paeds Flashcards
(145 cards)
1
Q
most common childhood malignancy
A
acute lymphocytic leukaemia
2
Q
key presentations of ALL
A
- lymphadenopathy = MC sx
- hepatosplenomegaly
- anaemia (fatigue and pallor),
- thrombocytopenia (bruising and epistaxis)
- neutropenia (recurrent infections and fever).
3
Q
conditions associated with Down’s syndrome
A
- four-fold increased risk of developing ALL
- duodenal atresia
- recurrent otitis media
- hypothyroidism
- Visual problems e.g. cataracts, squint + myopia
- Hearing loss – eustachian tube abnormalities
4
Q
core features of autism
A
- narrow interests
- language deficits
- repetitive behaviors
- repetitive hand movements
5
Q
fraser guidelines key components
A
- patient should understand the clinician’s advice,
- they cannot be persuaded to discuss the situation with their parents,
- are likely to continue having intercourse without treatment,
- are likely to suffer (mentally or physically) without treatment,
- that it is in the patient’s best interests to provide the prescription.
6
Q
Patients on methylphenidate should have what monitoring?
A
- height and weight because it can affect appetites –> slowed growth
- apetite
- BP
- pulse
- Psychiatric symptoms
7
Q
ADHD Mx
A
- 1st line = conservative Mx with behavioural therapy, CBT, social training. Extra support at school. Sleep support with sleep hygiene methods and failing that melatonin
- 2nd line = medical mx only for kids >5yrs. methylphenidate is 1st line.
lisdex or dexamphetamine are 2nd line options if methyl doesn’t work and is trialled for 6 weeks
8
Q
scarlet fever causative organism
A
Group A streptococcus - commonly strep pyogenes
9
Q
Over the last 48 hours he has developed a sore throat, headache and fever. In the last 24 hours he has developed a coarse, erythematous rash over his face and torso and his mother reports that his tongue appears bright red
A
scarlet fever
10
Q
what is the most common congenital cardiac defect
A
VSD
accounts for about 30-60% of all congenital heart defects
11
Q
key features of HSP
A
preceding history of URTI
classic triad of
- abdominal pain
- arthralgia
- purpura on the extensor surfaces
AND renal involvement as IgA immune complexes can deposit in the kidneys and cause haematuria and proteinuria.
12
Q
what is HSP
A
a small vessel vasculitis - MC vasculitis in kids
13
Q
cause of Down’s syndrome
A
Meiotic non-disjunction
an error during meiosis which leads to a gamete with 2 copies of chromosome 21 being produced. linked to maternal age
14
Q
what concentration of adrenaline is used in anaphylaxis
A
1: 1000
15
Q
paediatric doses of adrenaline
A
Immediate administration of adrenaline (1:1000, IM):
- Child > 12 years: 500 micrograms IM (0.5 mL)
- Child 6-12 years: 300 micrograms IM (0.3 mL)
- Child 6 months - 6 years: 150 micrograms IM (0.15 mL)
- Child < 6 months: 100-150 micrograms IM (0.1-0.15 mL)
16
Q
describe the common presentation of a strangulated hernia
A
There is often a history of preceding intermittent pain which resolves.
The hernia is able to reduce in the past but has become strangulated now –> worsening pain that doesn’t resolve
17
Q
what is the honeymoon period in T1DM
A
immediately after a diagnosis of T1DM the pancreas may still produce some insulin. therefore insulin requirements may be low.
these pts need close monitoring as their insulin requirements may suddenly increase as the remaining beta cells are destroyed
they are at high risk of DKA if this happens
18
Q
Mx of a hypo in an unconscious pt
A
- 2ml/kg IV 10% dextrose - preferred treatment if in hospital
- IM glucagon - preferred for outside of hospital
19
Q
what is the first step in resuscitation of an unresponsive paediatric patient
+ why
A
- 5 rescue breaths prior to commencing chest compressions
- because paediatric pts are more likely to suffer respiratory arrest than cardiac arrest.
