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Paeds Flashcards

1
Q

Hirschsprung’s disease define

A

Congenital absence of ganglia in a segment of colon

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2
Q

what’s in a septic screen?

A

bloods - WCC, CRP
blood cultures
LP
urine

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3
Q

why do you do an LP in a septic screen?

A

to exclude meningitis

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4
Q

how do you obtain a urine sample in a child?

A

clean catch
OR subrapubic aspirate
OR catheter

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5
Q

CSF shows ^WCC, ^protein, low glucose. Does this picture suggest a bacterial or viral infection?

A

bacterial

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6
Q

CSF shows WCC 50, normal protein and glucose. Does this picture suggest a bacterial or viral infection?

A

viral

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7
Q

gram negative diplococcus on LP culture

A

neisseria meningitidis

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8
Q

what causes the purpuric rash of meningococcal septicaemia

A

DIC

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9
Q

what does GP give in community for suspected meningitis?

A

IM benzylpenicillin

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10
Q

what supportive care may a child need in ITU following ^^fluids

A

O2

dialysis

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11
Q

prophylaxis for meningitis contacts

A

rifampicin or ciprofloxacin

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12
Q

contraindications/side effects of rifampicin

A

interacts with contraceptive pill
stains contact lenses
stains urine red

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13
Q

how is neisseria meningitidis passed on to contact

A

aerosolized

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14
Q

2 yr old
malaise, pallor, reduced appetite, febrile, rash
L thigh soreness, reluctant to weight bear
Differentials

A

systemic JIA [juvenile idiopathic arthritis]
septic arthritis
ALL

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15
Q

what aspect of examination is important in a child with JIA? and why

A

opthalmology

JIA associated uveitis

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16
Q

Tx for JIA

A 
NSAIDs
corticosteroid intra-articular injection
systemic steroids
methotrexate
TNF alpha inhib e.g. inflix
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17
Q

fever, red eyes/injected conjunctiva, sore mouth & throat, red cracked lips, strawberry tongue, maculopapular rash, cervical swelling, swollen red palms
Dx? differential?

A

Kawasaki disease

scarlet fever

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18
Q

management of kawasaki disease

A

IVIG

aspirin

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19
Q

complications of IVIG

A

anaphylaxis

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20
Q

complications of aspirin

A

bruising, nosebleed

reyes syndrome

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21
Q

reye’s syndrome

A

encephalopathy and liver failure following viral illness

^by aspirin

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22
Q

4 Sx of bowel obstruction

A

Vom
Pain
X opening bowels
Distension

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23
Q

Bilious vomiting - worry about?

