Paeds Flashcards
(274 cards)
1
Q
most cases of achondroplasia occur as
A
sporadic mutation (70%). once present inherited in an auto dom fashion
2
Q
main rf for achondroplasia
A
advacing parental age at time of conception
3
Q
features of achondroplasia
A
large head with frontal bossing
narrow foramen magnum
flattened nasal bridge
tridents hands
lumbar lordosis
4
Q
acute epiglottitis most likley caused by h. infulenza….
A
type B
5
Q
thumb sign is
A
epiglottitis
6
Q
what is present in up to 50% of cases with ALL
A
fever
7
Q
differentials for testicular torsion in kids
A
inguinal hernia and epididymitis
7
Q
what confirms dx of ALL
A
bone marrow biopsy
8
Q
alpha thalassameia has hypochromic and mcirocytic. if 1 or 2 alleles affected
A
Hb normal
if 3 affected have splenomegaly (Hb H disease)
4 affected (death in utero)
9
Q
most common cause of ambigious genitalia
A
congenital adrenal hyperplasia
10
Q
When should you do Apgar score
A
1 & 5 mins
11
Q
normal apgar score
A
greater than 7
12
Q
first step for asthma in kids 5-11
A
ICS (2 times a day) + SABA (as needed)
kids under 5 = same but only for 8-12 weeks ans see if symptoms have resolved
12
Q
all children with asthma attack should be given steriod for how many days
A
3-5
12
Q
formoterol is a
A
LABA
13
Q
first step mx of ADHD in kids
A
10 week watch and wait
14
Q
ADHD meds can only be given if over
A
5y/o
14
Q
1.2.3 drug therapies for ADHD in kids
A
Methylphenitade, Lisdexamfetamine, Dexamfetamine
15
Q
adhd in adults
A
Methylphenitdade or lisdexamfetamine
16
Q
all adhd drugs are potentially
A
cardiotoxic
17
Q
weight and height in ADHD should be measured every
A
6 months
18
Q
in auto dom
A
only affected individuals can pass on disase and normally appears in every generation
19
Q
examples of auto dom
A
Huntingtons
marfans
retinoblastoma
Von Willebrands type 1 disease
20
Q
auto recess
A
if both parents affected - then 25% of affected 50% carrier and 25% unaffected
one parent affected (got gene) - all children will be carriers
20
auto recess
not in every generation may skip a generation
21
4 examples of auto recessive
Cystic fibrosis
Gilberts syndrome
haemachromatois s
sickle cell
22
benign rolandic epilepsy
seizures at night
EEG - centrotemporal spikes
prognosis excellent with seizures stopping by adolescence
23
how does bilairy atresia present
jaundice (beyond physiological 2 weeks)
dark urine and pale stools
may have appetite and growth disturbance
24
ix finding in biliary atresia
conjugated bilirubin is abnormally high
25
only definitive mx in biliary atresia
surgery
26
in bronchioloitis if grunting then need
immediate to hospital
27
age of peak incidence of bronchiolitis
3-6 months
27
mx of bronchioloitis
supprtive - ocyhgen via head box
ng tubing if not feeding
28
caphalohaematoma
presents a few hrs after birth
parietal region adn does not cross suture lines
may take 3 months to resolve
28
soft puffy swelling over vertex of head
caput succedaneum- resolves within a few days - presents at birth
29
most causes of cerebral palsy occur
antenatal
30
infectivity of chiekcnpox
4 days before rash and 5 days after rash
31
chicken pox is a rf for necrotising fasciitis and
Nsaids may increase this risk
32
particualry fractures where suggest child abuse
metaphyseal
32
when is heel prick test done
5-9 days
33
healthivisior take over from midwife at
2-4 weeks
34
how does scarlet fever present
strawberry tongue
rash - fine punctate erythema sparing around the mouth
35
extra fingers, small eyes
patau
35
overlapping of fingers, low seat ears, unusually small jaw
edwards
36
williams sydnrome