20
Q
Bordetella pertussis microscopic morphology
A
Gram-negative coccobacillus
21
Q
The most common type of heart block in children is…
A
complete heart block [third-degree heart block]
22
Q
pathophysiology of third degree heart block
A
- In complete heart block, the electrical impulse never gets past the A-V node.
- thus the atria and ventricles contract independent of each other
- The only reason a person can survive is that another, weaker natural pacemaker takes over in the ventricles.
23
Q
presentation of third degree heart block
A
- loss of consciousness.
- cyanotic spells
- pre-syncope [feeling faint]
- syncope [fainting]
24
Q
MC complication of measles
+ other complications
A
- MC = otitis media
- others: pneumonia, acute encephalitis, hearing or vision loss.
25
double bubble on xray
duodenal atresia
26
duodenal atresia clinical presentations
- Antenatal and postnatal
- Antenatally, with association of polyhydramnios due to inadequate ingestion of amniotic fluid by the foetus
- Postnatally, with a distended abdomen and vomiting.
- The vomit may be bilious or non-bilious, the nature of which depends on the site of atresia.
- The vomiting typically onsets within hours to days of life.
27
Mx of duodenal atresia
Early surgical intervention is required, involving a duodenoduodenostomy
28
define duodenal atresia
congenital condition where the duodenum is blind-ending so is not patent and results in obstructive symptoms
29
define neonatal jaundice
yellowing of a newborn' skin and eyes due to build up of bilirubin
30
causes of neonatal jaundice
<24 hours = pathological always.
- Haemolytic disorders (Rhesus incompatibility, ABO incompatibility, G6PD deficiency, spherocytosis)
- Congenital infections (TORCH screen indicated)
- Sepsis
24hrs - 14 days
- Physiological jaundice
- Breast milk jaundice
- Dehydration
- Infection, including sepsis
>14 days [21 if preterm]
- Hypothyroidism
- Biliary obstruction (including biliary atresia)
- Neonatal hepatitis
- physiological, breastmilk, infection.
31
physiological neonatal jaundice
Is common and caused by
- Relative polycythaemia in newborns
- Shorter red blood cell lifespan compared to adults
- Less efficient hepatic bilirubin metabolism in the first few days of life
32
Sx of neonatal jaundice
- yellowing of skin and eyes
- poor feeding
- lethargy
- kernicterus in severe untreated cases
33
what is kernicterus
Sx?
- a complication of untreated neonatal jaundice
- excess bilirubin damages the basal ganglia within the brain
Sx:
- irritability
- vomiting
- hypotonia FOLLOWED BY hypertonia
34
yellowing of skin and eyes + pale stool + dark urine =
biliary atresia
35
Ix for neonatal jaundice
- transcutaneous bilirubin levels if baby born after 35 weeks gestation + is over 24 hours old - >250 requires serum testing to corroborate.
- serum bilirubin if TC levels are >250 OR baby born before 35 weeks gestation
- plot levels of a nomograph
- FBC, LFT,
- USS of liver to investigate for hepatitis and biliary atresia
36
A thrill and grade 4/6 systolic murmur radiating to the left axilla and back, with no variation on respiration or posture, suggests...
a significant ventricular septal defect.
37
- MC cause of nephrotic syndrome in kids
- what is seen on histology of renal biopsy
- Minimal change disease is the most common cause of nephrotic syndrome in children
- characterised by minimal or no histological changes on biopsy.
38
Clinical features of nephrotic syndrome
key triad
1. proteinuria
1. hypoalbuminaemia
1. oedema
ALSO
- HTN, raised lipids, immunosuppression and hyper coagulability
39
Mx of nephrotic syndrome
- high dose corticosteroids for 4 weeks and weaning for 8.