A

MALROTATION

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24
Q

nephrotic syndrome - what do you see 1. Symptom, 2. in blood, 3. in urine

A
  1. oedema
  2. hypoalbuminaemia, hyperlipidaemia
  3. proteinuria
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25
Mx steroid sensitive nephrotic syndrome
``` prednisolone pneumococcal vaccine varicella titres pen V diuretics Na/H2O moderation ```
26
renin, angiotensin, ACE, aldosterone do what
salt and water retention, ^BP
27
signs and Sx of glomerulonephritis (urine, blood, systemic)
proteinuria, haematuria, ^blood creat, HTN, oedema
28
oedematous child 10 days post nasopharyngeal infection. Dx? organism?
Acute post-streptococcal glomerulonephritis | group A beta haemolytic strep
29
Acute post-streptococcal glomerulonephritis Ix
urinalysis (haem,protein) microscopy (RBC casts) FBC (anaemia) U+E (^creat, urea)
30
Treatment of paeds post-strep glomerulonephritis, and what about if there was encephalopathy/
Na+ restrict diuretics antihypertensives penicillin nitroprusside [enceph]
31
what is henoch schonlein purpura and what areas does it affect?
vasculitis. skin, joints, kidneys, gut
32
what causes HSP nephritis?
IgA deposition
33
Sx of lower tract UTI in paeds
dysuria, ^freq, haematuria, low abdo pain, incont
34
Sx upper tract UTI in paeds
loin/abdo pain, fever, malaise, vom
35
what do you expect on UTI dipstick
nitrites, WBC
36
UTI Mx in paeds
Abx, fluids, pain relief, image for underlying abnorm
37
what is Vesicoureteric reflux
retrograde reflux of urine from bladder into ureter/kidney
38
what is a dangerous side effect of giving a child too much IV fluids
cerebral oedema
39
what GCS is indication to intubate?
8
40
fluids for 5% dehydrated child
4ml/kg/hr for 1st 10kg 2ml/kg/hr for next 10kg if dehydrated, add 50ml/kg/day
41
DKA initial management
IV fluids | insulin 1-2 hrs after fluid administration
42
neonate 10 days of age. Raised TSH. Diagnosis?
congenital hypothyroidism
43
most common cause of congen hypothyroidism in uk, consanguinous, and worldwide
uk - dysgenesis consang - dyshormonogenesis world - iodine def
44
what investigation could you perform to differentiate dysgenesis and dyshormonogenesis in congen hypothyroid
radioisotope US
45
consequence of congen hypothyroid that screening has helped prevent
cretinism [mental and physical retardation]
46
Tx for congen hypothyroidism
levothyroxine
47
congenital adrenal hyperplasia sign on physical exam
ambig gen
48
why is CO2 low in met acidosis?
hyperventilation to correct ^acid by breathing out CO2
49
blood gas - pH 7, CO2^
resp acidosis
50
what blood gas derangement do you see in congen adrenal hyperplasia and why?
met acidosis | low aldosterone -> fluid loss, low Na, ^K
51
describe congen adrenal hyperplasia
disorder of the adrenal gland. deficiencies in enzymes required for the production of the steroid hormones [cortisol/aldosterone]
52
antenatal Tx for adrenal hyperplasia
dexamethasone
53
postnatal Tx of confirmed CAH
hydrocortisone, fludrocortisone, sodium chrloride
54
define wheeze
expiratory | whistling/polyphonic
55
causes of paediatric wheeze
Persistent infantile wheeze Viral episodic wheeze Asthma CF, chronic lung, aspiration, tracheobronchomalacia
56
Tx acute asthma
``` O2 salbutamol [neb] ipatropium bromide[atrovent] pred 1mg/kg IV salb aminophylline/MgSO4 ```
57
causes of poor Tx response in paeds asthma
``` Compliance Bad disease Choice of drugs/devices Diagnosis Environment ```
58
risks of long term inhaled corticosteroid use
Adrenal suppression Growth slowing Osteoporosis?
59
important environmental factors not to be missed in wheezy children
smoking, pets
60
how does viral wheeze differ from asthma
NO interval Sx NO excess atopy improve w/age regular inhaled steroids don't help
61
child with diff. breathing, neck extended, drooling. Dx?
epiglottitis
62
how is pneumonia diagnosed in a child over 3 years
history of cough +/- diff breathing <14 days | ^RR
63
usual cause croup
para-influenza virus
64
barking seal-like cough. Diagnosis?
croup
65
Tx of croup
oral dexamethasone/pred > inhaled budesonide
66
common bacterial cause of pneumonia in children
Strep pneumoniae S. aureus Klebsiella pneumoniae
67
why is epiglottitis now rare
HiB vaccine
68
most common viral cause of pneumonia in children. 1 other
RSV | influenza
69
define hypochondroplasia
hereditary. Retarded growth of long bones
70
first sign of normal puberty in boys and girls
breast buds | testicular enlargement
71
what age is defined as early and delayed puberty in boys and girls
girls <8, >13 | boys <9, >14
72
factors that affect birth weight
``` Maternal size + weight Parity Gestational diabetes Smoking Paternal size ```
73
paeds: causes of short stature
``` psychosocial endocrine disease e.g. cushings short parents delayed puberty low birth weight chronic disease ```
74
what is stridor?
high pitched inspiratory sound | due to obstruction of larynx/large airways
75
how does wheeze differ from stridor?
wheeze is polyphonic/musical wheeze expiratory smaller airways takes long time to breathe OUT
76
differential diagnosis from stridor
``` viral croup bacterial tracheitis epiglottitis foreign body laryngomalacia ```
77
what should you NOT do in a child with stridor
upset/ attempt to examine throat -> complete obstruction
78
age range for croup
6months to 6 years
79
what is the pathophysiology of croup?
subglottic oedema, inflammation, exudate
80
causes of breathing difficulties in 6 month old
bronchiolitis pneumonia cardiac failure
81
main cause of bronchiolitis and other cause
Respiratory synctial virus | mycoplasma, paraflu, adenovirus
82
who is at ^risk of bronchiolitis
