Paeds Flashcards
(217 cards)
1
Q
What symptoms are associated with HSP?
A
Purpuric rash, joint pain, abdo pain
2
Q
What is the likely Hx in HSP?
A
Recent throat infection
3
Q
What investigation is key in HSP follow up and what are you looking for?
A
Urine - proteinuria and haematuria
4
Q
Where is the rash most commonly seen in HSP?
A
Legs and bum, arms face and trunk
5
Q
Diagnosis of HSP?
A
Bloods - raised IgA, CRP, ESR, platelets
6
Q
What distinguishes HSP from ITP/TTP?
A
Low platelet count
7
Q
what are the cyanotic CHD?
A
- VSD
- ASD
- PDA
8
Q
What are the symptoms of VSD?
A
Tachycardia, tachypnoea, panysystolic murmur at lower left sternal edge
9
Q
What are the symptoms of ASD?
A
Asymptomatic!!! Ejection systolic murmur at left upper sternal edge
10
Q
What are the symptoms of PDA?
A
Continuous blowing murmur below left clavicle
11
Q
What time frame is a PDA pathological?
A
> 1 month
12
Q
How do you treat a small VSD?
A
Leave it and it will spontaneously close but monitor
13
Q
How do you treat a PDA?
A
NSAIDS to close it
14
Q
What are the cyanotic CHD?
A
Tetralogy of Fallot and transposition of great arteries
15
Q
What are the 4 features of ToF?
A
- Pulmonary stenosis
- Overriding aorta
- VSD
- Right ventricular hypertrophy
16
Q
What are the symptoms of ToF?
A
Cyanosis, difficult breathing, squatting on exercise, clubbing of fingers and toes and systolic murmur
17
Q
How is ToF treated?
A
Open heart surgery
Beta blockers
noradrenaline
18
Q
What vessels are affected in transposition of great arteries?
A
SVC, IVC, Pulmonary artery, pulmonary veins, aorta
19
Q
When is Transposition identified?
A
When the ductus arteriosis closes
20
Q
How do you treat Transposition (2 things)
A
Induce a PDA with prostaglandins and arterial switch operation
21
Q
What is the leading cause of acute epiglottis?
A
H. influenza B
22
Q
What is a key fact in kids with acute epiglottis
A
Not up to date with vaccines!!!!
23
Q
What are some symptoms of acute epiglottits
A
Sat upright, open mouth breathing, drooling, can’t speak or swallow, NO COUGH
24
Q
What is the most important thing to do when you suspect acute epiglottis?
A
Call anaesthetist to intubate
25
What must you NOT do in acute epiglottis?
Examine throat
26
What symptoms are suggestive of croup?
Worse at night, barking cough, stridor, following short coryzal episode
27
What is the most common cause of croup?
Parainfluenza
28
What heart murmur would you get for pulmonary stenosis?
Ejection systolic at left upper sternal edge
29
What heart murmur would you get for aortic stenosis?
Ejection systolic at right upper sternal edge
30
What heart murmur would you get for coarctation of the aorta?
ejection systolic at left upper sternal edge
31
What symptoms might you get for coarctation of aorta?
Increasing with age, SoB, intermittent claudication, radio-radial/femoral delay
32
What are the 4 S's of harmless murmurs?
1. Soft
2. Systolic
3. aSymptomatic
4. left Sternal edge
33
Investigations if you find a murmur?
ECHO (antenatal)
ECG
CXR
34
What direction does the blood flow in Acyanotic CHD?
Left to right
35
What direction does blood flow in cyanotic CHD?
Right to left
36
What syndrome do you get if you do not treat acyanotic heart defects?
Eisenmenger's syndrome
37
What is the risk with Eisenmenger's?
Reversal of L-R shunt so causes cyanosis
38
What is the other name for croup?
Laryngeotracheobronchitis
39
Where in the resp tract is the obstruction in croup?