- prophylactic pen V as immunoglobulins are wee'd out --> immunossupression
- diuretics for oedema
- albumin infusions for severe hypoalbuminaemia
- low salt diet
- measles and VZV vax status
40
appearance of the heart if ToF
boot shaped heart
41
causative organism of roseola infantum
human herpes virus 6
42
main complication of roseola infantum
febrile convulsions caused by spikes in temperature
43
NEC key presenting features
- premature infant
- abdominal distention
- bilious vomiting
- bloody stool
- feed intolerance
- absent bowel sounds
- Signs of systemic compromise, including an acidosis on a blood gas and respiratory distress
44
NEC gold standard Ix + results
Xray
* Rigler’s sign: both sides of the bowel are visible due to gas in the peritoneal cavity
* Dilated bowel loops
* Distended bowel
* Thickened bowel wall
45
kawasaki Mx
Aspirin and intravenous Immunoglobulin (IVIG)
46
scarlet fever Mx
10 day course of phenoxymethylpenicillin
47
when do kids typically start walking unassisted
1yr
Most toddlers start walking unaided between 13 and 15 months of age.
48
when should a kid not starting to walk unaided by trigger a referral
If a toddler has not started walking by 18 months, a referral to paediatrics should be made to see if there are any underlying health issues
49
what should a baby be able to do at 6 months
roll over and may be able to sit up
50
what should a baby be able to do at 9 months
pull up to stand
crawl independently
51
risk factors for SUFE
which is MC
- obesity is MC
- endocrine disorders: hypothyroidism, growth hormone deficiency, hypopituitarism and renal failure osteodystrophy
52
when should a child with croup be sent to hospital
* Stridor and/or signs of resp. distress e.g. sternal recession at rest
* Hypoxia / cyanosis
* High fever
* Respiratory rate > 60
* Lethargy or agitation
* Fluid intake < 75% of normal or no wet nappies for 12 hours
* Aged under 3 months
* Chronic conditions such as immunodeficiency, chronic lung disease or neuromuscular disorders
53
asthma diagnostic investigations
1. spirometry with bronchodilator reversibility
2. FeNO testing. In children with uncertain asthma diagnosis despite normal spirometry results, measuring fractional exhaled nitric oxide can provide additional diagnostic value.
3. Peak flow variability monitoring should also be offered at the same time as FeNO testing
54
Kawasaki disease clinical features and Dx criteria
Diagnosis is made based on a high-grade fever for 5 days + 4/5 CREAM features:
1. Conjunctivitis (bilateral, non-exudative)
1. Rash (any non-bullous rash[polymorphous])
1. Edema/Erythema of hands and feet – can peel later.
1. Adenopathy (cervical, commonly unilateral and non-tender)
1. Mucosal involvement (strawberry tongue, oral fissures, red cracked lips etc)
55
main complication of kawasaki
Coronary artery aneurysms or dilation: arises in up to a quarter of affected children
56
causes of bilious vomiting
- intestinal malrotation and volvulus
- intussusception [not always, dependent on location]
- Hirschprung's disease
- NEC
57
ENT manifestations of Downs
- small nose with a flat nasal bridge,
- small and low set ears,
- hearing issues and ear infections,
- hypothyroidism
58
coeliac disease skin manifestation
dermatitis herpetiformis
papulovesicular rash which is commonly found on the buttocks, legs, arms or abdomen
59
What is the CENTOR criteria used for and what are its components
used to indicate the likelihood of a sore throat being caused by bacteria:
- Fever over 38ºC
- Tonsillar exudates
- Absence of cough
- Tender anterior cervical lymph nodes (lymphadenopathy)
60
when should antibiotics be given for tonsillitis
when the CENTOR score in ≥3
61
What is an alternative to CENTOR criteria and what are the components
FeverPAIN - must score 4 or 5
- Fever during previous 24 hours
* P – Purulence (pus on tonsils)
* A – Attended within 3 days of the onset of symptoms
* I – Inflamed tonsils (severely inflamed)
* N – No cough or coryza
62
sore throat / tonsillitis management
* Conservative mx if viral or bacterial unlikely with paracetamol and ibuprofen + adequate fluid intake.
* MUST safety net. Come back if no improvement within 3 days OR if fever rises above 38.3
* ABX if centor score ≥3 or feverPAIN ≥4.