less than 6 months chronic lung disease congen heart dis immunodef
83
investigations for bronchiolitis
nose swab RSV
84
Mx of bronchiolitis
O2 NGT CPAP intubate/ventilate
85
prevention of bronchiolitis
palivizumab monthly IM
86
how would you manage bronchiolitis-type illness differently if the child had CF?
give Abx [even if it might be viral]
87
what conditions are included in the newborn heel prick?
``` CF sickle cell congen hypothyroidism MSUD PKU MCADD IVA GA1 HCU ```
88
what is the mode of inheritance for CF
autosomal recessive
89
pathophys behind CF
mutation in CF gene on chromosome 7 that codes for CFTR protein Na/Cl channel = thick mucus
90
describe some body systems affected by CF and how
GI - meconium ileus, steatorrhoea resp - like bronchiectasis, recurrent pneum pancreas - exocrine insufficiency poor growth/failure to thrive
91
mx of VSD
furosemide, 2nd line ACEi/ digoxin surgical closure if large
92
where does PDA go to and from
aorta to pulm artery
93
describe the initial immediate paediatric life suport steps for an unresponsive child
``` shout for help open airway 5 rescue breaths 15 chest compressions CPR 15:2 call resus team ```
94
in a choking child, who is now unconscious, what is your initial step
open the airway check for foreign body 5 rescue breaths CPR 15:2
95
in a choking child who is conscious, what is your initial management?
5 back blows 5 chest/abdo thrusts check for foreign body
96
name some organic and non-organic causes of faltering growth
non-org - neglect, poor feeding technique, short stature | organic - CF, heart defect, Downs, UTI, CP, diarrhoea
97
Ix faltering growth
``` FBC [anaemia] urine dip [then culture to confirm UTI] UandE LFT coeliac screen TFT glucose ```
98
normal amount of milk for child
150ml /kg /day
99
what parameters will be raised on a urine dip in UTI
nitrites, leucocytes
100
2 usual organisms for paeds UTI
E. coli | Klebsiella
101
treatment of paediatric UTI >3 months old
trimepthoprim
102
paeds UTI, done urine dip and culture. Potential further Ix and why?
US kidney for reflux/ hydronephrosis DMSA scan for scarring MCUG for reflux
103
5 yr old starts soiling herself at school, unaware she's doing it, L iliac fossa mass. Diagnosis?
overflow secondary to constipation
104
name 5 causes of diarrhoea in children
``` breast feeding gastroenteritis thyrotoxicosis IBS intesusception crohns coeliac CF food intolerance overflow sec to constip ```
105
Mx of diarrhoea due to overflow secondary to constipation
movicol diet toilet behaviour
106
4 yr old, swelling of face ankles and scrotum. Proteinuria, no blood. Diagnosis?
nephrotic syndrome
107
causes of proteinuria in chldren
orthostatic proteinuria nephrotic syndrome glomerulonephritis
108
how do you distinguish nephrotic syndrome and glomerulonephritis on urinalysis
neph - protein | glom - protein and blood
109
diagnostic criteria for nephrotic syndrome
hypoalbuminaemia proteinuria peripheral oedema
110
Ix for neph syndrome
urine dip U and E BP complement/ immunoglob levels
111
Mx of nephrotic syndrome
``` pred fluid and salt restrict if v oedematous then diuretics penicillin due to low imm pneumococcal vaccine ```
112
signs of resp distress
Tachypnoea, subcostal recession, intercostal recession, nasal flaring, head bobbing, tracheal tug, cyanosis
113
4 domains of the developmental examination
Gross motor Fine motor and vision Speech and hearing Social & emotional
114
where is erythropoetin released and in what instance
kidney due to low blood O2
115
what happens in erythroblastosis fetalis [ haemolytic disease of the newborn.]
Rh-ve mother previously sensitised to Rh+ve cells, Transplacental passage of antibodies, Haemolysis of fetal cells
116
erythroblastosis fetalis [ haemolytic disease of the newborn.] signs and symptoms
anaemia splenomegaly, hepatomegaly jaundice
117
erythroblastosis fetalis [ haemolytic disease of the newborn.] Tx
immunoglobulin | intrauterine transfusion
118
most common anaemia in children
iron def
119
causes of paeds iron def anaemia
LBW, excessive cows milk intake, GI bleed (e.g. hookworm)
120
iron deficiency anaemia in paeds Sx O/E CXR
Sx: pallor, anorexia, fatigue O/E: tachycardia, murmur, splenomegaly CXR: cardiac dilatation
121
why do children with sickle cell disease need imms [ Pneumococcal, influenza, meningococcal}
asplenia
122
other than vaccination how might you treat children with sickle cell to prevent sepsis
prophylactic penicillin
123
complications of sickle cell disease
``` anaemia cardiomegaly pain crises stroke acute chest syndrome ```
124
Tx for sickle cell
blood transfusion stem cell transplant hydroxycarbamide
125
what is G6PD deficiency? + how does it present
haemolysis neonatal jaundice, anaemia
126
what induces G6PD
drugs, fava beans, fever, acidosis
127
Mx for von willebrands
desmopressin vWF containing Factor 8 concentrate avoid NSAIDs
128
most common childhood leukaemia
ALL
129
maintenance fluids. How much ml/kg/hr?
1st 10kg = 4ml 2nd 10kg = 2ml rest, 10kg = 1ml
130
when calculating the fluid requirements of a child, if here are signs of shock what should you do first in terms of fluids? (+ vol and exceptions)
fluid bolus 20ml/kg or 10ml/kg in DKA, neonates or trauma
131
in paediatrics, generally replace deficit over 24 hrs. When would you replace over 48hrs?
DKA | Hypernatraemic dehydration
132
give some examples of organisms that commonly cause tonsilitis
strep pyogenes [group A strep] adenovirus EBV
133
what organism causes epiglottitis
haemophilus influenza B
134
what organism causes whooping cough
pertussis
135
common organisms croup
parainfluenza | RSV
136
common organism causes of pneumonia in children