Upper
40
Age range for croup?
6 months - 6 years (peak at 2y)
41
Tx for simple croup?
Dexamethasone (single dose - 0.15mg/kg)
OR
Nebulised budenoside
42
Tx for severe croup?
High flow oxygen
| Nebulised adrenaline
43
Tx for acute epiglottis?
IV Cefuroxime
44
What is the other name for whooping cough?
Pertussis
45
What is the main cause of whooping cough
Bordatella pertussis
46
What are the symptoms of whooping cough?
Inspiritory whoop, worse at night, vomiting, cyanosis, nose bleeds, subconjunctival haemorrhages
47
How long does phases of whooping cough last?
Paroxysmal phase = 3-6 weeks
| Cough = months (100 days_
48
Ix for whooping cough?
Nasal swab culture and PCR
49
Tx for whooping cough if <1 month old?
5 days of Azithromycin
50
Tx for whooping cough in >1 months old?
7 days of Azithromycin and Erythromycin
51
What is the main age range for bronchiolitis?
1-9 months
52
What is the main cause of bronchiolitis?
RSV (respiratory syncytial virus)
53
What are some other causes of bronchiolitis?
Parainfluenza, human metapneumovirus
54
Symptoms of bronchiolitis?
Resp distress, coryzal, breathless, poor feeding
55
6 signs of resp distress?
Head bobbing, nasal flaring, subcostal recessions, intercostal recessions, tracheal tug, grunting
56
Ix for bronchiolitis?
Nasal swab and PCR
| CXR for hyperinflation
57
Mx for bronchiolitis?
SUPPORTIVE!!!
humidified O2
NG feeds if cannot feed
Fluids
58
What is a preventative treatment for bronchiolitis, and when is it given?
Palivizumab.
IM once a month
Indications: CF, downs, immunocompromised, CHD
59
Define asthma
Chronic inflammatory disorder of the lower airways, secondary to hypersensitivity. It is reversible airway obstruction.
60
Classic triad of symptoms in asthma?
1. Bronchospasm
2. Mucosal swelling and inflammation
3. increased mucus forming a plug
61
Features of asthma
Nocturnal dyspnoea, wheeze, cough, sputum, diurnal variation, low exercise tolerance, disturbed sleep
62
Diagnosis of asthma (3 kinds)
1. FEV1:FVC = <70%
2. Reversibility with bronchodilator of FEV +12%
3. FeNO >35ppb
63
What cells are involved in asthma?
CD4 cells / eosinophils / IgE
64
What role does IgE have in asthma?
Binds to mast cells in mucosa, causing release of inflammatory mediators + histamine
65
What causes increased mucus in asthma?
Histamine
66
What Tx must be done for asthma in all ages?
Avoid triggers, check inhaler technique
67
What to add if SABA and low dose ICS don't work in >5y?
Leukotriene receptor antagonists (e.g. Montelukast)
68
If SABA, ICS, LTRA don't work in asthma >5y
LABA / Maintenance and reliever therapy
69
What to add if asthma not controlled by SABA in <5y?
8 week trial of moderate-dose ICS
70
Difference in measuring <5 and >5y asthma attack
If >5y must include PEF values
71
Severe asthma attack
1. Sats <92%
2. PEF <50%
3. Unable to talk
4. Tachycardic and pnoeic
5. Use of accessory muscles
72
Life threatening asthma attack
1. Sats <92%
2. PEF <33%
3. Silent chest
4. Poor resp effort
5. Decreasing consciousness
6. Cyanosed
73
Mx of asthma attack
1. ABCDE
2. High flow O2
3. Nebulised Salbutamol
4. IV Hydrocortisone
5. Ipratropium Bromide
6. Mg Sulphate IV
CALL ICU!!!!!!!!!
