Paeds Flashcards
(198 cards)
1
Q
What kind of murmur does ASD have?
A
Ejection systolic
Left upper sternal edge
Fixed splitting of S2
2
Q
What kind of murmur does VSD have?
A
Pan-systolic
Left lower sternal edge
3
Q
What kind of murmur does PDA have?
A
Continuous machinery-like murmur
4
Q
What kind of murmur does coarctation of the aorta have?
A
Mid-systolic murmur
Radiates to back
Radio-femoral delay
5
Q
What kind of murmur does Pulmonary stenosis have?
A
Ejection systolic
Louder on inspiration
6
Q
What kind of murmur does aortic stenosis have?
A
Ejection systolic
Louder on expiration
7
Q
What kind of murmur does mitral regurgitation have?
A
Pansystolic murmur
High pitched blowing
8
Q
What kind of murmur does tricuspid regurgitation have?
A
Pansystolic murmur
Louder on inspiration
High pitched blowing
9
Q
What kind of murmur does aortic regurgitation have?
A
Early diastolic murmur
High pitched blowing
10
Q
What kind of murmur does pulmonary regurgitation have?
A
Early diastolic murmur
High pitched blowing
11
Q
Which murmurs are pansystolic?
A
VSD
Tricuspid regurgitation
Mitral regurgitation
12
Q
Which murmurs are ejection systolic?
A
ASD
Pulmonary stenosis
Aortic stenosis
13
Q
Which murmurs are early diastolic?
A
Pulmonary regurgitation
Aortic regurgitation
14
Q
Pathophysiology of Hirschsprungs?
A
Absence of parasympathetic ganglion cells in the myenteric plexus
15
Q
Red signs for paediatric traffic light system?
A
Colour - mottled/blue/ashen/pale
No response to social cues/does not wake when roused
Weak
Continuous high-pitched cry
Grunting/tachypnoea
<3months with temp >38
Non blanching rash
Seizures
16
Q
Fluid bolus requirements? (Paeds)
A
10mg/kg 0.9% NaCl
17
Q
Maintenance fluids? (Paeds)
A
100mg/kg for 10kg
50 mg/kg for 10kg
20mg/kg for the rest
0.9% NaCl + 5% glucose
18
Q
Organism for hand foot mouth disease?
A
Coxsackie A16
19
Q
Examples of live vaccines?
A
MMR, BCG, chicken pox, NASAL influenza, rotavirus
19
Q
When is newborn blood spot test?
A
5 days
20
Q
Conditions tested for on newborn blood spot?
A
CF, sickle cell disease, congenital hypothyroidism, phenylketonuria, maple syrup urine disease
21
Q
Which vaccines are given at 8 weeks?
A
6-in-1, Rotavirus, Meningococcal B
22
Q
Which vaccines are given at 12 weeks?
A
6-in-1, Rotavirus, Pneumococcal
23
Q
Which vaccines given at 16 weeks?
A
6-in-1, Meningococcal B
24
Which vaccines given at 1 year?
2-in-1, MMR, Meningococcal B, Pneuomoccal
25
When is nasal flu vaccine given?
2-8 years
26
What vaccines given at 3 years 4 months?
4-in-1, MMR
27
When is HPV vaccine given?
13-14 years
28
Which vaccines given at 14 years?
3-in-1, Meningococcal ACWY
29
Which vaccines are in the 6-in-1?
Diptheria
Polio
Pertussis
Tetanus
Hepatitis B
HiB
30
Examples of inactivated vaccines?
Polio, flu
31
Treatment for meningitis in infants >3 months?
IV Ceftriaxone or Cefotaxime
32
Treatment for meningitis in <3 months?
IV Cefotaxime and Amoxicillin
33
By what age does infantile colic usually subside?
6 months
34
Features to be explored in monitoring asthma control?
Pattern of medication use (overuse)
Persistence of symptoms e.g. wheeze/nocturnal cough/reduced physical activity
Involvement of secondary care e.g. HDU/ICU admission
35
Appearance of meningococcal bacteria on microscope?
Gram negative diplococci
36
How long before notifiable disease reported?
Immediately
37
What is glandular fever also known as?
Infectious mononucleosis
38
Causative organism for glandular fever?
Epstein-Barr virus (HHV4)
Other causes - HHV6, CMV
39
Triad of symptoms in glandular fever?
