Paeds Flashcards
1
Q
Unexplained lump/swelling
Bone pain
A
Osteosarcoma
2
Q
Joint pain
Locking
Swelling
A
Osteochondritis dissecans - cracks in articular cartilage + underlying subchondral bone
3
Q
Batter’s syndrome - cause?
Effect on BP?
Effect on U+Es?
A
Na/K/Cl transporter is defective
Normotension
Hypokalemia
4
Q
Congenital heart defect where tricuspid valve leaflets are attached to R ventricle?
Associations?
A
Ebstein’s anomaly
- tricuspid regurg
- WPW
5
Q
Cause of scarlet fever
A
Grp A haemolytic streptococci
6
Q
Mx of Perthe’s disease? depends on age?
A
<6yo: observation + keep femoral head in cast, braces
>6yo: surgical management with limited benefit
7
Q
Slipped capital femoral epiphysis - how does the femoral head displace?
How is movement limited?
Where is the pain?
A
Femoral head is displaced posteroinferiorly
- Loss of internal rotation when leg is flexed
- Pain in hip, groin, medial thigh, knee pain
8
Q
Kocher criteria for septic arthritis
A
Raised ESR
Can’t weight bear
Fever
9
Q
Continuous hum heard below both clavicles
- what is it called? what is the cause?
A
Venous hum
Due to turbulent flow from great veins
10
Q
Benign murmur heard on lower left sternal border
A
Still’s murmur
11
Q
Benign murmur heard on upper left sternal border
A
Pulmonary flow murmur
12
Q
Salmon pink rash + pain and stiffness in knees
- Dx? potential other clinical features?
A
Systemic onset JIA
lymphadenopathy
Uveitis
Anorexia
Pyrexia
13
Q
Roseola infantum vs chicken pox
A
Chicken pox is itchy
Roseola = high grade fever which subsides before non=itchy rash appears
14
Q
Severe hip pain + inability to weight bear. USS shows effusion in joint capsule
No fever, no haemodynamic changes
A
Transient synovitis
15
Q
Tx of threadworm
A
Give one dose of mebendazole to whole household
16
Q
Best first line investigation for suspected intussusception?
A
USS
17
Q
Red currant jelly stool
A
Intussusception
18
Q
Colicky abdo pain
Draws up knees
Vomiting
Palpable abdominal mass
A
Intusussception
19
Q
Management of Intusussception
A
Air insufflation with radiological guidance
If peritonitis or air insufflation fails –> surgery
20
Q
Normal apgar score?
A
> =7
21
Q
what factors determine the apgar score?
A
HR Resp effort reflex response colour Muscle tone
22
Q
Management of child with mild cow’s milk protein intolerance
A
Extensive hydrolysed formula milk
23
Q
Management of severe cow’s milk protein alergy
A
Amino acid based formulas milk
24
Q
difference between cow’s milk protein intolerance and allergy?
A
intolerance = delayed reaction (non-IgE mediated) allergy = immediate reaction (IgE mediated)
25
Kawasaki disease - 6 features
```
Fever >5 days
Conjunctivitis
Strawberry tongue
Cracked red lips
Skin peeling from hands and feet
Cervical lymphadenopathy
```
26
Management of Kawasaki's disease
High dose aspirin
| IVIG
27
3 treatments for treating spasticity in CP?
Botulinum toxin type A
Baclofen
Diazepam
28
at what age would you refer a child if the cannot:
- sit without support?
- walk without support?
sit w/o support = 12 months
walk without support = 18 months
29
Neonatal CPR - what is the protocol?
If not breathing = 5 ventilation breaths
If HR doesn't improve: 3:1 chest compressions:ventilation breaths
30
When is the meningitis B vaccination given
2, 4 and 12 months
31
Which vaccinations are routinely given to teenagers?
3 in 1 teenage booster (DTP)
| Meningitis ACWy
32
- Rash like sandpaper on the body
- Fever
- Flushed cheeks
- Cervical lymphadenopathy
- White coating on the tongue
Scarlet fever
33
Dx and Mx of scarlet fever?