74
Mx CF
High calcium and fat diet
Chest physio and draining
Pancreatic enzyme replacement therapy
Prophylactic Abx
75
Main pathogens in causing chest infection in CF
Pseudomonas aeriginosa
| Staph aureus
76
What acid-base disturbance might you find in pyloric stenosis
HypoK, hypoCl, metabolic acidic alkalosis
77
Most common site for intussusception?
Ileum into caecum via oleo-caecal valve
78
What signs would you find in intusseption?
Child drawing knees up to chest and going pale.
Redcurrent jelly stool.
Sausage shaped mass in Right Lower Quadrant
79
What would an USS show if a pt had intussusception?
Doughnut / target sign
80
How to treat intussusception?
Rectal air insufflation
81
What can intestinal malrotation lead to?
Volvulus and infarction of the entire midgut
82
What age does intestinal malrotation present?
1-7 days
83
Signs and symptoms of intestinal malrotation
BILLIOUS VOMITING
Abdominal pain
Tenderness
84
What is the single diagnostic test for malrotation?
Upper GI contract study
85
What is the treatment for intestinal malrotation?
Ladd's procedure - rotate bowel anticlockwise
86
What would you suspect in a premature baby that is fed with cow's milk with GI symptoms?
Necrotising enterocolitis
87
Signs and symptoms of NEC
BILLIOUS VOMITING
Fresh blood in stool
Abdo pain and distension
Shock
88
What might and X-ray show if a baby has NEC?
Distended loops of bowel
Thick bowel wall
Football sign
89
Mx for NEC?
ABCDE
Stop oral feeds
Broad spectrum antibiotics (ampicillin, gentamicin, cefotaxime)
Surgery
90
What causes Hirschsprung's?
Absence of ganglionic cells from myenteric plexus of large bowel
91
What actually happens to the bowel in Hirschsprung's?
Narrowing, contracted segment
92
What is the identifying factor for Hirschsprung's?
Failure to pass meconium within 48 hours
93
What disorder is associated with Hirschsprung's?
Down's
94
Clinical features of Hirschsprung's?
1. Abdo distension
| 2. Late bile stained vomit
95
What happens if you do a PR exam in Hirschsprung's?
You feel a narrow segment and then when you withdraw, there is a flow of liquid stool
96
What is the diagnostic test for Hirschsprung's?
Suction rectal biopsy
97
Most common cause of nephrotic syndrome?
Minimal change disease
98
Triad of features in nephrotic syndrome?
1. Hypoalbuminaemia
2. Proteinuria
3. Oedema (peripheral, scrotal/vulval, periorbital, ascites)
99
Tx for the MOST nephrotic disease
Prednisolone (60mg/m2/day)
100
Tx if steroid-resistant nephrotic disease
```
Diuretics
Salt restriction
ACEi
NSAIDs
Cyclophosphamid + ciclosporin
```
101
3 main features of haemolytic uraemic syndrome
1. Acute renal failure
2. Thrombocytopenia
3. Microangiopathic haemolytic anaemia
102
What classically precedes HUS?
Bloody diarrhoea caused by E. coli
103
Tx for HUS
Supportive
| Plasma exchange if severe thrombocytopenia and anaemia
104
Complications of HUS
HTN, chronic renal failure
105
3 main features of Henoch-Schonlein Purpura
1. Sandpaper like raised purpura
2. Arthritis in knees and ankles
3. Abdo pain
106
What classically precedes HSP
URTI caused by Strep pyogenes
107
What are the features of an infantile spasm?
Head nodding, arm jerking
108
What is the diagnostic test for infantile spasms
EEG shwoing hypsarrhythmia
109
How to you define status epilepticus
>30min tonic-clonic seizure (but treat after 5 min)
110
How to treat status epilepticus
Buccal midazolam
IV lorazepam
IV phenytoin
111
What MUST you give in the community if you suspect meningitis
IM benzylpenicillin
112
What causes meningitis in neonates
Group B Strep
E. coli
Listeria
113
What causes meningitis in infants? (1m - 6y)
N. meningitidis
Strep. pneumonia
H. influenza
114
What causes meningitis in older kids?