strep pyogenes [group A strep] strep pneumoniae staph haemophilus influenzae
137
secondary infection with which bacteria can signif worsen varicella zoster
strep/staph
138
antibiotics for meningitis in <3 months
cefotaxime and amoxi [for listeria]
139
antibiotics for meningitis in >3 months
cefotaxime or ceftriaxone
140
drowsy child with full fontanelle and neck stiffness
meningitis
141
a child with tachypnoea and non-blanching red/purple rash
meningococcal septicaemia
142
treatment of priamry immune deficiency in children
Antibiotic /antiviral prophylaxis Prompt treatment of infections Replacement immunoglobulin Bone marrow transplant
143
how do vaccines work?
induce antibody production specific to organism
144
Sx TB
fever, night sweats, wt loss, cough
145
what type of fluids for maintainence paeds
0.9% NaCl and 5% glucose | and KCl 10mmol
146
how much extra fluid do you prescribe when a child is 5% dehydrated and 10% dehydrated/shocked
5% - 50ml/kg/day | 10% - 100ml/kg/day
147
what would a blood gas of a child with bronchiolitis show? [met/resp alk/acid]
resp acidosis
148
what would a blood gas of a child in septic shock show? [met/resp alk/acid]
metabolic acidosis | [^lactate due to poor perfusion]
149
what would a blood gas of a child in respiratory distress show? [met/resp alk/acid]
resp alkalosis
150
what would a blood gas of a child with projectile vomiting show? [met/resp alk/acid]
metabolic alkalosis
151
4 week old with projectile vomiting. Diagnosis?
pyloric stenosis
152
what age does a child have to be before you would diagnose asthma?
>5
153
what is the age limit for the diagnosis of bronchiolitis?
<1
154
in acute asthma management, when would you give salbutamol nebulised/ in spacer?
if on O2 -nebulised
155
ACUTE - if asthma not controlled on salb/steroids, what other options can you try?
aminophylline, IV salbutamol, magnesium
156
what do you hear on auscultation of bronchiolitis chest
wheeze and crackles
157
bronchiolitis symptoms
SOB decreased feeding coryza
158
investigation for cohorting bronchiolitis patients
nasal pharyngeal aspirate
159
most common cause of nephrotic syndrome
minimal change disease
160
what Ix in nephrotic syndrome [paeds], because you're gonna immunosuppress them with steroids
varicella titres
161
criteria for kawasakis
``` fever 5/7 and 4 out of: mucosal hand and feet desquam eyes conjunc adenopathy cervical rash truncal ```
162
differential for kawasaki
group A strep, measles
163
There is no diagnostic Ix for kawasaki. But what investigation might you wish to perform with regards to a serious consequence of kawasakis?
echocardiogram [CAA]
164
management of kawasakis
aspirin | IVIG
165
neonatal jaundice <1 day old, differentials?
haeomolysis e.g. rhesus | sepsis
166
main treatment of neonatal jaundice, and 1 other treatment for severe
phototherapy | exchange transfusion
167
Ix for neonatal jaundice
FBC check haemoglob direct coombs test split bilirubin
168
what type of bili is high in neonates with biliary atresia jaundice?
conjugated
169
prolonged neonatal jaundice [not fading with 14 days / 21 days for prem] Causes?
``` biliary atresia breastfeeding sepsis CF hypothyroidism ```
170
severe adverse consequence of neonatal jaundice
kernicterus
171
what is the age range for febrile fits
6 months to 6 yrs
172
what increases risk of neonate having cranial bleed
prem | intubated and ventilated
173
how do you investigate and diagnose neonatal intraventricular bleed
cranial US
174
eye complication of prematurity
retinopathy of prem
175
most common heart murmur in prem babies
PDA
176
drug to help close PDA
ibuprofen/ indomethacin
177
what causes resp distress sydrome in neonates
surfactant deficiency
178
why starve prem enonates for 48 hrs?
reduce risk of nec ent
179
neonate, distended abdomen and acidotic blood gas. X-ray shows distended loops of bowel and air in bowel wall. Diagnosis?
Nec ent
180
management for nec ent
cefotaxime and vancomycin | surgery
181
what is gowers sign on examination and what condition commonly seen in
shows proximal weakness, patient uses arms/hands to 'walk up' body duchennes muscular dystrophy
182
paeds - what conditions might give trendelenburg gait?
perthes disease develpomental dysplasia of hip slipped capital femoral epiphysis CP [hemiplegic]
183
what is perthes disease
reduced blood supply to head of femur -> necrosis
184
paeds - causes of equinus gait
``` idiopathic CP limb-length discrepancy clubfoot muscular dystrophy ```
185
trendelenburgs tests the competence of which muscles?
hip abductors
186
most common anatomical origin of limp in paeds?
hip
187
differentials for limp in <4 yr old
``` fracture septic arthritis osteomyelitis JIA foreign body in foot ```
188
differentials for limp in 4-10 yr olds
``` fracture septic arthritis osteomyelitis JIA foreign body in foot Perthes transient synovitis ```
189
differentials for limp in >10 yr olds
fracture septic arthritis osteomyelitis SCFE
190
most common cause of limp in under 10s
transient synovitis
191
Sx transient synovitis and which gender affected more
``` limp pain in thigh/knee fever reduced ROM BOYS ```
192
9-16 yr old, Hx of trauma, acute limp, knee pain, hip abducted and ext rotated
slipped capital femoral epiphysis
193
Mx septic arthritis
aspirate/drain | Abx [fluclox]
194
organisms in septic arthritis
STAPH group B strep in infants strep pnemoniae in <4 Neisseria gonorrhoeae in adolescents
195
chronic limping child, age 4-8, unilateral pain and family history. Likely diagnosis?
perthes
196
11 yr old boy, 5/12 L knee pain, antalgic gait, reduced int rotation
SCFE
197
16 month old, waddles, no pain, reduced abduction
developmental dysplasia of hip?
198