friendly extrovert personaluty
37
noonan syndrome
webbed neck
pectus excavatum
pulmoanry stenossi
38
what increases risk of cleft palate
maternal anti epileptic use
39
what is repaired earlier cleft lip or palate
lip
40
screening tests for coeliac in kids
anti endomysial and anti gliadin antibodies
41
diagnossi of coeliac
jejunal biopsy
42
what can cause resp distress shortly after birth
congenital diaphragamtic hernia
43
Fallot is more common that TGA however at birth
TGA is more common lesion as Fallot generallly present at around 1- 2months
44
Cyanotic heart disease
Tetraology of fallot
Transpostion of great arteries
tricuspid atresia
45
Ventricualr seeptal defects are more common than atrial septal defects, however in adult pts ASDS are
the more new common new diagnosis as they generally present later
46
CMV presents with
purputric skin lesions + sensorineural hearing loss
46
most common congenital infection in UK
CMV
47
toxoplasmosis preseents with
cerebral calcification, chorioretinitis
48
rubella presents with
sensorineural deafness, cataratc, heart disease pa
49
pt udner 16 can be given treatment if deemed compotent but cant
refuse treatemtn if seen in their best interests
50
red flag for constipation in infants
ribbon stools
51
mx of cows milk allergy if breastfeeding
mother stopping drinking cows milk. consider prescribing calcium supplements
51
cows milk prtein allergy/ intolerance
regurg and vomitting, irritability, diarrhoea
51
mx of cows milk if formula fed
first line is extensive hydrolysed formula. amino acid formula if no response
52
croup is most common in
AUTUMUN
53
what test can test for congenital cyanotic heart disease
Nitrogen washout test
54
what can be given for suspected congenital cyanotic heart disease until a definitive dx is made and surgical correction
prostaglandin eg alprostadil
55
cyanosisi in hands and feet and mouth in newborns is nornal for
up to 48hrs
56
Cf causes
increased viscocity of secrections from lungs and pancreas
57
msot common reason for false neg in sweat test for CF is
skin oedema due to hypoalbumaneia seconadry to pnacreatic exocrine insuffiency
57
features of CF
meconium ileus ( first stool is abnormally thick and sticky)
recurrent chest infection
malabsorption cuasing steatorrhoea
male infertility
58
what is a CF contraindication to lung transplantation
chronic infection with Burkholderia cepacia
58
mx of CF
twice a day chest physio and postural drainage
high calorie and fat diet
avoid otehr CF to reduce trasmitssion of Burkolderia cepacia and pseud
pancreatic enzyme supplemtns
59
what drug is used to treat CF if got the delta F508 gene
Lumacaftor/Ivacaftor
60
dermoid cysts typcially have
hair follciles that bud out
61
referral for developmental delay
no smile at 10 weeks
cannot sit on own at 12 months
cannot walk at 18 months
61
definitive dx test for DDH
US however if infant is >4.5months then xray is first line
62
DDH
most will spontaneosult reduce by 3-6 weeks
pavlik harness in children younger than 4-5 months
63
3 months - turns towards sounds
6 months - palmar grip
9 month s- points with finger & crawls
12 months - good pincer grip & waves bye bye - knows and responds to name
18 months - tower of 3
2 years - compotent with spoon and doesnt spill cup
64
msot common cause of gastroenteritis in kids
rotavirsu
65
most common cuase of chronic diarrhoea in infants is
cows milk intolerance
66
Klinefelters
high LH and low testosterone
67
kallman
Low Lh and testosterone
68
klinefleters
tall
small firm testes
chromsomal analysis
69
androgen insensitivity syndrome
geneticlaly male but female phenotype.