N. meningitidis
| Strep. pneumonia
115
What do you screen for at 11-13 weeks?
Down's syndrome, Patau's syndrome, Edward's syndrome
116
At 11-13w, what do you measure?
1. hCG
2. PAPP-A
3. USS nuchal translucency
117
What defects might you pick up on the 20w scan?
Neural tube
Major heart defects
Renal agenesis
Skeletal/CNS
118
What is the name of the heel-prick, blood spot test?
Guthrie's
119
What age is Guthrie's done?
5-8 days
120
What 6 things does Guthrie's test for?
```
Cystic fibrosis
Congenital hypothyroid
Phenylketonuria
Medium-chain-acetly-coA-dehydrogenase-deficiency
Maple syrup urine
Sickle cell
```
121
What is the only antenatal test for chromosomal and inherited disorders?
Chorionic villous sampling - placental biopsy of fetal cells
122
Signs for Patau's syndrome (13)?
Polydactyly, cleft palate, heart defects, global developmental delay
123
Edward's syndrome signs (18)?
Cleft palate, heart defects, global delay, kidney malformation
124
What type of people get Turner's syndrome?
Females (because deletion of X)
125
Symptoms of Turner's syndrome?
Short, wide spaced nips, webbed neck, micrognathia, amenorrhoea, delayed puberty, infertile, coarctation of aorta
126
Tx for Turner's
growth hormone and oestrogen replacement via COCP
127
What maternal things might cause spina bifida?
```
Insufficient folic acid
Antiepileptic drugs (valproate, carbamazepine)
```
128
What are the two manoeuvres used in testing for hip dysplasia?
Barlow's - dislocation
| Ortolini's - relocation
129
Risk factors for hip dysplasia
Breech
Family Hx
Prematurity
Twins
130
At why age would you be concerned about palmar grasp?
5 months
131
At what age would you be concerned if the child couldn't yet walk?
18 months
132
What would you expect a 6 week old baby be able to do?
social smile, eye tracks movements, head stabilisation
133
What are the 4 categories for development?
1. Gross motor
2. Fine motor and vision
3. Speech and language
4. Social
134
Presentation of cerebral palsy
```
Spasticity
Rigidity
Hypereflexia
Weakness
Delayed milestones
Poor coordination
Peristent primitive reflexes
```
135
Key 3 features of hemiplegic cerebral palsy?
1. More likely arm than leg spasticity.
2. Tiptoe.
3. Dystonic posture
136
Key features of diplegic cerebral palsy?
1. more likely leg than arm
| 2. knock-knees
137
Main cause of cerebral palsy
cerebral malformation
138
prenatal causes of cerebral palsy
1. cerebral malformation
| 2. TORCH infection
139
perinatal causes of cerebral palsy
1. hypoxia
2. trauma
3. premature
140
postnatal causes of cerebral palsy
1. head trauma
2. stroke
3. meningitis
141
What is the 6 in 1 vaccine?
```
Diptheria
Tetanus
Pertussis
Polio
Haemophilus influenza B
Hepatitis B
```
142
At what ages are the 6-in-1 vaccine given?
2, 3, and 4 months
143
At what ages are the MMR vaccines given?
1 year and 3y+4m
144
At what ages is the PCV vaccine given? (pneumococcal virus)
2, 4 and 12 months
145
At what age is the Rotavirus vaccine given?
2 and 3 months
146
At what age is the Men B vaccine given?
2, 3 and 12 months
147
What is given as a 4 in 1 vaccine (pre-school booster)?
1. Diptheria
2. Tetanus
3. Pertussis
4. Inactivated Polio
148
What is given as a 3-in-1 booster vaccine at 14 years?
1. Diptheria
2. Tetanus
3. Inactiated Polio
149
What vaccine is given pre-uni?
