Paeds 4 Flashcards
(137 cards)
1
Q
Average age for running as a gross motor developmental milestone?
A
16m to 2y
2
Q
Average age for riding a tricycle with pedals?
A
3y
3
Q
How far apart should MMR vaccines be given (if not in routine schedule)?
A
3 months apart
4
Q
What are the 2 most serious long term heakth problems for women with Turner’s?
A
1) aortic dissection
2) aortic dilatation
5
Q
Why may patients with Turner’s syndrome develop X-linked recessive conditions?
A
As they only have 1 X chromosome
6
Q
What imaging is 1st line for DDH in children >4.5 months?
A
Xray
7
Q
Typical age that a child can pull to stand?
A
8-10 months
8
Q
Typical age that a child can hop on one leg?
A
3-4y
9
Q
Typical age that a child can squat to pick up a ball?
A
18 months
10
Q
What murmur is heard in Ebstein’s anomaly?
A
The posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the RV.
1) Tricuspid regurg –> pansystolic murmur
2) Tricuspid stenosis –> mid-diastolic murmur
There is also enlargement of the RA.
11
Q
1st line Abx for pneumonia in children where Mycoplasma pneumonia is suspected?
A
A macrolide e.g. erythromycin
12
Q
When should a c-section be planned for in exomphalos?
A
37 weeks
13
Q
what term is used to describe the mode of inheritance for Prader-Willi syndrome?
A
Imprinting
For this disease to occur, the patient does not receive the gene from their father. The mother’s gene may be normal, but that does not prevent the phenotype occurring.
14
Q
What 3 infections can cause HUS?
A
1) E. coli (Shiga toxin)
2) HIV
3) Pneumococcal
15
Q
What is the criteria for a very urgent referral (for an appointment within 48 hours) in regard to Wilms’ tumour?
A
1) Palpable abdominal mass
2) Unexplained haematuria
3) Unexplained organomegaly
16
Q
Referral time in suspected Wilm’s tumour?
A
<48h
17
Q
What mutation is the cause of ARPKD?
A
Polycystic kidney and hepatic disease 1 (PKHD1) gene on chromosome 6.
18
Q
What is the most common site of metastasis in Wilm’s tumour?
A
Lung
19
Q
What is a posterior urethral valve?
A
Tissue at the proximal end of the urethra (nearest bladder) that causes obstruction of urine.
20
Q
How can severe posterior urethral valve present in utero?
A
1) Bilateral hydronephrosis
2) Oligohydramnios –> lung hypoplasia (resp failure shortly after birth)
21
Q
Give some risk factors for cryptorchidism
A
- prematurity
- low birth weight
- maternal smoking during pregnancy
- other abnormalities of genitalia e.g. hypospadias
- FH (1st degree)
22
Q
What does the epididymis drain into?
A
Vas deferens
23
Q
What are 2 key side effects of quinolones (e.g. ciprofloxacin)?
A
1) lowers seizure threshold
2) tendon damage & rupture (Achilles)
24
Q
Should you wait for swab results before treating epididymo-orchitis?
A
No - treat empirically
25
How quickly should surgery occur in testicular torsion?
Within 4-6h of pain onset (due to risk of irreversible testicular necrosis).
26
What is epididymo-orchitis in individuals with a low STI risk usually due to?
Enteric organisms e.g. E. coli --> get MSU
27
What is Prehn's sign?
Elevation of testicle does not ease pain (testicular torsion)
28
Mx of intermittent testicular torsion?
Consider bilateral orchiopexy (prophylactic)
29
What is paraphimosis?
When the foreskin cannot be returned to its original position after being retracted.
It causes the glans to become painful and swollen.
In severe cases, circumcision may be required to treat it.
30
When do hydroceles typically resolve by?
1-2 y/o
31
What is a varicocele a significant risk factor for?
Male infertility
32
What can a varicocele be a presenting feature of?