Pyrexia, lymphadenopathy, sore throat
40
How long does glandular fever typically last?
2-4 weeks
41
Glandular fever diagnosis?
Heterophil antibody test (monospot test) in the 2nd week of illness
42
Management of glandular fever?
Supportive
Analgesia
Avoid contact sports for 4 weeks after - risk of splenic rupture
43
What is androgen insensitivity syndrome?
End-organ resistance to testosterone due to X-linked recessive condition
44
How does androgen insensitivity present?
Genetically male 46XY have female phenotype
45
Features of androgen insensitivity syndrome?
'Primary amenorrhoea'
Little or no pubic/axillary hair
Undescended tests -> groin swellings
46
Diagnosis of androgen insensitivity syndrome?
Buccal smear/chromosomal analysis shows XY
After puberty - testosterone concentrations normal to elevated
47
Management of androgen insensitivity syndrome?
Counselling - raise as female
Bilateral orchidectomy
Oestrogen therapy
48
Causes of jaundice in the first 24 hours of birth?
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency
49
Causes of jaundice 2-14 days old?
Common - usually physiological
More RBCs and less developed liver function
Breastfeeding jaundice
50
Causes of jaundice after 14 days?
Biliary atresia
Hypothyroidism
UTI
Breast milk jaundice
Prematurity
Congenital infections
51
What is in a prolonged jaundice screen?
Conjugated and unconjugated bilirubin
Coombs' test
TFTs
FBC and blood film
Urine MCS
U&Es and LFTs
52
Which type of bilirubin causes kernicterus?
Unconjugated bilirubin
53
Which type of bilirubin is high in biliary atresia?
Conjugated
54
What is the APGAR score?
Assess health of newborn baby
55
When is APGAR score assessed?
1 and 5 minutes. Repeated at 10 minutes if low score <7
56
What is assessed in the APGAR score?
Appearance (colour)
Pulse
Grimace (reflex irritability)
Activity (tone)
Respiration (crying)
57
How long excluded from school with hand, foot, and mouth disease?
No need if feel well
58
Gross motor milestones?
2m - lifts head to 45 degrees
6m - pulls to sit/rolls
7-8m - sits up straight
9m - crawls
12m - walking
59
Gross motor milestones for walking, running jumping etc?
Walking - 12 months
Running - 16 months
Jumping - 18 months
Stairs (one at a time) - 2 years
Upstairs normally - 3 years
Downstairs normally - 4 years
60
Fine motor milestones?
6w - tracks objects/faces
3m - reaches for objects
6m - palmar graps
9m - pincer grip
12m - good pincer grip
61
Block building milestones?
12m - 2 blocks
18m - 4 blocks
2y - 8 blocks
3y - bridge
62
Drawing milestones?
18m - scribble
2y - straight lines
3y - circle
4y - square and cross
5y - triangle
63
Speech/hearing milestones?
3m - squeals
6m - babbling
9m - mama/dada
12m - 2-3 words
2y - combine 2 words
2.5y - vocab 200 words
3y - short sentences, who, what?
4y - why, when, how?
64
Social milestones?
6w - smiling
6m - food/objects in mouth
9m - stranger fear
12m - waves bye-bye, drink cup w 2 hands
18m - play alone
2y - parallel play
3y - fork and spoon
4y - play with others
65
Which genetic defect is Down's syndrome?
Trisomy 21
66
Which genetic defect is Edwards syndrome?
Trisomy 18
67
Which genetic defect is Patau syndrome?
Trisomy 13
68
Symptoms of Edwards syndrome?
Rocker bottom feet
Overlapping fingers
Microcephaly
Low set ears
VSD/ASD/ToF
69
Symptoms of Patau syndrome?
Polydactyly
Microcephaly
Cleft lip/palate
Scalp lesions
70
What is Noonan syndrome?
Autosomal dominant condition
'Male Turners'
71
Symptoms of Noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
72
What type on inheritance is Prader-Willi?
Imprinting
73
Symptoms of Prader-Willi?
Obesity
Hypotonia
Hypogonadism
Learning difficulties
74
What is Kleinfelter?
47XXY
Male with additional X chromosome
75
Symptoms of Kleinfelters?
Taller height
Wide hips, gynaecomastia
Small testicles/infertility
76
Management of Kleinfelter?
Testosterone injections
Breast reduction surgery
77
What is Turner's syndrome?