Meningitis ACWY
150
What fluids do you give in dehydration?
10-20ml/kg bolus of 0.9% saline
151
How do you calculate the rate for maintenance fluids?
total daily requirement / 24
152
What fluids do you use for maintenance?
1. Saline 0.9%
2. Dextrose 5%
3. KCl 10mmol
153
What are the fluid requirements for first 10kg?
100 ml/kg/day
154
What are the fluid requirements for the 2nd 10kg?
50ml/kg/day
155
What extra do you give a child if they are >20kg?
20ml/kg/day
156
What would you expect to be raised in a blood test for mumps that is ~diagnostic?
Amylase
157
What are 5 complications of prematurity?
1. Intraventricular haemorrhage
2. Retinopathy of prematurity
3. Respiratory distress syndrome
4. NEC
5. Sepsis
158
Key 6 features of Kawasaki's?
1. Conjunctivitis - bilateral
2. Rash
3. Adenopathy (cervical/unilateral)
4. Strawberry tongue and cracked lips
5. Hand and foot erythema and desquamation
6. Fever >5 days
159
Tx for Kawasaki
Aspirin
| IV Ig
160
What must you not forget to do in follow up of Kawasaki's?
ECHO AND CARDIO REFERRAL!!!
161
What can aspirin cause in kids?
Reye's syndrome - coronary artery aneurysms
162
What would you diagnose if you saw a child who had long term joint swelling and couldn't walk upstairs (they may also have rash etc.)?
JIA!!!
163
What would you diagnose if an 8 year old boy came to you with hip pain, and on X-ray you saw necrosis of the femoral head?
Perthe's disease
164
What would you diagnose if you saw a baby with retinal haemorrhages, who had also had multiple fractures in the past?
Nothing - suspect non-accidental injury
165
What would metaphysical corner fractures indicate?
NAI
166
What might you see if you were to examine the ear of a child with otitis media?
Red, bulging tympanic membrane
167
What are the main causes of otitis media
viral - RSV, rhinovirus
| back - pneumococcus, h.influeza
168
Complication of otitis media?
Otitis media with effusion (glue ear) which can cause hearing loss
169
If a child is abnormally tall, what syndrome might they have?
Kleinfelter's
Marfan's
GH secreting adenoma
170
What makes up a septic screen?
1. Urine sample
2. Bloods - FBC, cultures
3. Lumbar puncture
171
What to do first in a very sick, febrile baby?
```
Septic screen
IV antibiotics (cefotaxime, ceftriaxone OR ampicillin if <1m)
```
172
Red flags for sepsis?
1. Fever >38 (if <3m)
2. Fever >39 (3-6m)
3. Pale, mottled or cyanosed
4. Low GCS
5. Bulging fontanelles
6. Seizures
7. Respiratory distress
8. Bile-stained vomit
173
What is there a lack of in osteogenesis imperfect?
Type 1 collagen
174
Symptoms of osteogenesis imperfect?
```
Blue sclera
Easy fractures
Short
Loose joints
Hearing problems
Aortic dissection
```
175
What is the hormone/thing issue in CAH?
Low cortisol
| Low aldosterone
176
CAH symptoms in a male?
```
Enlarged penis
Small testes
Deep voice
Early puberty
Arrhythmias
Vomiting
Dehydration
Hypoglycaemia
Hyponatraemia
```
177
CAH symptoms in a female?
```
Virilised genitalia (ambiguous)
Dehydration
Vomiting
Absent or abnormal periods
Deep voice
Facial hair
Hypoglycaemia
Hyponatraemia
```
178
Which department input do you need for CAH?
Endocrinology and Urology
179
What is the treatment for CAH?
IV fluids and electrolyte
Cortisol and aldosterone replacement (lifelong)
Hormone replacement and genital surgery if female
180
What do you need to be aware of if CAH child becomes unwell/stressed?