Dx: throat swab BUT start Abx before results arrive
Tx: Oral penicillin V for 10 days
- Return to school 24 hours after Abx started
- Notifiable disease
34
Most common complication of scarlet fever
Otitis media
35
2 year old boy with a 1 day history of limp + pain - next step?
Urgent hospital assessment du not higher risk of septic arthritis in <3 yo
36
Clinical Fx of bronchiolitis
```
<1yo
Coryza precedes:
- Dry cough, SOB
- Fine inspiratory crackles
- Wheeze
```
37
Immediate referral for bronchiolitis is indicated by...?
- Apnea
- Looks v unwell
- Severe respiratory distress (RR>70)
- Central cyanosis
- Sats <92%
38
What Fx in the history would lead you to a diagnosis of constipation in a child?
- <3 stools/week
- Overflow soiling
- 'Rabbit droppings'
- Blocking the toilet
- Pain on passing stool
- Anal fissure
- Bleeding with stools
39
Causes of constipation
```
Dehydration/lowfibre diet
Opiates
Anal fissure
HYPOthyroid
Hirschsprung's
hypercalcemia
Learning disability
```
40
Red flags in constipation
- Constipation since birth
- 'Ribbon' stools
- Abdominal distension
- Social care - child mistreatment
41
Management of constipation
Start with escalating dose regimen of Movicol
- Use stimulant laxative if not responding, then use lactulose
- continue mediation until regular bowel habit is established, then reduce dose
-Improve fluid intake, increase fibre
42
Dx of malrotation?
upper GI contrast study + USS
43
Main RF for necrotising enterocolitis
Prematurity
44
mx for necrotising enterocolitis
total gut rest + TPN
45
at what age can a child consent to sex?
13
46
Elevation of the testicle = increased pain?
Elevation of the testicle = relieves pain?
Increased pain = torsion
Relieves pain = epididymitis
47
Stepwise mx of bed wetting
1. look for other causes (UTI, DM, constipation)
2. Fluid intake - reduce
3. Reward chart - reward peeing before bed
4. Enuresis alarm vs desmopressin - depends on child
48
3 heart defects in Turners
- Bicuspid aortic valve
- Aortic root dilation
- Coarctation of the aorta
49
6 in 1 vaccine - how many times and when is it given?
| What does it protect against?
```
Diphtheria
Tetanus
Pertussis
Polio
Hib
Hep B
```
Given 3 times, at 2, 3, 4 months
50
When is MMR vaccine given?
12 months
51
What is included in the 4 in 1 booster? when is it given?
Diphtheria
Tetanus
polio
Pertussis
Pre school - 3-4 years old
52
When is Men B vaccine given?
2 months
4 months
12 months
53
2 prognostic factors for congenital diaphragmatic hernia
```
Liver position (if raised, this is poor)
Chest to head ratio (>1 is good)
```
54
Mx of Kawasaki's
High dose aspirin
IVIG
Echo - to look for coronary artery aneurysm
55
Cervical LNopathy
Swollen red tongue
Gunk in eyes
Fever for a week
Kawasaki's
56
Intraventircular haemorrhage - RF? complications? When does it present? Mx?
RF - PREMature babies
Complications - hydrocephalus (as clot occludes CSF flow)
Presents in first 3 days
Mx - supportive
57
Abdominal migraines consist of what features in order to diagnose?
Abdominal pain + 2 of the following:
Nausea, vomiting, pallor, anorexia
with normal examination
58
Vaccines given at 2 months?
- 6 in 1 (diphtheria, tetanus, polio, pertussis, Hib, Hep B)
- PCV (pneumococcal conjugate)
- Men B
- Oral rotavirus vaccine
59
In a boy with precocious puberty, what particular thing do you want to examine?
Testes
60
How does examination of the testes help with finding the cause of precocious puberty
Bilateral enlargement --> central cause (FSH/LH from intracranial lesion)
Unilateral enlargement --> gonadal tumour
No enlargement --> ADRENAL CAUSE (congenital adrenal hyperplasia)
61
Causative organism in croup?
parainfluenza
62
What is given as prevention of bronchiolitis? To whom?