primarry amenorrhoea
undescended tests causing groin swellings
70
msot common cardiac complciation in downs
endocardial cushing defect(40%)
Vsd is 30%
70
what has repalced muscle biopsy as definitve dx of duchennes muscular dystrophy
genetic testing
71
ebsteins anamoly has
large atrium and small ventricle sometimes refered to as atrialisation of teh right ventricle
71
duchenne musclar dystriphy associated with
cardiomyopathy
72
ebsteins anaomly can persent with what murmur
pansystolci worse on inspiration
73
for eczema using emollient and steriod
emollient should be applied first followrs by waiting at least 30mins before the steriod
74
severe case of eczema in kids what oral can be used
ciclosporin
75
status epilepticus if longer than
30mins
76
when phone ambulance in febrile convulsions
seizure is over 5mins
77
mx of gord in babies
posiion of feeds - head up
try smaller and more freq feeds
78
gastroschisis
hole in tummy of baby
78
exomphalos
hole in tummy of baby with sac with abdo contents - do c section to reduce risk of sac rupture
79
gastroschisos should have urgent repair whereas exomphalos should have
delayed rapir
80
factors of growth
infnacy - insulin
childhood- GH and thyroxine
puberty - GH and sex steriod
81
what icnreases risk of haemorrhgaic disease of newborn
breast ded and maternal antieplieptics
82
newborns are given vit K shortly after birth either
Im or orally
83
in hand foot and mouth do they need to be kept off school
if they feel well they can go in
84
immedite CT in children after head inhury
vomit at least 3 times
85
dx head lice
fine combing
mx - only if lice arre found- malathion, wet combing
86
most common cause of primary headahce in chidlren
migraine without aura
86
what is thought to be moer eefective for paediatric migraine
ibuprofen
87
sumatriptan nasal spray is poorly tolerted in children due to
taste
87
triptans can be used in children older than
12y/o
88
oral triptans not licensed if udner
18
89
migraine prevention in ch9ldren
pizotidfen and propanolol
90
what test is done for newborn hearing screen
otoacoustic emission test
91
pure tone audiometry can be done when over
3y/o
92
important differnetila of childhood constipation
Hirschsrpungs dissease
93
gold ix for hirschsprungs
rectal biopsy
94
mx of hirschsprungs
intial can do rectal washout/bowel irrigation and defintiive is surg
95
homocystinuria
fine fair hair
treatmenr is vit B6 (pyridoxine)
96
hypospadias surg is done when
12 months fo age - essential child is not circumcised prior to surgery as the foreskin may be used in teh corective prceudre
97
petechial or purpuric rash in kids follwing infection
ITP?
98
child with ITO bone marrow examiantion only rquired if
lymph node enalrgement/ eplenomegaly
99
mx of ITP in kids
nada
99
when should vaccines be delayed
febrile illness
100
contraindications to live vaccines
preg, immunosupressed
100
diptheria, tetanus, pertusis vaccine should be deferred if evolving or unsatble
neurologcial condition
101
get MMR at
12 montsh
101
6 in 1 vaccine contains hep B and is given at
2,3,4 months
102
Men B vaccine given at
2,4,12 months
103
17/18 y/o get
Men ACWY vaccine
104
infantile colic
20% of infants - excessive crying and pulling up legs worse in evenign
105
infantile spasms
felxion of head, trunk and arms followed by extension of arms
106
first line for infantile spasms despite having poor prognosis
vabigatrin
107
innocent murmur in chidlren that has a continous blowing noise heard just beloe the claviclces
venous hums
108
ix of intussusception
US
109
first line in intussusception
reduction by air
110
most important test if got prolonged jaundice (>14days)
conjugated and uncojugated bilirubin as raised conjugated inidcates biliary atresia
111
when is jaundice physiological in newborns
2-14days
112
jaundice in first 24hrs is always
pathological
113
most common type of juvenile idiopathic arthritis
pauciarticular
113
causes of jaundice in the first 24hrs
rhesus haemolytic disease
ABO haemoltuc disease
herediatry spherocytosis
glucose 6 phosphodehydrgenase
114
juvenile idiopathic arthritis the systemic type has
salmon pink rash
115
features of kawasaki
fever> 5days
bright red cracked lips
stawberry tongue
cervica lymphadenoapthy