45XO
Female with single X chromosome
78
Symptoms of Turner's?
Short stature
Webbed neck
High arching palate
Broad chest, wide spaced nipples
79
Heart defects in turners?
Coarctation of the aorta
Bicuspid aortic valve
80
Puberty in Turner's?
Primary amenorrhoea
81
What is Fragile X syndrome due to?
Mutation on the X chromosome- trinucleotide repeat
82
Symptoms of Fragile X?
Long, narrow face
Large ears
Large testicles after puberty
Intellectual disability
83
What is Kallman syndrome?
Delayed puberty due to hypogonadotrophic hypogonadism
84
Symptoms of Kallman syndrome?
Male with anosmia
Delayed puberty
Hypogonadism/cryptorchidism
LH/FSH inappropriately low
85
Pattern of inheritance for Kallman?
X-linked recessive
86
Treatment for whooping cough?
Clarithromycin within 21 days of onset
87
Treatment for scarlet fever?
PO Penicillin V for 10 days (phenoxymethylpenicillin)
88
Exclusion criteria for scarlet fever?
24 hours after starting antibiotics
89
Exclusion criteria for whooping cough?
2 days after starting antibiotics or 21 days from onset of cough
90
Exclusion criteria for measles?
4 days from onset of rash
91
Exclusion criteria for rubella?
5 days from onset of rash
92
Exclusion criteria for mumps?
5 days from onset of swollen glands
93
Exclusion criteria for chicken pox?
Until all lesions crusted over
94
Exclusion criteria for impetigo?
Until lesions crusted over or 48 hours after antibiotics
95
Organism causing slapped check?
Parvovirus B19
96
Risk factors for DDH?
Oligohydramnios
Breech presentation
Female
Family history
Macrosomic history
97
Dietary advice for cystic fibrosis?
High calorie, high fat diet w/ enzyme supplementation
98
Electrolyte abnormalities in CAH?
Hyponatraemia, hyperkalaemia
99
Inheritance pattern of CAH?
Autosomal recessive
100
Most common cause of CAH?
21-hydroxylase enzyme deficiency
101
Episodes in ToF with crying turning blue are called?
Hypercyantoic/Tet spells
102
Symptoms of ToF?
Recurrent chest infections
Poor feeding
Breathlessness
103
What is Duchenne muscular dystrophy?
Disorder in the dystrophin genes needed for normal muscle function
104
Duchenne muscular dystrophy inheritance pattern?
X-linked recessive
105
Investigations for Duchenne muscular dystrophy?
Muscle biopsy
Genetic testing
Serum CK
Muscle MRI
106
Management of Duchenne muscular dystrophy?
Supportive - no cure
Medical - corticosteroids
Surgical - correct contractures
Physio
Exercise
Education
Counselling
107
Surgical procedure for biliary atresia?
Kasai procedure/portoenterostomy
108
Which cancers Noonan syndrome increased risk of?
Neuroblastoma (N=N)
Leukaemia
109
Neuroblastoma symptoms?
Abdominal mass
Blueberry muffin rash
Raccoon eyes
Weight loss
Bone pain
110
Management of UTI in <3months?
Refer to paeds
111
Treatment for lower UTI in children and how long?
Nitrofurantoin or Trimethoprim for 3 days
112
Causes of UTI in children other than E. Coli?
Proteus
Klebisella
Pseudomonas
Enterococcus
113
Risk factors for UTI in children?
<1 year
Female sex
Sexual abuse
Immunosuppression
Poor hygiene
Anatomical abnormalities
114
Typical toddler's fracture?
Spiral fracture of the tibia
115
How can unconjugated bilirubin be treated?
Phototherapy
116
What is Caput succedaneum?
Oedema on presenting part of head
117
Common cause of Caput succedaneum?
Ventouse delivery
118
Features of Caput succedaneum?
Soft swelling
Crosses suture lines
Present at birth
(CS = CS = crosses sutures)
119
What is cephalohaematoma?
Swelling on newborn head
120
Possible complication of cephalophaematoma?
Jaundice
121
Features of cephalohaematoma?
Develops hours after birth
Doesn't cross suture lines
Up to 3 months to resolve
122
By what age is it a red flag to not be walking?
18 months
123
Triad of haemolytic uraemic syndrome?