``` 6 yr old girl right thigh pain antalgic gait recent cough good ROM temp 37.6 Diagnosis? ```
transient synovitis?
199
4 yr old girl, swollen joints knee/ankle, stiffness reduced ROM, little pain. Diagnosis?
JIA
200
5 yr old boy, toe walking, no pain, ^lumbar lordosis. Diagnosis?
muscular dystrophy
201
paeds most common type of leukaemia
ALL
202
paeds - brain tumours presenation
early morning headache vomiting ataxia personality change
203
paeds - hodgkins lymphoma presentation
lump in neck, otherwise well
204
most common malignancy in children
leukaemia
205
children at ^ risk of developing malignancy
downs [ALL, AML] neurofibromatosis 1 [astrocytoma, sarcoma] immunosuppressed [lymphoma]
206
paeds leukaemia presentation
fever, freq infections, pale, tired, bone/ joint pain, anaemia, lymphadenopathy, bruising
207
abnormal red reflex in the eye [paeds] diagnosis?
retinoblastoma
208
Ix for ALL
``` FBC blood film CXR [mediastinal mass] bone marrow aspirate LP ```
209
paeds ALL Mx
chemo | stem cell transplant
210
when to scan in paediatric headache
``` papilloedema decreased acuity/vision loss other neuro signs early morning ass. w/vom decelerated growth under 3 neurofibromatosis 1 ```
211
child with abdominal mass, proptosis
orbital involvement from metastatic neuroblastoma
212
late effects of paeds malignncy Tx
``` growth/ development intellectual cardiac toxicity renal toxicity fertility psychological ```
213
paediatric condition of congenital fragile bones
osteogenesis imperfecta
214
plastic bones in paeds mean they get what types of fracture
greenstick [partial]
215
paeds - strawberry neavus self limiting, but worrying in which areas?
eye | airway
216
what is turners syndrome and what consequences?
part or whole of 1 X chromosome missing | infertility, short stature, lymphoedema at birth, coarcttio of aorta
217
more than 5 cafe au lait spots =
neurofibromatosis
218
cough, coryza, conjunctivitis, Koplik spots. Followed by red rash
measles
219
'slapped cheek' rash
parvovirus
220
hand foot and mouth is causes by what virus
coxsackie
221
impetigo is caused by?
staph aureus or strep pyogenes
222
scalded skin syndrome is caused by
staph aureus toxin
223
sx of HSP
rash joint pain abdo pain
224
erisypelas is caused by
Group A beta haemolytic streptococci (Streptococcus pyogenes).
225
what bacteria causes scarlet fever and can lead to glomerulonephritis
streptococcus
226
when is fetal surfactant produced during gestation
32 weeks
227
27 weeker born, difficulty breathing, on O2. Causes/differentials?
surfactant sepsis congen heart disease
228
what type of bacteria does ben pen cover
gram +ve cocci
229
what type of bacteria does gent cover
gram -ve bacilli
230
what Abx would you prescribe in a prem neonate in resp distress following prolonged ROM
ben pen and gent
231
how do you begin feeds in a prem?
IV dextrose bolus 2-4ml | gut priming with breast milk
232
prem in resp distress, capillary blood glucose drops to 2.2mmol/L. Reasons?
haven't fed it hypothermia ->> use energy [glucose] sepsis
233
how do you monitor whether you are giving a prem neonate adequate feeds?
monitor albumin and glucose, input/ output, growth chart
234
prem baby in resp distress deteriorates suddenly, goes pale, low BP. Wjhat might have happened?
intraventricular haemorrhage
235
Prem baby with IVH. Name specific problems that may arise from damage sustained to eyes, hearing, lungs and brain.
retinopathy of prem sensorineural and conductive loss chronic lung CP
236
how do you assess level of jaundice clinically?
direct coombs test transcutaneous bili serum split bili
237
what Ix would you perform in a jaundiced neonate within 24 hrs of birth?
FBC, blood film, blood groups, coombs test
238
causes of hyperbilirubinaemia after 24 hrs of life in neonate
^bili production due to shorter RBC lifespan dec conjugation due to hepatic immaturity dec gut flora -> dec elimination of bile pigment breastfeeding
239
consequence of neonatal jaundice due to biliary atresia
liver failure >> death
240
clinical signs of KERNICTERUS
lethargy, poor feeding, hypertonicity, Opisthotonus [arching], shrill cry
241
2 yr old brought to A and E with inconsolable crying, R leg not moving. FH of fractures and 'getting shorter'. Diagnosis?
osteogenesis imperfecta
242
what eye feature is seen in osteogenesis imperfecta
blue sclera
243
Ix for osteogenesis imperfecta
bone profile bloods xray DEXA
244
OSTEOGEN IMPERFECTA MODE OF INHERITANCE
type 1 - AUTO DOM type 2 - recess type 3 - recessive
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meningitis organisms in < 3months
e coli [major cause in neonates] group B strep [via vaginal delivery] listeria [presents soon after birth, imm comp] neiss men [any age] strep pneum [any] haemophilus infl [<4]
246
meningitis organisms age 1-6 yrs
Neisseria meningitides strep pneumonia haemophilus influenza
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meningitis organisms in > 6 yr old
neiss men | strep pneum
248
what is the moro reflex
drop baby a few inches from one hand to other. Arms abduct, hands open, then arms adduct.
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significance of retaining primitive reflexes
lack of frontal lobe development e.g. CP
250
at what age does a child develop a hand preference?
18 months
251
define cerebral palsy
chronic disorder of posture and movement due to non progressive lesions sustained <2yrs
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what are the TORCH infections
``` Toxoplasmosis Other (syphilis, varicella-zoster, parvovirus B19) Rubella CMV Herpes ``` causes of congenital abnorm/ neonatal mortality/morbidity
