
no need to stay off school if the child feels well
149
what are the outcome statistics for enuresis alarms?
2/3rd children acheive cure within 3-5 months
50% remain cured after stopping the alarm
can always bring the alarm back
150
what are the medical explanations for childhood obesity? (5)
other than lifestyle factors, which are by far the most common reasons
growth hormone deficiency
down's syndrome
hypothyroidism
prader-willi
cushing's syndrome
151
no earlier than ______ should hand preference develop
12 months
152
what is the treatment and prognosis of HSP?
analgesia for the arthralgia
steroids/immunosuppression have inconsistent evidence
prognosis excellent - generally self-limiting disease
caution in children with pre-existing renal disease
around 1/3rd will relapse
153
school exclusion for whooping cough?
5 days from starting antibiotics
154
school exclusion for roseola infantium?
no exclusion
155
school exclusion for D&V?
until symptoms have settled for 12 hours
156
what is the advice for newborn children with conjunctivitis with exudate, other than possible antibiotic therapy?
wash out the eyes with cooled, boiled tap water 4 times per day
157
what is the definition of JIA?
what are the classifications of JIA?
arthritis before age 16, persisting for \>6 weeks with no other cause identified
* systemic JIA
* oligoarticular JIA
* polyarticular JIA
* enthesitis-related JIA
* psoriatic arthritis
158
what is the criteria for oligoarticular JIA?
=\<4 joints affected, RF-negative
associated with high ANA and risk of uveitis
159
what are the features of polyarticular JIA?
\>4 joints affected, older girls, RF-positive
C spine and temporomandibular joints often affected
160
at what GCS must a CT head be ordered for children \>1 year old and \<1 year old (paediatric GCS)?
\>1 year old - \<14...
\<1 year old (infant) - \<15...
...on assessment in A&E
After 2 hours, if GCS is \<15 in either then send for CT
161
what signs of trauma in the head would prompt CT scan? (5)
racoon eyes/Battle sign
skull bone depression
tense fontanelle
haemotympanum
CSF drip from nose or ear
162
what is this?
Battle sign - indication of basal skull #
send for CT w/o contrast
163
how many episodes of vomiting after head trauma is an amber flag for CT head?
3 or more discrete episodes
164
what duration of amnesia should be an amber flag for CT head?
\>5 minutes
anterograde or retrograde
165
what duration of loss of consciousness should be an amber flag for head CT?
\>5 minutes
166
what are the indications for antibiotic use in acute otitis media?
child \<2 years old
associated perforation of ear drum, otorrhoea/discharge
167
roughly at what age can children be asked to do a PEFR?
about 5
168
what are Brushfield spots?
white spots seen in the iris of Downs sydnrome patients
169
what is hypertelorism and in what condition is it mostly seen?
increased space between the eyes
foetal alcohol syndrome
170
other than short stature, what are the features of growth hormone deficiency?
doll-like face
neonatal hypoglycaemia and jaundice
delayed bone age
growth restriction does not present until 6-12 months old
171
what is the mechanism of short stature in Cushing disease?
premature fusion of the growth plates/advanced bone age
172
how do you get a bone age?
radiograph of carpal bones, scoring the ossification centres and caculating the age
173
what are the components of the traffic light system of identification in children with fever?
colour
activity
breathing
circulation/hydration
other
174
what is the definition of delayed puberty in boys and girls?
boys - \>14 years
girls - \>13 years
OR - failure to progress for \>2 years
175
how do you classify the causes of pubertal delay?
hyper-/hypo-gonadotrophic
176
what are some examples of hypergonadotrophic hypogonadism?
turner syndrome/kleinfelter syndrome
surgery, radiation, chemotherapy damaging the gonads
androgen/oestrogen resistance
177
what are some examples of hypogonadotrophic hypogonadism?
kallmann syndrome (with anosmia and developmental delay)
chronic illness (CF, asthma, Crohn's, **anorexia**)
HPA damage - panhypopituitism, hypothyroidism, CNS tumour
178
describe benign rolandic epilepsy
7-10 years old
male
twitch at corner of mouth, spreads to ipsilateral cheek and face
drooling, grunting and slurred speech
mostly happens at night
will grow out of it by adolescence
179
a symmetrical jerking of arms and legs in teenagers
most likely in the morning
precipitated by alcohol
progress to generalised seizures
juvenile myoclonic epilepsy
180
what pharmacotherapy is used in congenital heart disease in infancy?
what is the purpose of medical management?
thiazide diuretics and ACE-I
improve outcome by limiting growth restriction until child is big enough to tolerate surgery
181
what age do children frequently get breath holding attacks?
as toddlers
start: 6-18 months
finish: 4-5 years
182
what is the frequency of acute renal failure in HSP?
1%
183
a rash develops after streptococcal infection
what are the two differentials to be considered?
scarlet fever
guttate psoriasis
184
what antiepileptic medication should be avoided in absence seizures?
carbamazapine
185
what are the ages for children to build block towers of:
2
3
6
9
.. blocks?
2 - 15 mo
3 - 18 mo
6 - 2 years
9 - 3 years
186
what %age of retinoblastoma cases are hereditary?
10%
187
what are the age definitions of precocious puberty?
8 for girls
9 for boys
188
first line treatment for intussusception?
rectal air insufflation, followed by surgical correction if that doesn't work
189
what are the side effects of carbamazepine?
**senses** - diplopia, dizziness & ataxia
**neuro** - headache, drowsiness
**systemic** - SJS, leukopenia, agranulocytosis, SIADH, enzyme inducer
190
what is the maintenance fluid eqn for children?
what is a suitable fluid?
100 mL/kg for first 10 kg;
50 mL/kg for 2nd 10 kg;
20 mL/kg thereafter
0.45% normal saline and 5% dextrose
191
what is the prognosis for Peutz-Jaghers syndrome?
50% die from CRC before age 60
192
in what proportion of patients with roseola infantum do febrile convulsions develop?
10-15%
193
what are the treatment options for spasticity in cerebral palsy?
oral diazepam
oral/intrathecal baclofen
botox A
surgery (orthopaedic) or selective dorsal rhizotomy
194
what is the prevalence of cows milk protein intolerance?
3-6% of all bottle fed infants
rarely seen in exclusively breastfed infants too
195
what is the management for meconium ileus?
**think CF**
gastrograffin enema is both therapeutic and diagnostic. if peritonitic, send to theatre for laparotomy
sweat test at 6 weeks to confirm
prophylactic flucloxacillin
196
to confirm a diagnosis, what investigation is suitable for a girl with microcytic monochromic anemia, fussy eater, presenting to hospital today with acute UTI?
nothing at the moment
have to measure ferritin to confirm IDA but is an acute phase reactant, so must wait until she's better then you can measure
197
developmental milestones for fix and follow (90 deg and 180 deg)
90 deg = 6 weeks
180 deg = 3 months
198
management of SIADH
mild, moderate and severe
**mild**: fluid restriction & treat underlying cause
**moderate**: consider ADH antagonist (tolvaptan)
**severe**: + IV hypertonic saline & IV furosemide
199
are growing pains worst in the morning or at night?
at night.
by definition, never present in the morning after the child is woken
200
how would you bring on an absence seizure?
hyperventilation or stress
201
* failure to thrive
* polyuria, polydipsia
* hypokalaemia
* normotension
* weakness
diagnosis?
Bartter's syndrome
202
what age do the primitive reflexes disappear? roughly in what order?
4 months
stepping, moro, rooting then grasping
203
other than prematurity, what are the risk factors for NRDS?
male sex
caesarean delivery
diabetic mother
second of twins