AKI
Microangiopathic haemolytic anaemia
Thrombocytopenia
124
What is Henoch-Schonlein purpura?
IgA mediated small vessel vasculitis
125
Features of Henoch-Schonlein purpura?
Following infection
Purpuric rash - legs, arms, buttocks
Abdo pain
Poly arthritis
IgA nephropathy e.g. haematuria, renal failure
126
What is Immune thrombocytopenia?
Immune mediated reduction in platelets
127
Triad of Immune thrombocytopenia?
Bruising
Rash
Epistaxis/gingival bleeding
128
Findings from Immune thrombocytopenia investigations?
Isolated thrombocytopenia
129
Paediatric NICE amber flags?
Nasal flaring
Lung crackles on auscultation
Not responding normally to social cues
Reduced nappy wetting
Dry mucous membranes
Pallor reported by parent or carer
130
Paediatric NICE red flags?
Moderate or severe chest wall recession
Does not wake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting
131
Findings for Hirschsprung disease?
Rectal biopsy
X-ray: loops of dilated bowel + air/fluid
132
Findings for intestinal malrotation?
X-ray: double bubble sign
Lack of stool in RLQ of colon
133
Sausage shaped mass in RUQ is?
Intussusception
134
Olive lump in upper abdomen is?
Pyloric stenosis
135
Undescended testes increase the risk of which complications?
Testicular torsion
Testicular cancer
Infertility
136
What type of murmur in ToF?
Ejection systolic
137
Causes of bilious vomiting?
Duodenal atresia
Malrotation/obstruction
Hirschsprung
NEC
138
Complications of measles?
Pneumonia
Otitis Media
Encephalitis
139
Which heart defect in Fragile X?
Mitral valve prolapse
140
Which boney prominence affected in Osgood-Schlatter?
Tibial tuberosity
141
Common complication of roseola infantum?
Febrile convulsions
142
Antibiotic choice for mycoplasma?
Macrolide
143
Which movement is lost in SUFE?
Internal rotation of the leg in flexion
144
Features of maternal CMV?
Low birth weight
Purpuric rash
Microcephaly
145
Features of maternal Rubella?
Sensorineural deafness
Congenital cataracts
Congenital heart disease
146
Features of maternal toxoplasmosis?
Cerebral calcification
Chorioretinitis
Hydrocephalus
147
Pyloric stenosis blood gas results?
Hypokalaemia
Hypochloraemia
ELEVATED bicarbonate
148
What are nasal polyps a key feature of?
Cystic fibrosis
149
Features of life threatening asthma?
PEFR <33%
O2 <92%
Silent chest/cyanosis/poor resp effort
Bradycardia, hypotension, dysrhythmia
Exhaustion, confusion or come
150
Features of severe acute asthma?
PEFR 33-55%
Can't complete sentences
RR >25/min
Pulse >110bpm
151
What is the screening tool used for child development?
ASQ-3 (ages and stages questionnaire)
152
Asthma management steps if <5 years?
SABA
SABA + LTRA/ICS (very low dose)
SABA + ICA + LTRA
Increase ICS to low dose
153
Asthma management steps in 5+ years?
SABA
SABA + ICS (very low dose)
SABA + ICS + LABA/LTRA
Consider stopping LABA if no response
154
Nephrotic syndrome triad?
Low albumin
High urine protein
Oedema
Due to permeability of the basement membrane in the glomerulus
155
Causes of nephrotic syndrome and findings?
Minimal change disease
Hyaline casts in urine
156
Nephritic syndrome triad?
Reduced kidney function
Haematuria
Proteinuria
Due to inflammation of nephrons in the kidney
157
Causes of nephritic syndrome?
Post-streptococcal glomerulonephritis
IgA nephropathy
158
Findings for post-strep glomerulonephritis?
Raised anti-streptolysin O titre in blood
159
Findings for IgA nephropathy?
IgA deposits in renal biopsy
160
Drug treatments for neonatal abstinence syndrome?
Cocaine - phenobarbitone IV
Heroin - oral morphine
161
Heart rate for different ages?
<1 - 110-160
1-2 - 100-150
2-5 - 90-140
5-12 - 80-120
>12 - 60-100
162
Respiratory rate for different ages?
<1 - 35-40
1-2 - 25-35
2-5 - 25-30
5-12 - 20-25
>12 - 15-20
163
Red flags for development milestones?