red palms of the hands and soles of the feet which later peel
115
mx of Kawasaki
aspirin
116
what is the inital screenign test you do in Kawasaki for coronary artery aneurysms
echo
117
osgood schlatter
pain over tibial tubercle
118
osteochondiritis dissecans
pain after exercise, intermittent swelling and locking
119
McCune albright syndrome
GNAS gene
precociosu puberty
cafe au lait spots
scarlet
119
laryngomalacia presents with
inspiratory stridor
99% of cases resolve spontaenlusy by 18-24 months
120
very rare complciation that can occur after measles 5-10 years after
subacute sclerosin pancencpahlaits
121
contact of measles not had avccine
give vaccine right away
122
meckels diverticulum
remnant of omphalomesenteric duct
123
what is the most common cause of painless massive GI bleeding requring a transfusion between 1-2 y/o
Meckel's diverticulum
124
presentation of meckels diverticulum
can mimic appendicitis
rectal bleeding
obstruction
125
meckels diverticulum is where
2 feet from ileocaecal valve
126
scan for meckels diverticulu,
technetium scan
127
meconium aspiration syndrome more common in bbaies that are
post term delivereis
128
Men B vaccine given when
2,4 and 12 months
129
contraindication to LP
rasied ICP
meningococcal septicaemia ( do blood cultures and PCR)
130
mengigntiis in kids
< 3months amox + cefotaxime (IV)
> 3months = Cefotaxime + steriods
fluids
131
in bacterial meningitis in kids dont give steriods if
< 3months
132
Mitochondrial disease inheitance
all of children of a affected female will inheit disease
non of the chidlren of an affected male will get the disease
132
antibiotic prophylaxis of meningitis for contacts
ciproflxacin
133
in mitrochondiral disease inheritance is only via
maternal line
133
muscle biopsy shows what in mitochondrial disease
red ragged fibres
134
MMR vaccine given at
12 months and 3 years
134
allergy to what is a contraindication of MMR vaccine
neomycin
135
nappy rash geenral mx
disposable nappies preferrable to towel nappie s
expose rash to air when possible
apply cream
136
candida causes of nappy rash characteristic is
satellite lesions
137
nappy rash can be caused by
irritant dermatis (most common type)
candida
seaborrhoeic dermatitis
psoriasis
138
napkin rash refers to
nappy rash
139
neck mass
thyroglossal cyst, brancial cyst, cystic hygroma (poste)
140
what imaging for necrotising enterocolitis
abdo xray
141
abdo xray of nec entero show
dilated bowel loops
pneumatosis intestinalis ( intramural gas)
air both inside and outside the bowel wall and air outlining the falciform ligament
142
most common cuases of neonatal sepsis
Group B strep and E.coli
143
what is common
transient ypoglycaemia in teh first few hours after birth
143
jitteriness in a baby may suggest
hypoglycaemia
144
what will usually establish the diagnosis in neonatal sepsis
blood cultures
144
resp distress is how
neonatal sepsis presents with grunting for example
145
first line for neonatal sepsis
IV benxylpenicillin with gentamicin
146
first breaths in neonatal resus
inflation. then if HR<60 start compression and ventilation breaths at a rate of 3:1
147
children under age of 5 peeing themselves
reassurance - normal until 5
148
first line for nocturnal eneuresis in kids
eneruresis alarm
desmopressin if short term needed
149
Noonan has alot of the feeatures of turners ( webbed neck, widely spaced nipples, short stature pectus excavatum) but also
pulmoanry valve stenosis
150
flat feet
often resolves by 4-8y/o
151
intoeing
usually resolves itself
151
bow legs and knock knees (genu varum and valgum)
typically resovle overtime (bow at 4-5y/o)
152
Blounts disease
bowing of legs
153
opthalmia neonatorum
same day assessment
153
obesity
>91centile
>98
153
mx of oscgood schalteer
supportive
154
in kids check pulse
femoral
155
surgery for pyloric stenosis
Ramstedt pyloromyotomy
156
ladds procedure done for
intestinal malrotation
157
jaundice >14 dyas
increased conjugated bilirubin
Urgent Kasai procedure
biliary atresia
157
delayed passage of meconium and abdo distension
Hirschsprungs disease
157
meconium ileus
majority have CF
xray shows will not show fluid level
mx - PR contrast and NG N-acetly cysteine
158
main rf of necrotising entercolitis
prematurity
158