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causes of cerebral palsy antenatally, perinatally and postnatally
antenatal: APH, TORCH, alcohol, rhesus perinatal: trauma, fetal distress, hyperbilirubinaemia postnatal: IVH, hypoxia, meningitis
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signs and symptoms of cerebral palsy
motor: delayed milestones, weakness, paralysis epilepsy speech/ language learning disability EVOLVING
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WHY DO CP signs/Sx change over time
when child doesnt reach expected milestones, probelms are picked up
256
list the 4 types of cerebral palsy from most to least common and the area of the lesion
spastic (pyramidal) dyskinetic (basal ganglia) ataxic (cerebellar) (mixed)
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kernicterus causes which type of CP?
dyskinetic
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which limb is affected more by spastic hemiplegic CP and how might this present in home life
arm > leg | early hand prefernce
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which limbs are more affected in diplegic spastic CP
legs>arms
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most severe form of CP and consequences
spastic quadriplegia | swallowing difficulties, seizures, aspiration pneumoina, reduced IQ
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symptoms of dyskinetic/athetoid CP
hyper/hypotonia poor movement flow/chorea hearing probs dysarthria (weak muscles)
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Investigations in suspected CP
TORCH screen | MRI
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Mx of CP
treat complications e.g. epilepsy | botox for spasticity
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differentials of child daydreaming
``` absence seizure visual problems hearing problems ADHD behavioural sleep deprivation ```
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how can you investigate for absence seizure
hyperventilation [blowing windmill] induces absence video record EEG
266
describe an absence seizure
approx 10s pause stops mid sentence, then carries on where left off patient unaware eyes may roll up
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first line Tx for paeds absence seizures and 2 side effects
ethosuximide | D and V, rash
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absence seizures age 6, tonic clonic age 12, clumsy in the morning. Diagnosis?
juvenile myoclonic epilepsy
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1st and 2nd line Tx for juvenile myoclonic epilepsy
sodium valproate | lamotrigine
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prognosis of juvenile myoclonic epilepsy
8/10 need antiepileptics for life | well controlled by meds
271
at what age would you be concerned about a child squint
>3 months, must be seen by 6 months
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using a cover test, what type of squint would correct when other eye covered
non-paralytic
273
what are exo and esotropia in paeds squint
exotropia - divergent, one eye turned out | esotropia - convergent, one eye turned in
274
investigation in paralytic squint
CT or MRI
275
name the 6 muscles for eye movement
``` superior rectus inferior rectus medial rectus lateral rectus superior oblique inferior oblique ```
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causes of squint in paeds
``` attempt to overcome vision problem e.g. short sightedness measles CP retinoblastoma Downs ```
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Mx of squint
glasses, patch botox surgery
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consequences of not treating squint
persistent blurred /double vision a lazy eye low self-esteem
279
developmental milestones: at what age would you expect a child to:- smile sit with support sit without support
smile - 6 weeks with support - 4-6 months without - 6-9 months
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developmental milestones: at what age would you expect a child to:- reach out for objects pincer grasp waves goodbye drinks from cup what age
reach out for objects: 4-6 months pincer grasp: 7-12 months waves goodbye 7-12 months drinks from cup 12-15 months
281
developmental milestones: at what age would you expect a child to:- turns head to name speaks single words speaks 6 words
turns head to name 6-9 months speaks single words 12-15 months speaks 6 words 18 months
282
developmental milestones: at what age would you expect a child to:- crawl walks with hand held walks indep
crawl 6-9 months walks with hand held 7-12 months walks indep 18 months
283
developmental milestones: at what age would you expect a child to:- builds with blocks stacks 5-6 blocks uses a spoon what age
builds with blocks 18 months stacks 5-6 blocks 18 months - 2 yrs uses a spoon what age 18 months - 2 yrs
284
what is an Oral Glucose Tolerance test
2 hr measurement after ingestion of glucose load
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cerebral consequence of DKA management
cerebral oedema
286
DKA management
``` Fluid Insulin Monitor glucose hourly Monitor electrolytes: K+ /ketones (2 hourly) Fluid balance Hourly neuro obs ```
287
DM hypo Sx
``` Nausea Confusion Shakey Sweaty pallor Palpitations Dizzy Headache Visual problems Hearing loss Slurred speech LOC Convulsions ```
288
define cows milk allergy. | associated with?
immunological reaction to milk proteins | atopy
289
what is Giardiasis and how do you treat
protozoa causes villous atrophy, diarrhoea with cysts METRONIDAZOLE
290
pathophysiology of coeliac
^ T and B lymphocyte response to gluten -> villous atrophy
291
