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PAEDS Flashcards

1
Q

What is familial short stature?

A

Child is short but normal, parents are short and normal, with normal bone age.

Child will become short adult.

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2
Q

What is constitutional delay of growth and puberty (CDGP)?

A

Mainly occurs in boys, with family history and delayed bone age.

Can give testosterone, and child will have later growth spurt.

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3
Q

What are some pathological causes of short stature?

A
  • Undernutrition
  • Chronic illness (IBD, asthma)
  • Iatrogenic (Steroids)
  • Psychological and social factors
  • Hormonal (hypothyroidism, growth hormone deficiency)
  • Syndromes (Turner’s, Prader-Willi)

Requires exclusion of organic disease.

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4
Q

What are the tests for growth hormone deficiency?

A
  • GH stimulation tests (Arginine test, Insulin tolerance test)
  • Low IGF-1
  • Delayed bone age

Can be due to pituitary causes or congenital hypothyroidism.

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5
Q

What are the features of congenital adrenal hyperplasia (CAH)?

A
  • Androgen secreting tumor
  • Precocious pseudopuberty
  • Elevated adrenal hormones

Includes abnormal sex hormone secretion.

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6
Q

What is jaundice?

A

Yellow discoloration of skin and tissues due to accumulation of bilirubin.

Most obvious in sclera, visible once total bilirubin > 40-50 umol/l.

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7
Q

What can cause pathological jaundice in newborns?

A
  • Haemolysis
  • Sepsis
  • ABO incompatibility
  • Rhesus disease

Jaundice < 24 hours old is always pathological.

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8
Q

What is kernicterus?

A

Severe untreated jaundice in newborns leading to permanent brain damage.

Caused by high levels of unconjugated bilirubin crossing the blood-brain barrier.

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9
Q

What are the early signs of kernicterus?

A
  • Poor feeding
  • Lethargy
  • Seizures
  • Encephalopathy

Late consequences may include severe choreoathetoid cerebral palsy and learning difficulties.

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10
Q

What is pyloric stenosis?

A

Condition characterized by non-bilious projectile vomiting in infants aged 2-12 weeks.

Palpation of ‘olive tumor’ and visible gastric peristalsis may be observed.

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11
Q

What are common features of gastroesophageal reflux (GORD)?

A
  • Effortless vomiting
  • Feeding problems
  • Regular chest infections

Very common and usually self-limiting.

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12
Q

What is the typical presentation of intestinal atresia?

A

Portion of the intestine is completely blocked or absent, preventing normal passage of foods and fluids.

Symptoms often present immediately after birth with bilious vomiting.

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13
Q

What is the significance of a double bubble sign on abdominal X-ray?

A

Indicates duodenal obstruction, commonly seen in intestinal atresia.

Dilation of stomach and proximal duodenum.

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14
Q

What is the treatment for congenital biliary atresia?

A

Kasai portoenterostomy, best performed before 60 days of life.

Aims to restore bile flow and prevent liver failure.

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15
Q

What defines precocious puberty?

A

Onset of secondary sexual characteristics before age 9 in boys or age 8 in girls.

MRI pituitary to exclude tumors in cases of central precocious puberty.

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16
Q

What is the Tanner method?

A

A system for staging puberty from 1 to 5, where 1 indicates no puberty and 2 indicates the start of puberty.

Used to assess sexual maturity.

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17
Q

What are the signs of diabetes in children?

A
  • Thinner
  • Tired
  • Thirsty
  • Toilet more

Presents with heavy nappies and blurred vision.

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18
Q

What is the purpose of the finger prick test in suspected DKA?

A

To measure blood glucose levels, > 11mmol/l indicates need for same-day review.

DKA can occur rapidly in children.

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19
Q

What are the common tests for assessing jaundice?

A
  • FBC and ferritin
  • U/E, LFT, Ca, CRP
  • Coeliac and IgA
  • IGF-1, TFT, prolactin, cortisol, gonadotrophins
  • Karyotype

Important to differentiate between conjugated and unconjugated bilirubin.

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20
Q

What is the primary test for diagnosing Gilbert’s disease?

A

Assay for deficiency of the enzyme UDP glucuronic.

Common and mild condition leading to unconjugated bilirubin.

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21
Q

What is the treatment for prolonged jaundice?

A

Phototherapy using visible light at 450nm wavelength to convert bilirubin to a water-soluble isomer.

Thresholds for treatment are guided by charts.

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22
Q

What are the consequences of untreated congenital hypothyroidism?