Pavilizumab - against RSV!
| Given to high risk children - PREM, immunocompromised, heart/lung abnormalities
63
How does scarlet fever differ from Kawasaki's
Kawasaki's - any old rash
| Scarlet fever - sandpaper like rash
64
How does Downs' --> snoring?
Low muscle tone in upper airways
Large adenoids + tongue
Obesity
65
3 causes of nappy rash?
Irritant dermatitis = due to ammonia and faeces
Candida dermatitis = involves flexures + satellite lesions
Seborrheic dermatitis = flakes + scalp rash
66
General management for nappy rash
Disposable nappies (not towel nappies)
Expose area to air when possible
Use barrier cream (if severe, use mild steroid)
67
Sx of whooping cough OTHER than inspiratory whoop?
Coughing bouts: so bad it ends with vomiting + central cyanosis
- -> subconjunc haemorrhages + anoxia --> seizures + syncope
- Last 10-14 weeks
68
School exclusion for pertussis?
2 days after starting Abx (or 21 days form onset of Sx if no abx)
69
Abx treatment for pertussis?
Oral macrolide
70
Typical metabolic abnormality in pyloric stenosis?
Hypochloremic hypokalemic metabolic alkalosis
71
A mother brings her son in to surgery as she suspects he has a squint. She thinks his right eye is 'turned inwards'. You perform a cover test to gather further information. Which one of the following findings would be consistent with a right esotropia?
On covering the L eye, the R eye moves laterally to take up fixation
72
1st line Management of cows milk protein intolerante/allergy
If formula fed:
1. Extensive hydrolysed formula milk
If breast fed: eliminate cow's milk protein from maternal diet
Use eHF milk when breastfeeding stops
73
Rocker bottom feet is seen in which 2 syndromes?
Edwards
| Patau
74
Facial features of Fragile X?
Long face
Large ears
High palate
75
which vaccines are given at 2 months
6 in 1
MenB
PCV
76
Complications of roseola infantum?
Febrile convulsions
Aseptic meningitis
Hepatitis
77
3 causes of cyanotic congenital heart disease
Tetralogy of Fallot
Tricuspid atresia
Transposition of Great Arteries
78
Triad of shaken baby syndrome
Retinal haemorrhages
Encephalopathy
Subdural haematoma
79
Exclusion advice for HHV 6(roseola infantum)
None
80
Exclusion advice for scarlet fever
24 hours after commencing Abx
81
Exclusion advice for impetigo
until lesions have crusted over
82
Exclusion advice for mumps
until 5 days afte ronset of swollen glands
83
Does oligo or polyhydramnios predispose to DDH?
Oligo
84
Surgical management of pyloric stenosis?
Ramstedt pyloromyotomy
85
2 month old with H. influenza meningitis
| Name 2 drugs that should be given
Ceftriaxone + dex
86
Prophylaxis to close contacts of a child with meningitis?
Cipro
87
Anal itching + unremarkable examination?
Threadworm
88
HHV6 causes ... aka...
Roseola infantum aka sixth disease
89
Features of Sixth disease - name 5
```
Maculopapular rash
Diarrhoea
Cough
High fever
Febrile convulsions
```
90
Medical mx for nocturnal enuresis?
desmopressin
91
Eczema distribution:
in infants?
young children?
Older children?
Infants: face + trunk
Young child: extensor surfaces
Older child: Flexors
92
Pathognomic x-ray sign for NEC?
Intramural bowel gas
93
average age at which a child should drink from a cup without spilling anything?
2 years
94
Management of mild cradle cap?
- Baby shampoo + baby oil + emollients
95
how long is the ABx course for a 5 year old girl with lower UTI?
- 3 days of oral abx
96
Medication for whooping cough?
- macrolides (azithromycin/erythromycin)
Isolate the child for 2 days after starting abx.
97
SIDS - RFs?