what is Dermatitis Herpetiformis
gluten sensitivity Rash- erythematous/pruritus | with or without villous atrophy
292
non-GI manifestations of coeliac
osteoporosis dermatitis herpetiformis dental enamel defects
293
Ix for coeliac
endoscopy and biopsy for histo IgA, Tissue transglutaminase antibodies, endomysial antibodies, IgG Sx response to gluten exclusion
294
how do you manage the pancreatic insufficiency in CF children
Pancreatic Enzyme Replacement Therapy (PERT)
295
paeds crohns and UC Mx
``` Steroids Immunosupressives Azothioprine Methotrexate Infliximab (anti-TNFa) ```
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non-GI maifestations of IBD
arthritis osteoporosis erythema nodosum episcleritis
297
acute scrotum, main important differential and others
``` TESTICULAR TORSION! hydatiform torsion (blue dot on transilumination) epidydimo orchitis trauma acute hydrocoele idiopathic scrotal oedema ```
298
2 peaks in age of testicular torsion presentation
neonatal | puberty
299
symptoms of testicular torsion
sudden onset v severe pain tender on palpation can vomit late signs: red/swollen
300
how long do you have to save the testicle in testicular torsion?
6 hours
301
balantis xerotica obliterans (BXO)
phimosis (unable to retract foreskin) and urethral stenosis. Decreased urinary and sexual function
302
define hypospadius. And why is it important to palpate testes?
opening of the urethra is on the underside of the penis | in case it's ambiguous genitalia (congenital adrenal hyperplasia)
303
why do you gove CAH child sodium?
adrenals make too little aldosterone, salt and water loss
304
casues of groin swelling paeds
indirect inguinal hernia hydrocoele lymph nodes
305
neck lymph nodes in children - when worrying?
posterior triangle [behind SCM ] >2 weeks >2cm/ enlarging inflamed
306
what is pyloric stenosis?
hypertrophy of sphincter muscle
307
causes of conductive hearing loss
otitis media with effusion Ear wax perforated eardrum abnormality of the outer ear
308
1 yr old, fell and banged head Pale, stiff, unresponsive, jerking of all 4 limbs. Few seconds and then she came round. Diagnosis
reflex anoxic seizure
309
4 month old. Episodes of suddenly bending arms and neck and bring legs to chest. Last a few seconds. Seems to cry out in pain. Diagnosis?
west Syndrome (Infantile spasms)
310
define west syndrome
epilepsy syndrome composed of the triad of infantile spasms, EEG hypsarrhythmia, and developmenta delay
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3 months old with sudden jerks of the arm whilst asleep, does not wake. Diagnosis?
benign myoclonic jerks
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2 year old - flushed and unsettled, with 2 min episode of rigidity and shaking, drowsy afterwards. Diagnosis
febrile convulsion
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failure to thrive: Inadequate calorie intake - Organic causes
Impaired suck/ swallow: | Oro- motor dysfunction/neuro disorder e.g. CP/ Cleft palate
314
failure to thrive: Inadequate calorie intake – Non-Organic/ enviromental causes
poor feeding technique poor meternal-fetal relationship neglect
315
failure to thrive - Inadequate calorie absorption causes
coeliac, giardia, lactose intolerance, cows milk protein allergy, pancreatic disease, short bowel syndrome
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failure to thrive - Excessive calorie loss causes
vomiting (GORD/pyloric sten)
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failure to thrive - Excessive calorie requirements causes
chronic illness (resp/GI/immune def) Thyrotoxicosis Malignancy Abnormal movement disorder
318
earliest you should wean from breastmilk to solid food
6 months
319
define ADHD, 3 core problems, age criteria, when and where
ATTENTION DEFICIT HYPERACTIVITY DISORDER 1. inattention 2. hyperactivity 3. impulsivity - persistent and impact on daily functions - Present before 12 years - Developmentally inappropriate - 2 or more settings
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organic causes that predispose to ADHD
prem neurofibromatosis fetal alcohol/smoking
321
Mx of ADHD
advice on positive parenting, booklets, behavioural techniques parental education programmes older - CBT METHYLPHENIDATE
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3 aspects of autistic spectrum disorder
communication difficulty social interaction difficulty X imagination/rigidity of thought
323
define preterm
<37 weeks
324
how do you treat apnoeas and bradycardia in neonates
caffiene
325
what is transferred from mother to baby in the last 3 months gestation that prevents neonatal sepsis
IgG
326
complications of otitis media
mastoiditis tympanic membrane perforation extradural/subdural/cerebral abscess meningitis
327
management of recurrent otitis media
Analgesia Repeat antibiotic courses Antibiotic prophylaxis Grommet insertion
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predisposing factors for glue ear (otitis media with effusion)
parental smoking breast feeding male anatomical e.g. cleft palate
329
indication for tonsilectomy
recurrent tonsilitis > 7 times / year | sleep disordered breathing/obstructive sleep apnoea
330
define Developmental Delay
Development along the normal route | Child takes longer than norm to reach each milestone
331
define Developmental Disorder
Development does not follow normal patterns. | May make developmental progress but disordered
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define Developmental Arrest/Regression
Normal development first | Then failure/slow to gain new skills/ loss of skills
333
how long do children maintain Palmar and Plantar grasp primitive reflex