Renal cell carcinoma (due to compression of the renal vein between the abdominal aorta and the superior mesenteric artery) .
33
What is a epididymal cyst?
A cause of scrotal swelling which can be palpated as separate from the body of the testicle.
Found posterior to the testicle.
34
Give 3 associated conditions with epididymal cysts
1) polycystic kidney disease
2) cystic fibrosis
3) von Hippel-Lindau syndrome
35
Average age of diagnosis of retinoblastoma?
18m
36
Inheritance of retinoblastoma?
Autosomal dominant (around 10% of cases are hereditary)
37
Most common presenting symptom of retinoblastoma?
Absence of red reflex, replaced by white pupil (leukocoria)
38
Prognosis of retinoblastoma?
excellent, with >90% surviving into adulthood
39
3 key features of congenital rubella?
1) PDA
2) Sensorineural deafness
3) Congenital cataracts
40
When is bone marrow biopsy required in ITP?
Only if there is atypical features e.g. splenomegaly, failure to respond to treatment, lymph node enlargement
41
Mx of chickenpox?
Management is through supportive measures, including calamine lotion to soothe the itch and paracetamol to control the fever.
42
When is croup more common?
Autumn
43
Which childhood infection can cause suboccipital and postauricular lymphadenopathy?
Rubella
44
which antiepileptic can cause osteomalacia?
phenytoin - due to vitamin D deficiency
45
Which antiepileptic can cause megaloblastic anaemia?
phenytoin - due to vitamin D deficiency
46
What 2 medications are involved in mx of infantile spasms?
1) Vigabatrin
2) Prednisolone
47
What are infantile spasms usually 2ary to?
Usually secondary to serious neurological abnormality (e.g. tuberous sclerosis, encephalitis, birth asphyxia).
Can also be idiopathic.
48
What is the most common cause of a 1ary headache in children?
Migraine without aura
49
What condition have breath holding spells been associated with?
Iron deficiency anaemia
50
What can be used for excessive drooling in CP?
Glycopyrronium bromide or hyoscine hydrobromide
51
What 2 tests can be used to diagnose a squint?
1) cover test
2) Hirschberg's test
52
Give 4 postnatal causes of CP
1) Hyperbilirubinaemia (kernicterus)
2) Intraventricular haemorrhage
3) Meningitis
4) Head trauma
53
What is a significant intrapartum risk factor for CP?
Prematurity
54
Give 4 intrapartum risk factors for CP
1) Birth asphyxia/trauma
2) Prematurity
3) Low birth weight
4) Neonatal sepsis
55
When can you consider stopping anti-epileptic drugs?
How long should you stop them over?
Seizure free for >2 years
Stop drugs over 2-3 months
56
What is max weight for using formula to calculate maintenance fluids?
75kg
57
How to calculate estimated weight?
EW = (age + 4) x2
58
At what age is it recommended to include dex in mx of bacterial meningitis?
>3m
59
when is insulin started in DKA in paeds?
After 1 hour of fluid therapy
60
How can percentage dehydration be calculated by weight?
% dehydration = (well weight (kg) - current weight (kg)) / well weight then x 100
61
What is an umbilical granuloma?
An overgrowth of tissue which occurs during the healing process of the umbilicus.
It is most common in the first few weeks of life.
62
Presentation of an umbilical granuloma?
On examination, a small, red growth of tissue is seen in the centre of the umbilicus.
It is usually wet and leaks small amounts of clear or yellow fluid.
63
Mx of an umbilical granuloma?
It is treated by regular application of salt to the wound.
If this does not help then the granuloma can be cauterised with silver nitrate.
64
What is the most common cause of nappy rash in infants?
Irritant dermatitis
65
Mx of meningitis <3m?
IV cefotaxime + amoxicillin
66
Mx of child <16 refusing treatment?
Those over 16 can consent to treatment, but cannot refuse treatment under 18 unless there is one consenting parent, even if the other disagrees.
67
When do the majority of cases of cow's milk protein intolerance/allergy resolve?