Lying prone
Smoking
PREM
98
Which head lump which develops few hours after birth does NOT cross sutures
Cephalohaematoma
99
Growing pains - when do they tend to coccur
at night, and NEVER on waking
100
Baby born breech. Ortolani and Barlows sign are normal. next Mx?
USS hip
101
best imaging for visualising Perthe's
MRI hip
102
Time course of symptoms in Perthes
few weeks of progressive hip pain, limp and Reduced ROM
103
Mx of <6yo with Perthes
Cast, braces, active monitoring
104
Ix in suspected Perthes
X-ray
if X-ray normal but symptoms persist --> MRI
105
Intestinal loops protruding through the umbilicus in a neonate
Omphalocele
106
Intestinal loops protruding through a hole lateral to umbilicus in a neonate
gastroschisis
107
When does moro reflex typically disappear
3-4 months
108
Name 4 reflexes in babies
Moro
Rooting
Grasp
Stepping
109
Mx of intraventricular haemorrhage
Supportive
| - if hydrocephalus/high ICP --> think of a shunt
110
wtf is akathisia
severe restlessness
111
Screening test for depression
PHQ9
112
Common SEs of TCAs (imipramine)
antimuscarinic SEs: dry mouth, blurry vision, constipation
113
Inhaled steroid used for asthma control?
budesonide
114
eg of low dose ICS
<200mcg budesonide
115
eg of moderate dose ICS
200-400mcg budesonide
116
Male version of turners
- chest appearance?
- cardio probs?
Noonan
- pectus excavatum
- pulmonary stenosis
117
Facial appearance in Patau
microcephaly + small eyes
118
- Micrognathia (small jaw)
- Posterior displacement of the tongue
- Cleft palate
Pierre Robin
119
3 features of Pierre RObin
- Small jaw (micrognathia)
- Posterior displacement of tongue
- Cleft palate
120
knee pain when walking up and down stairs and rising from prolonged sitting
Chondromalacia patellae = inflammation of cartilage of patella
121
Oshgood Schlatter disease - classical presentation
sporty teens
| swelling and pain on tibial tubercle
122
Mx of chondromalacia patellae
RICE + anti-inflam + physio
123
mx of osgood schlatter
Rest
Ice
Elevation
Stretch thigh and hamstrings
124
Mx of child with itchy bottom and no other sx
treat empirically for threadworm ewww
Hygiene + single dose mebendazole for whole household
125
Mx of toddlers diarrhoea
Increase fat and fibre
| avoid juice + squash + carbonated drink
126
Mx of gastroenteritis with clinical signs of dehydration
ORS for 50ml/kg in 4 hours
| Avoid other fluids + solid foods
127
Mx of gastroenteritis with shock, after initial fluid bolus
maintenance + replacement with 0.9% saline + 5% dextrose
- monitor U+Es, glucose, Cr
- Avoid solid foods
128
When is guthrie test performed
day 5-9
129
Avg age for sipping from a cup and eating with spoon
2 years
130
Hirschsprungs - best initial tx?
| Definitive Tx?
Initial: bowel irrigation
Definite: anorectal pull through
131
mx of whooping cough
- Azithromycin if within first 21 days of onset
| - Notify PHE
132
neonatal hypoglycaemia in the first few days - how to Mx?
- Encourage regular feeding
- require dextrose if:
- <2mM
- cannot feed
- jittery/other Sx
133
When is menB vaccine given
2, 4, and 12 months
134
Child with ADHD on methylphenidate: what needs to be monitored?
Growth
Psychiatric assessment
BP (risk of HTN)
135
Markers of severe croup
Hypoxemia --> restlessness/agitation/lethargy
136
Child birth - what are the first things you do
Dry the baby, remove wet towels + start the clock
137
PDA is a connection between...?
- murmur?
Pulmonary artery + descending aorta
Continuous machinery murmur +
138
PDA pulse
Large volume + bounding + collapsing pulse
139
how many chest compressions/minute for children of all ages?
100-120
140
Contraindications to MMR vaccine
Allergy to neomycin
Had a diff live vaccine in the past 4 weeks
Had IVIG therapy in the past 3 weeks
Severe immunosuppression