* 1st line – phenoxymethylpenicillin for 10 days OR clarithromycin 10 days in pen allergic pts.
* Also consider abx in immunocompromised pts, pts with a hx of rheumatic fever and those with significant comorbidities as they are at a greater risk of serious infection.
63
what classes as a complex febrile convulsion
- duration >15 mins
- more than 1 episode within 24 hours
- child does not fully recover within 1 hour
64
what is the most specific sign for meningococcal disease
non-blanching rash
65
lumbar puncture contraindications
- Raised ICP
- extensive purpuric rash over the puncture site
-
66
language development expectations of a 3 yr old
A child at the age of three should have a growing vocabulary and be able to use simple sentences, as well as recognise and name at least one colour.
67
long term risks of untreated coeliac disease
- lymphomas (such as EATL - enteropathy associated T-cell lymphoma)
- small bowel adenocarcinomas
68
what are the trisomy syndromes
- 21 = Down's
- 18 = Edwards
- 13 = Patau
69
congenital anomalies of Pataus
microcephaly, cleft lip and palate, polydactyly, and cardiac defects
70
key features of JIA
**Sx lasting ≥6 weeks**
* joint pain and/ or swelling,
* morning stiffness
* limited RoM
* lymphadenopathy,
* uveitis,
* pyrexia,
* anorexia
* weight loss
71
Fraser guidelines are specifically for girls <16 seeking contraception
T/F
FALSE
it applies to <16 yr olds seeking treatment specifically for sexual health.
therefore also applies to boys.
72
Fraser guideline vs Gillick competence
The Fraser guidelines may be confused with Gillick competency. Gillick competency can be applied in the wider context of medical treatment of under 16s, whereas the Fraser guidelines are specific to sexual health.
73
how do you differentiate between septic arthritis and transient synovitis
high grade fever in septic arthritis
kocher criteria used to differentiate
74
what is the kocher criteria and what are its components
fever >38.5C,
non-weight bearing,
ESR > 40,
WCC > 12.
75
key features of inflammatory arthritis
Key features of inflammatory arthritis = joint pain + swelling + stiffness.
76
what is still's disease
systemic JIA
77
key features of systemic JIA
* **subtle salmon pink rash**,
* high swinging fevers,
* joint pain,
* enlarged lymph nodes,
* weight loss,
* muscle pain,
* pleuritis + pericarditis
78
combined test =
* 1st line testing for downs
* done between 11-14 weeks
* involves USS and maternal bloods
* scan loks for nuchal translucency thicker than 6mm = ↑ risk
* bloods:
* B-hCG: raised = ↑ risk
* pregnancy associated plasma protein A low = ↑ risk.
79
triple test
* done between 14 and 20 weeks
* maternal bloods only:
* B-hCG: raised = ↑ risk
* Alpha fetoprotein low = ↑ risk
* serum oestriol low = ↑ risk
80
quadruple test
same as triple test but includes inhibin A: raised = ↑ risk
81
Mx of neonatal jaundice
1st line = Phototherapy. usually sufficient.
Exchange transfusions: removing blood from the neonate and replacing it with donor blood. used in severe cases
82
what does a hand preference before the age of 18 months suggest
cerebral palsy
83
gross motor skills development red flags
- Not sitting by 1 yr
- not walking by 18 months
84
fine motor skills development red flag
hand preference before the age of 18
85
Speech and language development red flag
- not laughing + smiling by 3 months
- no words by 18 months
86
social development red flags
- no response to carers interactions by week 8
- no interest in playing with peers by 3 years.
87
questions to ask following an asthma exacerbation to ascertain asthma control.
Pattern of medication use eg Pattern of salbutamol use and if increasing and/or Oral steroid use
Persistence of symptoms eg Wheeze or cough on exertion/ Nocturnal cough Reduced physical activity Time off school
Involvement of secondary care eg Previous HDU/ICU admission
Hospital attendances due to asthma Under care of secondary care paediatrician
88
what is eczema herpeticum
what causes it
how is it managed
- Eczema herpeticum is a serious infection and a dermatological emergency.