By age of 5y
68
Mx of ITP for children with petechia/purpura only and no significant bleeding?
None
69
Mx of household contacts of patients with head lice?
Do not need to be treated unless they are also affected
70
Does dose a raised immunoreactive trypsinogen result on a heel prick test indicate?
CF - do a sweat test
71
3 most common fractures in paesd associated with NAI?
1) radial
2) humeral
3) femoral
72
Mx of umbilical hernias?
Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic peform elective repair at 4-5 years of age.
73
Chest compression rate in paeds BLS?
100-120
74
At what age are most children are able to briefly stand on one leg?
3y
75
At what age are most children toilet trained?
3 years
76
At what age can a child typically pull to stand?
8-10 months
77
At what age can a child typically squat to pick up a ball?
18 months
78
At what age can a child typically hop on one leg?
3-4 years
79
At what age does a child typically respond to their own name?
9-12 months
80
At what age does a child typically have a vocabulary of 2-6 words?
12-18 months
81
At what age can a child typically talk in short sentences (3-5 words)?
2.5-3 years
82
At what age does parallel play typically present?
2 years
83
At what age does a child typically play with other children?
4 years
84
At what age doe a child typically wave bye bye ?
12 months
85
At what age does a child typically play peek a boo?
9 months
86
At what age does a child typically run?
16m - 2y
87
At what age does a child typically turn towards loud sounds?
6 months
88
When does the moro reflex typically disappear?
The Moro reflex, or startle reflex, usually disappears around 3–4 months, and should no longer be elicited past 6 months of age.
89
At what age should a child be able to build a 3 block tower?
18 months
90
At what age should a child be able to build a 6 block tower?
2 years
91
When should you refer an infant with a squint?
8 weeks
92
When doe a child typically 'fix and follow'?
6 weeks
93
Limit age for a child to 'fix and follow'?
3 months
94
What Abx is a common cause of haemolysis in patients with G6PD deficiency?
Ciprofloxacin
95
Blood cultures for infective endocarditis in paeds?
3 sets of blood cultures from 3 different sites on 3 separate days
96
describe Levine's grading of a heart murmur
Grade I - very faint, may only be heard by an expert, not heard in all positions, no thrill
Grade II - soft, heard in all positions, no thrill
Grade III - moderately loud, no thrill
Grade IV - loud and associated with a palpable thrill
Grade V - very loud, with thrill, heard with stethoscope partly off chest
Grade VI - loudest, with thrill, heard with the stethocope entirely off chest (just above precordium, not touching skin)
97
What are the 3 distinct parts of the Moro reflex?
1) spreads out their arms
2) pulls their arms back in tight to their chest
3) starts crying
98
Startle reflex vs Moro reflex?
The startle reaction is induced by an auditory stimulus which shows clear habituation in premature infants, whereas the Moro reflex does not stimulate due to any auditory cues.
99
What condition associated with seizures is associated with Port Wine stains?
Sturge Weber syndrome (SWS)
100
What is Sturge Weber syndrome?
A condition in which there is usually a birthmark (port wine stain) involving the forehead or eye lid area, a layer of extra blood vessels over the surface of the brain (pial angioma) and sometimes extra blood vessels in the lining of the eye (choiroidal angioma).
101
What 2 prokinetics may be used in GORD in paeds?
1) Domperidone
2) Erythromycin
102
At what age is an MCUG performed in UTI?
<6m old
103
What is the most useful diagnostic test to confirm the suspicion of rheumatic fever?
Throat culture for GAS
104
What is the most appropriate long-term management strategy to prevent recurrence and potential complications in rheumatic fever?
2ary prophylaxis with long-term penicillin (IM benzathine penicillin or oral penicillin V)
105
What age does bleeding caused by Meckel's diverticulum typically affect?
1-2 y/o
106
How may an older child with missed DDH present?
Trendlenberg gait & leg length discrepancy
107
1st line mx of GORD in a breastfed baby?