A

Will be short in stature and have abnormal proportions.

Screened for early treatment within the first two weeks of birth.

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23
Q

What are common symptoms of obesity in pediatric patients?

A
  • Poor growth
  • Learning difficulties
  • Loss of appetite control

May be associated with syndromes and endocrine conditions.

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24
Q

What is the role of insulin in diabetes management?

A

Regulates blood glucose levels and may be necessary in cases of DKA.

DKA management often requires immediate insulin administration.

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25
What are the signs of septic-optic dysplasia?
Mild face hypoplasia, excess subcutaneous fat, and delayed skeletal maturation. ## Footnote Important features to consider in growth hormone deficiency.
26
What is the definition of hypertrophic cardiomyopathy?
A condition where the heart muscle becomes abnormally thick, potentially leading to heart failure. ## Footnote Important to monitor in patients with congenital heart defects.
27
What are the characteristics of non-bilious vomiting?
Projectile vomiting, often seen in conditions like pyloric stenosis. ## Footnote Differentiates from bilious vomiting, which indicates intestinal obstruction.
28
What is the main concern with bilious vomiting in newborns?
It signals potential intestinal obstruction and requires immediate evaluation. ## Footnote Conditions like malrotation or volvulus can be life-threatening.
29
What is the management for gastroesophageal reflux disease (GERD)?
* Dietary modifications * Positioning during sleep * Use of PPIs and antacids ## Footnote Surgery is a last resort in severe cases.
30
What defines the peak height velocity in girls during puberty?
Occurs around age 12, with growth slowing down as breast development matures. ## Footnote Menarche indicates nearing final height.
31
What is a life-threatening emergency that occurs due to ischemia and necrosis of the intestines?
Volvulus ## Footnote Volvulus is often caused by Ladd's bands, which are abnormal fibrous bands that obstruct the duodenum.
32
What are common symptoms of intestinal obstruction due to volvulus?
* Bilious vomiting (Green) * Severe abdominal distension * Irritability and inconsolable crying * Bloody stools if ischaemia occurs * Signs of shock if ischemic
33
What imaging finding is known as the 'double bubble sign'?
It indicates duodenal obstruction on an abdominal X-ray. ## Footnote This sign is often seen in cases of volvulus.
34
What is considered the gold standard for diagnosing upper gastrointestinal obstruction?
Upper GI contrast study ## Footnote This study can show a corkscrew appearance of twisted intestines.
35
What is the emergency procedure performed for volvulus?
Ladd's procedure ## Footnote This involves untwisting the volvulus, removing Ladd's bands, widening the mesenteric base, and performing an appendectomy.
36
During fetal development, how do the intestines normally rotate?
270-degree counterclockwise rotation around the superior mesenteric artery (SMA).
37
What is malrotation in the context of intestinal development?
Incomplete rotation of the intestines, leading to abnormal positioning of the small and large intestines.
38
What condition involves part of the intestine telescoping into an adjacent segment?
Intussusception ## Footnote This condition can lead to obstruction and potential ischemia.
39
What are common triggers for intussusception?
* Rotavirus * Adenovirus * Meckel’s diverticulum * Henoch-Schönlein purpura * Cystic fibrosis
40
What is a classic symptom of intussusception in infants?
Intermittent, severe, crampy, progressive abdominal pain.
41
What is the characteristic stool appearance associated with intussusception?
Red currant jelly stools.
42
What imaging finding is typical for intussusception?
Target-like mass or doughnut appearance on ultrasound.
43
What is meconium ileus?
A functional obstruction due to lack of peristalsis, often associated with cystic fibrosis.
44
What is the main symptom of meconium ileus in newborns?
Failure to pass meconium within 24-48 hours.
45
What does a contrast enema reveal in cases of meconium ileus?
Microcolon with meconium pellets.
46
What condition is characterized by the absence of ganglion cells in the colon?
Hirschsprung’s disease.
47
What is the gold standard for diagnosing Hirschsprung’s disease?
Rectal biopsy.
48
What is Meckel’s diverticulum?
A true congenital diverticulum of the small intestine resulting from incomplete obliteration of the vitelline duct.
49
What is the most common symptom of Meckel’s diverticulum?
Painless lower GI bleeding.
50
What is the typical age of presentation for symptoms of Meckel’s diverticulum?