- MC caused by herpes simplex virus or VZV
- Mx = Urgent anti-viral therapy with acyclovir is required
89
What precedes syncope?
Often associated with prodromal symptoms of dizziness, nausea and changes to the vision.
90
MC cause of respiratory distress in a preterm newborn
neonatal respiratory distress syndrome
91
RFs for respiratory distress in a newborn
- preterm delivery
- maternal GDM
- multiple pregnancy
- low birth weight
- males
- C-section without maternal labour
- family Hx of NRDS [neonatal respiratory distress syndrome]
92
MC cause of respiratory distress in a term newborn
transient tachypnoea of the newborn
93
what is transient tachypnoea of the newborn
a resp condition caused by delayed resorption of the amniotic fluid in the lungs --> rest distress
94
features of respiratory distress in infants and children
- head bob
- grunting
- sternal recessions
- nasal flaring
- wheeze
- use of accessory muscles
- skin discolouration due to cyanosis
- rapid breathing rate
95
asthma management in kids
Mx > 5yrs
- SABA
- SABA + low dose ICS
- SABA + low dose ICS + LTRA
- SABA + low dose ICS + LABA [consider stopping LTRA]
- SABA + MART [with ICS + LABA]
- SABA + moderate dose ICS + LABA [either separate or within MART]
96
what investigations are used to diagnose asthma in <5 and >5 and what indicates a positive result
- clinical Dx for < 5 as they can't follow instructions for the tests
> 5:
1. spirometry + bronchodilator reversibility. FEV/FVC **<70%. reversibility >12%** = +ve
2. FENO: done is normal spirometry or obstruction is seen without BDR. **>35ppb** = +ve
3. peak flow diary: diurnal variation of **>20%** = +ve
97
signs of an innocent murmur
**Soft**: The murmur is usually faint and not loud.
**Systolic**: The murmur is heard during systole. *Note that all diastolic murmurs are pathological*.
**Sensitive**: The murmur's intensity changes with the child's position or alongside respiration.
**Short**: The murmur is not holosystolic (does not last for the entire systolic phase).
**Single**: No additional sounds are accompanying the murmur.
**Small**: The murmur is localised and does not radiate to other areas.
98
pyloric stenosis Ix + Mx
Ix
- blood gas analysis: hypochloraemic, hypokalaemic metabolic alkalosis with ↑ lactate due to dehydration. [vomited up all the HCl in the stomach ∴ ↓ Cl + thirsty]
- abdo USS: shows pyloric thickness >3mm and length >15mm.
Mx
- fluid resus
- Laparoscopic pyloromyotomy [Ramstedt's operation]
99
causes of innocent murmurs
- periods of rapid growth
- physical activity
- accute illness
100
pathophysiology of SUFE
weakness in the growth plate allows for displacement of the upper femoral epiphysis
101
key investigations for non-accidental injury
- full skeletal radiographic survey
- blood tests to exclude organic causes of presentations.
102
child presents with hand foot and mouth disease + severe headache or neurological Sx. Mx
- suggests complication of viral meningitis OR **encephalitis**
- needs urgent assessment in A+E to investigate
103
ASD/VSD 1st line Mx if pt asymptomatic
Watch + wait: small ones shut on their own, just need monitoring with echoes.
104
auscultation of coarctation of the aorta
Systolic murmur in left infraclavicular region + below left scapula
105
typical presentation of osteosarcoma
adolescents with persistent localised bone pain and no history of trauma, a palpable mass and tenderness on examination
106
* clinical features of osteosarcoma
* how does ewings sarcoma differ
* Prolonged bone pain, worse at night and may wake them up
* Commonly mistaken for growing pains or sports injuries.
* Swelling typically in the long bone metaphysis area. Limbs usually affected.