Loss of milestones OR not able to:
Hold object at 5m
Sitting unsupported at 12m
Standing independently at 18m
No words at 18m
No interest in others at 18m
Walking independently at 2y
Not running at 2.5y
164
First management step in managing 'tet spells'?
Calm child and knees to chest position
165
What is seen on an x-ray in bronchiolitis?
Hyperinflation
166
Management of bronchiolitis as an inpatient?
Humidified oxygen
NG feeds
167
Which steroids given PO and IV in acute asthma?
PO prednisolone
IV hydrocortisone
168
Stepwise approach to acute asthma management?
1 - SABA inhalers
2 - Nebulised salbutamol/ipratropium
3 - PO predisolone
4 - IV hydrocortisone
5 - IV magnesium sulphate
6 - IV salbutamol
7 - IV aminophylline
169
What are the ages of delayed/precocious puberty?
No secondary sexual characteristics
Girls = 8/13
Boys = 9/14
170
Tanner staging in girls?
I - no pubic hair/breast dev
II - light/thin hair + breast buds
III - course/curly + elevate beyond areola
IV - adult-like hair not reaching thigh + areolar mound projects
V - hair to medial thigh + areolar mounds reduce, adult breast form
171
Tanner staging in boys?
I - testicular volume <3ml
II - changes in texture to scrotal skin (red and wrinkled), thin/straight hair
III - increase size of penis and testicles (skin darker, more wrinkled) coarse/curly hair
IV - further enlargement with development of glans penis (length and width), adult-like hair not reaching thigh
V - adult size and shape, hair to medial thigh
172
What is given until oedema is resolved in nephrotic syndrome?
Penicillin V
173
Testicular volume by tanner staging?
I - up to 3mL
II - 4-5mL
III - 6-10mL
IV - 11-16mL
V - 17-25mL
174
What is Ramsay Hunt syndrome?
Reactivation of the VZV in ganglion of the seventh cranial nerve
175
Symptoms of Ramsay Hunt?
Auricular pain
Facial nerve palsy
Vesicular rash around the ear
Vertigo/tinnitus
176
Dexamethasone dose for croup?
0.15mg/kg
177
First line management for ADHD in children?
10 week 'watch and wait' period to see if symptoms change or resolve
178
Common cause of haemolytic uraemic syndrome?
Shiga toxins from e coli or shigella
179
What is microangiopathic haemolytic anaemia?
Haemolysis due to pathology in the small vessels (microangiopathy).
Thrombi obstruct the vessels > churn RBCs as they pass through > causing rupture
180
Henoch-Schonlein purpura symptoms?
PAPAH
Purpura - buttocks
Abdominal pain
Poly arthritis
Haematuria
181
Organism causing Scarlett fever?
Strep. pyogenes
182
Impetigo causative organism?
Staph aureus (sometimes strep. pyogenes)
183
Impetigo treatment?
Hydrogen peroxide/fusidic acid
Flucloxacillin if extensive
184
Presentation of measles?
Rash from behind ears > body
Koplik spots
185
Mumps presentation?
Parotitis
Earache
Pain on eating
186
Complications of mumps?
Orchitis
Hearing loss (usually transient)
187
Rubella presentation?
Maculopapular rash from face > body
188
Most common cause of encephalitis in children?
HSV-1
189
Complications of slapped cheek?
Aplastic crisis in sickle cell anaemia
Pregnant women = hydrops fetalis
190
Exclusion criteria for hand, foot and mouth disease?
Non required - when child feels well
191
Causes of meningitis in <3 months?
Group B strep
Listeria
E. coli
192
Causes of meningitis >3 months?
Neisseria meningitidis
Strep pneumoniae
Haemophilus influenza B
193
Bacterial meningitis LP findings?
Cloudy
Low glucose
High white cells - neutrophils
High opening pressure
High protein
194
Viral meningitis LP findings?
Clear
Normal glucose
High white cells - lymphocytes
Normal opening pressure
Slightly high protein
195
Causative organism in roseola infantum?
Human herpes virus 6
196
Symptoms of roseola infantum?
High fever preceding:
Maculopapular rash
Febrile convulsions in 10-15%
Diarrhoea
Cough
Nagayama spots: papular enanthem on the uvula and soft palate
197
What is the shaken baby syndrome triad?
Retinal haemorrhages
Subdural haematoma
Encephalopathy