Before 2 years of age.
51
What imaging technique is used to detect ectopic gastric mucosa in Meckel’s diverticulum?
Technetium-99m Pertechnetate Scan.
52
What condition involves an allergy to milk proteins?
Cow’s milk protein allergy (CMPA).
53
What are common symptoms of cow's milk protein allergy?
* Loose, watery stools * Abdominal pain and distension * Excessive flatulence * Vomiting or gastro-oesophageal reflux
54
What is the main difference between lactose intolerance and cow's milk protein allergy?
Lactose intolerance is due to reduced levels of the enzyme lactase, not an allergy.
55
What is the typical age range for toddlers experiencing frequent loose stools due to immature gut motility?
6 months to 5 years.
56
What are common symptoms of chronic constipation in children?
* Poor appetite * Irritability * Abdominal pain or distension * Overflow diarrhoea
57
What is the typical management for chronic constipation in children?
* Dietary changes (increased fiber) * Osmotic laxatives (e.g., Movicol) * Stimulant laxatives (e.g., Senna)
58
What are common bacterial causes of meningitis in neonates?
* Group B streptococcus * Escherichia coli * Listeria
59
What are the classic symptoms of meningitis in older children?
* Fever * Headache * Photophobia * Neck stiffness
60
What laboratory findings are indicative of bacterial meningitis?
* Turbid or purulent CSF * High white cell count * Elevated protein * Low glucose
61
What is the recommended initial treatment for suspected bacterial meningitis?
3rd generation cephalosporin antibiotics.
62
What are the bacterial findings in meningitis?
Turbid or purulent, high opening pressure, high WCC (polymorphs), high protein, glucose < 50% of serum. ## Footnote WCC refers to white cell count.
63
What is the initial management for suspected sepsis in children?
ABCDE approach: Airway, Breathing, Circulation (20ml/kg fluid bolus, inotropes), DEFG (don't forget glucose 2ml/kg 10% dextrose).
64
Which antibiotics are recommended for meningitis?
3rd generation cephalosporin (e.g., cefotaxime/ceftriaxone), plus IV amoxicillin if < 1 month old to cover listeria.
65
What complications are associated with pneumococcal meningitis?
* Hydrocephalus * Neurodisability * Seizures * Hearing loss * Blindness
66
Describe Streptococcus pneumoniae.
Gram positive lancet shaped diplococcus, facultative anaerobe, colonises nasopharynx in 11-93%.
67
What is the transmission route for Neisseria meningitis?
Respiratory droplet transmission, often follows upper respiratory tract infection (URTI).
68
What are the clinical features of sepsis?
* Systemic inflammatory response * Suspected or proven infection * Severe = organ dysfunction * Shock = cardiovascular dysfunction
69
Which organisms are common causes of sepsis in neonates < 1 month?
* GBS * E. coli * Listeria
70
What are the red flags for serious infection in children?
* Pale/blue * No response to social cues * Weak, high pitched or continuous cry * Grunting * Tachypnoea (RR > 60) * Chest indrawing * Reduced skin turgor * Bulging fontanelle * Neck stiffness * Non-blanching rash * Focal seizures
71
What are the risk factors for infection in children?
* Prematurity < 37 weeks * Prolonged rupture of membranes (PROM) * Maternal GBS * Previous child with GBS * Maternal STI * SIRS > 2 criteria
72
What is the significance of a weak femoral pulse in neonates?
It indicates possible coarctation of the aorta.
73
What are the characteristics of innocent murmurs?
* Soft * Short * Systolic * Symptomless * Situation dependent * Asymptomatic * Short duration * Rated 1-2 out of 6 * No thrills
74
What is the most common innocent murmur in children?
Still's murmur.
75
What are the symptoms of aortic stenosis?
* Reduced exercise tolerance * Exertional chest pain * Syncope
76
What is the treatment for patent ductus arteriosus (PDA)?
* Echocardiogram * Fluid restriction * Diuretics * Prostaglandin inhibitors (IV ibuprofen, indomethacin) * Surgical ligation if symptomatic
77
What are the four abnormalities in Tetralogy of Fallot?
* Narrowing of RV outflow tract (pulmonary valve stenosis) * Large ventricular septal defect (VSD) * Overriding aorta * RV hypertrophy
78
What is the management for transposition of the great arteries?
* Prostaglandins E2 infusion to keep PDA open * Balloon septostomy * Switch procedure for correction
79
What are the symptoms of testicular torsion?
* Red scrotum * Asymmetry * Acute tenderness to touch
80
What is the clinical significance of Klinefelter syndrome?
47XXY, associated with infertility and other developmental issues.
81
What are the signs of rickets in children?
* Bowlegs * Harrison’s sulci * Bone pain * Stunted growth * Fragility
82
What is the definition of sepsis?