* Palpable mass
* ↓ range of motion
ewings
- same as osteosarcoma but pt may also present with fever, weight loss and fatigue
107
osteosarcoma Ix
- first line = X-ray
- urgent xray within 48 hrs indicated for unexplained bone pain or swelling
- GS = bone biopsy
108
hydrocele Mx - primary and secondary
primary
- parent reassurance as wit should self resolve within first year of life
- if persists past 1 yr old, will need surgical intervention
secondary
- usually managed conservatively as it self-resolves
109
age of dx of precocious puberty
- 8 for females
- 9 for males
110
Four common predictors of septic arthritis are identified as:
fever >38.5C,
non-weight bearing,
ESR > 40,
WCC > 12.
111
stepwise Mx of moderate - severe croup
* Hospital admission + Oxygen
* Oral dexamethasone 0.15mg/kg [oral or IV]
* Nebulised budesonide: if unable to tolerate oral dex.
* Nebulised adrenaline: if airway obstruction is imminent in an emergency
* Intubation and ventilation: if fatigued or hypoxic.
112
breath holding spells
Reflex anoxic seizures (RAS) and breath-holding spells are both common and benign episodes that can occur in young children, typically characterised by a brief loss of consciousness.
They are provoked by triggers such as sudden pain or emotional upset. The primary clinical manifestation is a temporary cessation of breath that can be accompanied by limb jerking and cyanosis.
Diagnosis is made primarily from the history provided by caregivers, and no special investigations are usually required.
Key management strategies involve reassurance to parents and caregivers, given the benign nature of these conditions.
113
slapped cheek syndrome: how long is the child infectious for
once the rash appears they are no longer infectious.
114
MC heart defect in turners
bicuspid aortic valve.
115
Sx of neonatal sepsis
Non-specific Sx:
- Fever
- poor feeding
- hypoxia
- tachycardia or bradycardia
- reduced tone or activity
- vomiting
- resp distress of apnoea
- jaundice within 24 hrs
- seizures
116
neonatal sepsis red flags
- confirmed or suspected sepsis in mother
- seizures
- term baby needing mechanical ventilation
- Resp distress starting >4 hrs after birth
- signs of shock
117
neonatal sepsis risk factors
- maternal GBS colonisation
- prior GBS sepsis in another child
- maternal sepsis, chorioamnionitis or fever >38C
- prematurity <37 weeks
- Prolonged ROM - > 18 hours before delivery.
118
initiation of Mx in neonatal sepsis
- If there's 1 RF or clinical feature then monitor clinical observations for at least 12 hours
- if there's 2 or more RFs or clinical features then START ABX
- if there's 1 red flag sign - START ABX
- start ABX within 1 hour of making decision.
- take blood cultures and baseline FBC + CRP before initiating abx
- Perform a lumbar puncture if infection is strongly suspected or there are features of meningitis (e.g. seizures)
119
first line abc for neonatal sepsis
IV benzylpenicillin + gentamicin
OR
IV cefotaxime + gentamicin if meningitis suspected.
120
signs of dehydration
1. Appears unwell/deteriorating
1. Altered responsiveness (irritable, lethargic)
1. Sunken eyes
1. Tachycardia
1. Tachypnoea
1. Reduced skin turgor
1. Dry mucous membranes (not reliable if the child is mouth breathing or just after a drink)
1. Decreased urine output
1- 6 are red flags and indicate possible progression to shock
121
signs of clinical shock
* Decreased level of consciousness
* Pale or mottled skin
* Cold extremities
* Pronounced tachycardia
* Pronounced tachypnoea
* Weak peripheral pulses
* Prolonged capillary refill time
* Hypotension
**Hypotension is a sign of decompensated shock and indicates that the child is critically unwell**
122
when might a paeds pt in shock need a smaller volume for resus
* Neonatal period (<28 days of age)
* Diabetic ketoacidosis
* Septic shock
* Trauma
* Cardiac pathology (e.g. heart failure)
123
how would you proceed with total 24 hour fluid requirements following fluid resus due to shock
- NICE say to proceed as normal and NOT to subtract the bolus volume from the 24 hr fluid requirement.