ealry features - abdo distension and passage of bloody stools
xray - pneumatosis intestinalis and evidence of free air
Mx - total gut rest and TPN
159
in SUFE
limitation of internal rotation
159
mx of SUFE
bed rest and non weight bearing
160
DDH on xray
Shenton lines should form a smooth arc
160
Omphalitis is
infection of the umbillicus
161
urachus
urianry discharge from umbillicus
161
persisten vitello intestinal duct
umbilical dischage of small bowel content
162
other features of pDA part from continois machienry murmru
left subclavciualr thrill
large volume, bounding, collapsing pusle
163
mx of PDA
Preterm- try let it rsilve itseld however if haemodynacmically significant then ibuprofen, indoemtahcin or paracetmol given to the motehr in the antenatal period
term- transcatheter PDA closure ( ibuprofen / indmethacin) not effective in term infants
if PDA is associated with another congenital heart defect amenable to surgery then Prostaglandin E1 is useful to keep the duct open until after surgical repair
164
still born if after
24 weeks
165
mx of perthes
<6 then observe
165
Phenylketonuria presents with
fair hair and blue eyes
musty odour to urine and sweat
166
the guthrie test as part of heel prick test can pick up
phenylketonuria
167
first line for all children with pneumonia
amox
macrolides can be addded
macrlides should be used if mycplasma or chlamydia is suspecetd
if asscoaited with flu then co-amoxiclav is recommendd
168
wheeze in kids can try
saba if its episodic
ICS if multiple trigger wheeze
168
prader willi gene delelted from
father
angelman deleted from mother
169
precociosu puberty if
before 8 in female s
before 9 in males
170
precocoius puberty in females
mccune albright
170
thelarche
first stage of breast developemnt
171
adrenarche
first stage of pubic hair developemtn
172
male puberty
first sign is testiculr grwoth
around 12 (15 max)
172
female puberty
first sign is breast sevelopent around 11.5
menarche at 13 (max 15)
173
diagnsosi of pyloric stenosis made by
US
174
hypocholaemic hypokaalemic alkalsosis in
pyloric stenosis
175
abscence of red reflex replaced by a white pupil
retinoblastoma
176
reflex anoxic seizure
syncope epside as a result to pain or emotional stimuli
no treatmetn and prognossi sis excelelnt
occurs in those 6 months -3 years
177
mx of rickets
oral Vit D
178
rickets casusing wisening of wrist joints knwon as
rickety rosary
- raised ALP
179
roseola infantum
HHV6
high fever follwed by rash, spots of uvula and soft palate(6months -- 2years)
180
scarlet fever
stawberry tongue
fine punctare erthema (pinhead)
flushed appearance with circumoral pallor
sandpaper
- antibitoics immediately ratehr than awaiting results
180
roatvirus vaccine is
live
- 2 doses one at 2 months and second at 3 months
shuldnt be given late as risk of intusscueption
181
mx of scarlet fever
oral penicllin - can return to school 24hrs after starting antibitocis
otitis media is most common complciation
rhematic fever ccurs 20 days afetr infection
182
seaborrhiec dermatitis (craddle cap)
reassurance ususaly rssolves within a fe weeks
topcial emollient
182
kocher criteria
septic arthritis in kids
183
shaken baby triad
retinal haemorrhage, subdural haematoma, encephalopathy
184
plagiocephaly head
angled
185
premature fusion of skull bones
craniosynostosis
186
imaging of SUFE can be described as
frogs legs
187
mx of SUFE
internal fixation
188
croup - parainfleunza
autumn
189
laryngomalacia
infants present at 4 weeks of age with stridor
190
commonest cause of death in first year
sudden infant death syndroem
191
what is protective against sudden infant death syndrome
use fo dummies
192
following a cot death siblings should be
screened for potential seosus and inborn errors of metabolism
193
CXR is surfactant deficiency lung disease
ground glass appearnace with indistinct heart border
194
prevention of surfactant deficiency lung disease
maternal steriods
195
most common cuase of congenital cyanotic heart disease
tetralogy of fallot
195
tetraology of fallot
VSD
right ventricualr hypertrophy
pulmonary stenossi
overriding aorta
196
TOF is
misalignemnt of the aorticopulmonary septum
197
what determienes teh degree of cyanosis in tetralogy of fallot
right ventricualr outflow obstruction (puomaory stenosis?)