A systemic inflammatory response plus suspected or proven infection.
83
What are the typical findings in a child with coarctation of the aorta?
* Increased blood pressure proximal to narrowing * Weak/absent femoral pulse * Harsh systolic murmur
84
What is the treatment for cryptorchidism?
Orchidopexy to prevent complications like infertility and malignancy.
85
What are the typical features of Staphylococcus aureus infection?
* Gram positive cocci * Produces exotoxins * Colonises skin and mucosa * Associated with MRSA
86
What is the significance of non-blanching rash in children?
It may indicate serious bacterial infection.
87
What is orchidopexy?
A surgical procedure to correct undescended testicles ## Footnote Typically performed in children to prevent complications such as infertility or malignancy risk.
88
What is the risk of malignancy associated with orchidopexy?
<1% ## Footnote This indicates a very low risk of developing cancer post-surgery.
89
What is a possible complication of a non-retractable foreskin?
Recurrent balanitis ## Footnote This condition may occur due to difficulty in cleaning the area.
90
What is Balanitis Xerotica obliterans?
A condition characterized by a non-retractile foreskin and scarring ## Footnote It can lead to difficulties in urination.
91
What are the signs of testicular torsion?
* Red scrotum * Asymmetry * Acutely tender to touch ## Footnote These symptoms require immediate medical attention.
92
What is the 'Twist score' related to?
A scoring system to assess the likelihood of testicular torsion ## Footnote It helps guide urgent surgical intervention.
93
What is a common indicator of torsion appendix testis?
A red scrotum with no asymmetry and a blue/black spot ## Footnote This condition typically presents with tenderness but is less urgent than testicular torsion.
94
What is hypospadias?
A condition where the meatus of the urethra is located on the ventral aspect of the penis ## Footnote Severity can vary; anterior is most common, posterior is most severe.
95
What are the risk factors for migraines?
* Family history * Bright light/noise * Fatigue/stress ## Footnote These factors can trigger or aggravate migraine attacks.
96
What are the symptoms of a migraine?
* Abdominal pain * Nausea and vomiting * Hemicranial pain * Photophobia * Phonophobia ## Footnote Symptoms can vary and may include focal neurological symptoms.
97
What are the preventative treatments for migraines?
* Pizotifen * Propranolol * Amitriptyline * Topiramate * Valproate ## Footnote These medications require consistent use for effectiveness.
98
What characterizes tension headaches?
Diffuse, symmetrical, bandlike distribution with no localizing features ## Footnote They are often chronic but can have symptom-free periods.
99
What is the most common cause of acute asymptomatic seizures in childhood?
Febrile convulsions ## Footnote Typically occur in children aged 3 months to 5 years with fever.
100
What defines epilepsy?
Recurrent, unprovoked epileptic seizures ## Footnote Seizures result from abnormal excessive discharge from cortical neurons.
101
What is the role of EEG in seizure diagnosis?
Useful for distinguishing the type of seizure ## Footnote However, EEG results should not be interpreted in isolation.
102
What are the signs of hydrocephalus?
* Large head circumference * Bulging fontanelles * Symptoms of increased intracranial pressure ## Footnote It indicates an abnormal accumulation of cerebrospinal fluid in the brain.
103
What is Duchenne muscular dystrophy?
A genetic myopathy characterized by progressive proximal muscle weakness ## Footnote It is linked to mutations in the dystrophin gene.
104
What is the developmental milestone for a baby at 6 months?
* Rolls over from back to front * Sits up steadily without support * Transfers toys from one hand to another ## Footnote These are key gross motor skills expected at this age.
105
What vaccinations are given at 2 months?
* Diphtheria * Tetanus * Pertussis * Polio * Haemophilus influenzae Type B * Hepatitis B * Pneumococcal disease (13 serotypes) * Rotavirus * Meningococcal group B ## Footnote These vaccinations are crucial for infant health.
106
What is enuresis?
Bedwetting ## Footnote It can be classified as primary (always wet) or secondary.
107
What is nephroblastoma?
The most common cause of abdominal mass in children, associated with Wilms' tumor ## Footnote Symptoms include lethargy, weight loss, and abdominal pain.
108
What are the signs of an inhaled foreign body?
* Sudden shortness of breath * Focal chest findings * Non-productive cough ## Footnote Immediate intervention may be required, especially for high-risk objects.

Medicine year 3 (38 decks)

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