BUT
- you need to use 10% as the dehydration value to calculate the fluid deficit [which is used for shocked pts]
124
triad of HUS
- AKI
- thrombocytopenia
- normocytic anaemia
125
causes of raised ALP
- hepatobiliary disorder
- bone mineralisation disorders [vit D deficiency, rickets, osteomalacia
126
DKA triad:
1. Acidaemia,
2. Hyperglycaemia,
3. Ketonaemia
127
inheritance pattern of haemophilia
X-linked recessive.
therefore only seen in boys
128
Von willerbrand disease is only seen in males
T/F
FALSE
autosomal inheritance pattern?
von Willebrand = Women too.
129
deficiency in haemophilia A vs B
- In haemophilia A, there is a factor VIII deficiency.
- Factor IX deficiency is seen in haemophilia B.
130
MC cause of septic arthritis in kids
most commonly, septic arthritis will result from haematological spread from a bacterial infection elsewhere in the body, it can occur following a skin wound such as chickenpox scar.
131
RFs for DDH
- oligohydramnios
- female [6x more likely]
- breech birth
- high birth weight
- premature delivery
132
when is DDH screening done + what test is used
DDH is screened for in the 6-8 week baby check using Barlows and Ortolani tests.
133
transient synovitis Mx and monitoring
A child with transient synovitis can be managed in primary care if they are otherwise well and the limp or pain has been present for <48hrs.
- BUT must safety net to go to A+E immediately if their Sx worsen or they develop a fever.
- Must follow up **2 days and 1 week later** to ensure Sx are improving and fully resolve.
Rest, analgesia and physiotherapy can be used as supportive Mx.
134
what type of heart block is seen in children
- how does it present
- RFs
-Mx
complete congenital heart block
- presents in neonates and infants with bradycardia and circulatory shock
- presents in older kids with pre/syncope
- RFs = maternal SLE
- ~50% of cases are associated with congenital heart defects
-Mx = close monitoring for asymptomatic kids
- symptomatic neonates/kids = ICU admission, isoprenaline + pacemaker
135
order of Mx for acute asthma
1. Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours
1. Nebulisers with salbutamol / ipratropium bromide
1. Oral prednisone (e.g. 1mg per kg of body weight once a day for 3 days)
1. IV hydrocortisone
1. IV magnesium sulphate
1. IV salbutamol
1. IV aminophylline
136
define a recurrent and an atypical uti
137
Mx of vesicoureteric reflux
**conservative:**
- prophylactic antibiotics to prevent UTI
- laxatives if needed to prevent constipation,
- regular monitoring of kidney fx and growth
**surgery**
138
Mx of haemolytic disease of the newborn
Postnatal Mx with phototherapy or exchange transfusion to manage high bilirubin levels
- same as neonatal jaundice
139
score of 6 on APGAR
concerning
≥7 is a normal healthy baby
140
T/F
acute bilirubin encephalopathy is caused by a toxic build-up of conjugated bilirubin
FALSE
it is unconjugated.
conjugated could not cross the BBB as it is water soluble unlike unconjugated which is lipid soluble.
141
RFs for testicular torsion
Age, History of Testicular Torsion, Undescended Testes and Family History
142
what is laryngomalacia
a common congenital laryngeal abnormality characterised by
flaccidity of the supraglottic structures.
The larynx is soft and floppy as a result and
collapses during breathing. This is present since birth but gets worse for the first 8
months before self-resolving around 18-24 months.
It is worse when lying down and feeding.
It doesn’t need investigation apart from checking sats, it is only if it is severe and
causes symptoms like GORD, Resp distress etc.
If it is severe we refer to ENT
143
what infection is chronic in cystic fibrosis
pseudomonas aureginosa
144
types of cerebral palsy
- Spastic cerebral palsy: Increased muscle tone, scissoring, extensor posturing, hyperreflexia; can be hemiplegic, diplegic, or quadriplegic = MC
- Ataxic cerebral palsy: Problems with balance and coordination
- Dyskinetic cerebral palsy: Involuntary movements such as chorea, athetosis, or dystonia
145
what is a complication of otitis media
mastoiditis
meningitis
recurrent ear infection