0–3 months
334
define neglect
A standard of care that does not meet the needs of the child
335
UTI in neonates/ infants, acutely ill, suspected pyelonephritis or vomiting. Treatment?
IV cefuroxime
336
characteristic features of trisomy 21
``` Learning/ developmental delay Hypotonia Short Stature Congenital Heart Disease (AVSD, TOF) Duodenal Atresia Upward Sloping Palpebral Fissures Epicanthic Folds Brachycephaly Single Palmar Crease ```
337
what is disability living allowance
benefit which helps with the extra costs involved in looking after a child with disability
338
causes of osteoporosis in children
``` osteogensis imperfecta idiopathic endocrine drug induced (steroids) malabsorption immobile ```
339
symptoms/ complications of osteogenesis imperfecta
``` fractures deformity pain impaired mobility poor growth Deafness hernias valvular prolapse ```
340
medical treatment for osteogenesis imperfecta
bisphosphonatres (pamidronate)
341
how does vitamin D affect bones
strengthens. makes calcium available by increasing absorption from the gut. regulates calcium an phosphate levels
342
what can low maternal vitamin D cause in the newborn
bowed legs/ rickets
343
systemic onset JIA symptoms
``` arthritis fever rash lymphadenopathy hepatosplenomegaly ```
344
define marophage activation syndrome
potentially fatal abnormal proliferation of macrophages, cytokines, T lymphocytes, NK cells. Cytopaenia and coagulopathy. Complication of rheumatic disease
345
what can trigger macrophage activation syndrome?
infection
346
which rheumatological diseases can be complicated by macrophage activation syndrome
SOJIA SLE kawasakis
347
macrophage activation syndrome Sx
fever hepatosplenomegaly purpuric rash
348
macrophage activation syndrome Tx
NSAIDs | steroid
349
foramen ovale connects...
right atrium to left atrium
350
ductus arteriosus connects..
pulm artery to aorta
351
features heard on ausculation in ASD
ejection systolic over pulm area | fixed split S2
352
ASD symptoms
asymptomatic when young, older - palpitations
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how might a baby present with a PDA, and what might you find on examination
symptoms: poor feeding, failure to thrive, tachypnoea, hepatomegaly, oedema signs: Thrill, continuous murmur
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murmur of PDA
continuous 'machine-like'
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murmur of VSD
pansystolic
356
name the 5 cyanotic congenital heart condition
``` tetralogy of fallot transposition of great vessels tricuspid atresia Total anomalous pulmonary venous return pulm HTN secondary to lung disease ```
357
how would you differentiate a cyanotic child with lung/heart disease?
give O2 -> lung disease will improve
358
systolic murmur, weak femoral pulses, BP discrepancy between arms and legs. Which congenital heart defect?
coarctation of the aorta
359
Ejection systolic murmur in aortic area, Thrill palpable in suprasternal region and carotid area. defect?
aortic stenosis
360
4 aspects of tetrallogy of fallot
pulm artery stenosis right ventricular hypertrophy overriding aorta ventricular septal defect
361
which heart defects have diastolic murmurs
aortic/pulm regurg | mitral/tricusp stenosis
362
factors that increase risk of neural tube defect
Folic acid Maternal diabetes affected individual in the family
363
symptoms of Prader- Willi Syndrome
``` obesity small genitalia learning difficulties neonatal hypotonia poor feeding infant ```
364
genetic cause of Prader- Willi Syndrome
Caused by a deletion in paternal chromosome 15 or maternal uniparental disomy
365
symptoms of Angelmans Syndrome
``` laughing, clapping learning difficulties microcephaly seizures ataxia and broad based gait ```
366
genetic cause of Angelmans Syndrome
paternal uniparental disomy chromosome 15 or maternal chromosome 15 deletion
367
what is amblyopia
"lazy eye" Defective visual acuity which persists after correction of the refractive error and removal of any pathology
368
define hyper and hypotropia
eye with squint deviates upwards/downwards
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define latent strabismus
eyes straight when both eyes are open. | Deviation of the visual axes can be elicited when each eye is covered
370
casues of Pseudostrabismus
``` Epicanthus Narrow or wide interpupillary distance Facial asymmetry Unilateral ptosis Deep set or prominent eyes ```
371
management of amblyopia
glasses patch good eye surgery botulinum toxin injection
372
``` on a pedigree chart, how are the following drawn: male female someone with the disease carrier unborn child of unknown gender deceased ```
male - square female - circle someone with disease - coloured in carrier - half coloured in [dot for x-linked] unborn child of unknown gender - diamond deceased - diagonally crossed out
373
causes of lobar colapse in the lung
blocked airway e.g. mucous plg/ foreign body pneumothorax mediastinal mass
374
causes of unilateral/ bilateral pleural effusion
unilateral suggests infection bilateral suggests fluid overload e.g. HF, nephrotic
375
how would temperature help you differentiate bronchiolitis from pneumonia
bronch - low grade fever | consider pneumonia if temp >39 or focal crackles
376
how do you calculate rate on an ECG?
5 big squares = 1 second | count 30 squares and X10
377
what is meckel's diverticulum
bulge in small intestine caused by congenital remnant
378
management of TGA and TOF
prostaglandins to keep shunt open til surgery at 6 months
379
management of pyloric stenosis
nil by mouth fluids correct electrolytes Pyloromyotomy

3A GH (8 decks)

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