1-2 week trial of an alginate e.g. Gaviscon
108
1st line mx of GORD in a bottle fed baby?
1-2 week trial of feed thickener
109
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers.
What syndrome?
Edward's
110
What are some features suggestive of hypernatraemic dehydration?
- jittery movements
- increased muscle tone
- hyperreflexia
- convulsions
- drowsiness or coma
111
Typical age that a child will:
a) combine 2 words
b) ask 'what' and 'who' questions
c) ask 'why', 'when' and 'how' questions
a) 2 years
b) 3 years
c) 4 years
112
What is JIA called if diagnosed >16 y/o?
Still disease
113
Mx of a simple sickle crisis with an obvious trigger?
IV fluids (for rehydration) and pain relief
114
Sickle cell disease:
Reticulocyte count in aplastic crisis vs acute splenic sequestration?
Aplastic crisis --> low reticulocyte count
Acute splenic sequestration --> raised reticulocyte count
115
What are the main components for managing sickle cell crisis?
1) O2
2) Analgesia
3) Fluids
4) + Abx if fever
5) Transfusion if Hb low
116
When is sequestration crisis in sickle cell most common?
In early childhood as repeated sequestration and infarction of the spleen during childhood gradually results in an auto-splenectomy.
117
Features of a sequestration crisis in sickle cell?
- severe anaemia
- marked pallor
- CVS collapse (due to loss of effective circulating volume)
118
What vaccine should sickle cell patients receive?
Sickle cell patients should receive the pneumococcal polysaccharide vaccine every 5 years
119
What conditions can a decrease in haptoglobin levels be seen in?
Intravascular haemolysis e.g. G6PD deficiency, autoimmune haemolytic anaemia and HELLP syndrome
120
Does sickle cell cause extra or intravascular haemolysis?
Extravascular
121
What can be given to reduce the incidence of complications and acute crises in sickle cell?
Long term hydroxycarbamide/hydroxyurea
122
What type of anaemia does sickle cell cause?
Normocytic anaemia with raised reticulocyte count
123
How can a definitive diagnosis of sickle cell be made?
Haemoglobin electrophoresis
124
What causes headlice?
Parasitic insect --> Pediculus capitis
125
How can a diagnosis of headlice be made?
Fine toothed combing of wet or dry hair
126
Mx of headlice?
A choice of treatments should be offered - malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone.
Note - household contacts of patients with head lice do not need to be treated unless they are also affected
127
Is school exclusion advised for children with head lice?
No
128
What are the major risk factors for SIDS?
- prone sleeping
- parental smoking
- bed sharing
- hyperthermia and head covering
- prematurity
129
How can plagiocephaly be differentiated from craniosynostosis?
The ear moves around with the skull in plagiocephaly vs fixed in craniosynostosis
130
What conditions are associated with neonatal hypotonia?
- neonatal sepsis
- Werdnig-Hoffman disease (spinal muscular atrophy type 1)
- hypothyroidism
- Prader-Willi
also:
- maternal drugs e.g. benzos
maternal myasthenia gravis
131
Define ophthalmia neonatorum
Conjunctivitis <28 days old --> always refer to ophthalmology for same day assessment
132
Investigations in Perthe's disease?
Xrauy of hips
If no evidence - MRI
133
Why are babies with Pierre-Robin syndrome placed prone?
Triad of:
1) micrognathia (undersized jaw)
2) glossoptosis (posterior displacement of the tongue)
3) cleft palate
This places the tongue at a higher position than normal which can obstruct the airway or interfere with feeding.
Prone position reduces chance of upper airway obstruction.
134
Inheritance of achondroplasia?
Autosomal dominant
135
What is the main risk factor for a sporadic mutation causing achondroplasia?
Advancing paternal age at the time of conception
136
Mx of children with pneumonia if mycoplasma is suspected?
A macrolide e.g. erythromycin
137
At what age does infantile colic normally resolve by?
6 months