198
TOF can have
tet spells- loss of cociousness
cxr- boot shaped heart
199
tof mx
surgery
beta blcokers can helo cyanotic episodes
200
therapetic cooling used in
neonatal hypoxic ischaemic encephalopathy
200
at birth transpositon of greta arteies is moe commiin at birth as TOF generlly presnets at
1-2 months
201
mx of threadworms
treat all members of hosuehold
202
treatment for threadworms
Mebendazole
203
presence of what should make you investigate septic arthritis and not just transient synvotiis
fever
204
transpotsion of great arteries
loud single S2
prominent right ventricualr impulse
egg on side appearance on cxr
mx - prostaglandisn
205
transient tachypnoea of newborn
c sections
hyperinflation of lungs and fluid in horizontal fissure
mx - supprtice ussually settles within 1-2 dyas
206
trinuceltide repeat disroders
fragile X
Huntingtons
myotonic dystphy
friedrichs ataxia
207
what trinucelotide disorder does not have antcipation
friedrichs ataxia
208
msot serious long term health problems for thosw with turners
aortic dialtation and dissection
209
in turners
lymphoedema in feet in neonats
gonadotrophins will be elevated
horseshoe kidney is the most common renal abnormality
210
unilateral undescended testes should be referred from
3 months of age
bilateral should be seen within 24hrs urgent
210
mx of umbilicial hernia in kids
nothign as usualy resolve by 3 months
211
msot common organism for UTI in kids
E.coli
212
vesicoureteric reflux in kids
seen in 35% of chidlern who present with a uti
retrograde flow of urine from bladder into ureters and potentially to kidney
213
Uti is more commoner in girls but when is it more common in boys
<3 motnhs of age
213
baby <3 minths present with UTI
referr imeddiate to paediatrician
214
vesicoureteric reflux daignsoed by a
micturating cystourethrogram
215
kid follwing a UTI should investigate for vesicureteirc reflux so do
micturating cystourthrogram
216
other scan - DMSA to look for renal scarring
associated with cortical thinnign
217
mx of whooping cough
oral macrolide if onset within 21 days
is a notifiabe disease
218
whooping cough school exclsuion
48hrs after starting antibitoc
218
women offered whooping cough vaccine between
16-32 weeks
219
dx of williams syndrome
FISH studies
220
child with unexapliend abdo mass
wilms tumour - paediatric review within 48hrs
221
most alport syndrome arre
X linked dom
222
X linked recessive
only males affectd
transmitted by females (carriers)
male to male transmission is not seen
boy of carrier mother has 50% chance of being affected and each daughtter has 50% chance of being a carrier
affcetd males can only have unaffceted sons and carrier daughters
223
x linked recessive
duchennes
G6PD def
HAmeohphilia A and B