Extra cortisol needed
181
What is the most common leukaemia in children?
Acute Lymphoblastic Leukaemia
182
What is there a lack on in muscular dystrophy?
Dystrophin - links actin to cytoskeleton and regulated Ca2+
183
What would a raised creatinine phosphokinase suggest?
Muscular dystrophy
184
When might you consider Duschenne's MD?
A boy, around 12-18 months when they start walking
185
How is DMD inherited?
X-linked
186
Symptoms of DMD?
```
Progressive muscle wasting
Poor balance
Scoliosis
Progressive walking inability
Waddling gait
Resp problems
Muscle spasms
```
187
Medical Tx for DMD?
Low dose pred - to maintain muscle tone.
| Quinine for myotonia
188
At what point is jaundice in a neonate normal?
2-14 days
189
What are the causes of jaundice in <24h
Rhesus haemolytic disease
ABO incompatibility disease
G-6-PD deficiency
Spherocytosis
190
What are the causes of jaundice >14 days?
1. Biliary atresia!!!
2. Breast milk jaundice
3. Congenital hypothyroid
4. Pyloric stenosis
5. TORCH infections
191
What is involved in a jaundice screen?
1. Conjugated and unconjugated bilirubin
2. Coombs test
3. TFT
4. FBC
5. Blood film
6. Urine
7. UandE
8. LFT
192
What complication can you get if you do not treat jaundice?
Kernicterus
193
What type of bilirubin causes kernicterus?
Unconjugated
194
Symptoms of kernicterus
1. Poor feeding
2. Hypotonia
3. Fatigue and lethargy
195
Why does prolonged unconjugated jaundice cause kernicterus?
Unconjugated bilirubin can cross the BBB and accumulate in the grey mater
196
Main 2 pathogens causing Scarlet Fever?
1. Strep pyogenes
| 2. Group A beta-haemolytic Strep
197
What symptoms are you likely to get in early stages of scarlet fever?
Vomiting, fever, headache, sore throat, abdo pain
198
What symptoms does scarlet fever progress to?
Rash (starting on neck and spreading to limbs and torso)
Strawberry tongue
Enlarged tonsils
199
Tx for scarlet fever?
Pencillin 10 days
| Isolation, fluids and rest
200
Complications of scarlet fever?
Rheumatic fever
| Post-strep glomerulonephritis
201
Complications of mumps?
Male infertility, meningitis, deafness, pancreatitis
202
Tx for whooping cough?
Azithromycin
203
Where does the measles rash begin/spread?
Begins behind ears and spreads to forehead and neck, then trunk and limbs
204
What are Koplik spots?
White clusters inside buccal mucosa, seen in mumps
205
What does a positive Coombs test indicate?
ABO incompatibility haemolytic disease
206
What happens in ABO?
Maternal IgG passes through placenta to baby and attaches to fetal RBC, causing haemolysis
207
What blood group causes symptomatic ABO?
O
208
Tx for ABO?
Phototherapy
IV Ig
Exchange transfusion
209
What status do mum and dad have to be to have Rh+ baby?
Mum -
| Dad +
210
What happens in Rhesus haemolytic disease?
Fetal blood enters maternal circulation. maternal IgG made against RhD antigen. This IgG passes through placenta and destroys fetal
211
How do you prevent Rh disease?
IM anti-Rh antibodies
212
What needs to change about delivery if Rh?
Early delivery at 36 weeks, and IV transfusion
213
Is a Rh disease more likely to happen in baby 1 or baby 4?
Baby 4
214
Why are there no neurological side effects of biliary atresia?
Liver can still conjugate bilirubin
215
Tx for biliary atresia?
Kasai procedure - salvage liver and restore bile flow
| Liver transplant
216
Does progesterone increase or decrease risk of prematurity?
Decrease
217
What do breech babies born >=36weeks need to screen for DDH?
USS at 6 weeks
