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kierans cards > paeds > Flashcards

paeds Flashcards

1
Q

unable to palpate testes, normal penis with no hypospadias anus is patent
normal baby. what do you need to rule out?

A

21-hydroxylase deficiency. These infants
may present with ambiguous genitalia or bilateral undescended testicles
and are at risk of a salt-losing adrenal crisis (vomiting, weight loss,
floppy unwell infant), typically around 1–3 weeks of age. It is therefore
important to measure urea and electrolytes in addition to chromosomal analysis and a pelvic ultrasound to look for the location of the sex
organs.

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2
Q

status 2 doses of benzo weened off phenytoin recently what next?

A

IV phenytoin as 2 doses benzo and no longer on pheyntoin

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3
Q

iron overdose presentaiton

A

2 phases
vomitting diarrhoea gastric irritation + malaena
>24h improvement then deterioraiton with liver failure drowsiness andcoma

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4
Q

neonate with recurrant ecoli. uti/sepsis, vomitting catarcts

A

Galactosaemia

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5
Q

Phenylketonuria

A

PKU is an autosomal recessive metabolic condition resulting in a defect
in enzyme phenylalanine hydroxylase, which converts phenylalanine to
tyrosine. Due to the accumulation of phenylalanine and conversion to
phenylketones, unrecognized and untreated PKU can result in seizures
and musty smelling urine and eventually microcephaly and learning
difficulties.

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6
Q

CAH management

A

IV dextrose IV hydrocortisone and 0.9% saline

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7
Q

neonate with jaundice after 2 weeks from day 5, pale stool dark urine

A

biliary atresia must be investigated due to risk of cirrhosis

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8
Q

preterm on itu recieving formula milk, billious aspirates from ng, distended abdomen bloody stool, NEC

A

NBM, IV fluids AXR, surgical review

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9
Q

VACTERL

A

vertebral, anal imperforation, cardiac, tracheo-oesophageal fistula, renal limb anomalies

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10
Q

symmetrical vs asymetrical IUGR

A

symmetrical - smoking, alcohol, congenital infection

asymmetrical - maternal diabetes preeclampsia –> placental insufficiency

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11
Q

intersusseption management in DGH

A

Up to 75 per cent of cases may be reduced by air insufflation rectally,
but if this fails the child will need to be taken directly to theatre as there
is a risk of perforation with the procedure. As it is unlikely that a district
general hospital will be able to take such a young child to theatre, all
procedures should be carried out in a paediatric surgical centre

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12
Q 
CMV infection which is not
deafness
iugr
hydrocephalus
thrombocytopaenia
congenital cardiac
A

congenital cardiac not associated

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13
Q

SCID B CELLS T CELLS AND iG

A

LOW B LOW T LOW IG

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14
Q 
wiskott aldrich
W
A
T
E
R
A 
WASP GENE
APC'S
thrombotcytopaenia
eczema
recurrant infection
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15
Q

A 3-year-old child presents to the GP with a chronic cough for the last month.
He had previously been fit and well since he suffered a severe pertussis infection
when he was 1 month of age. He has subsequently been fully immunized but
was noted to be on the 0.4th centile for height. What is the most likely cause
for his cough?

A

severe respiratory infection in early childhood can present later in
life with bronchiectasis. caused by dilatation and poor mucociliary
clearance, predisposing to further infection. Any chronic illness may
impact on the growth and development of a child.

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16
Q

children aged above 5 most common pneumonia?

A

mycoplasma

strep is less than 4

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17
Q 
rheumatic fever major criteria except
new murmur
swollen right knee
geographic shaped rash (erythema marginatum
involuntary arm movements
fever
carditid
A

fever

18
Q

duct depedent cardiac disease management

A

prostoglandin IV + echo

antibiotics to cover for sepsis

19
Q

12yr old boy not growing past 2 years, classmates overtaken, was tallest in class. developed pubic hair 8-9 and voice changed around that time

A

congeintal adrenal hyperplasia
isosexual precocious puberty, all changes of pubertal boy in normal order. late onset cah. stunted height due to epiphyseal fusion

20
Q

hsp triad

+ rare complications

A

rash (symmetrical rash on buttocks and extensor surfaces purpuric or maculopapular)
arthalgia (knees ankles periarticular oedema)
colicky abdo pain (can vomit from pain+ haematemsis/ malaena),
kidney involvement (40%) haematuria(micro/macro) /nephrotic syndrome

ileus, orchitis CNS involvement , intusussception

21
Q

periostitis in neonate with jaundice conjugated and unconjugated

A

neonatal heptatitis due to congenital syphilis

22
Q

A 10-year-old girl presents to the emergency department with a seizure that
lasted 2 minutes before resolving on its own. Her mother described her as
suddenly collapsing to the ground, going stiff and then shaking all four
limbs. She was ‘drowsy’ for 15 to 20 minutes after the seizure. The girl has no
recollection of the event. Her temperature is 36.2°C, and she was well before
the event. Examination, including a full neurological assessment, is normal.
Blood sugar level was 4.5 mmol/l. Electrolytes were normal.

A. 12-lead ECG
B. Electroencephalogram
C. Head MRI
D. Serum prolactin
E. None of the above
A

All children who have had a ‘convulsive seizure’ (such as in this case)
should have an ECG. The ECG may reveal a cardiac cause for the fit and,
in particular, a prolonged QTc interval needs to be excluded. The girl in
this case collapsed suddenly before fitting, so an ECG is warranted to
exclude a cardiac cause.

23
Q

An 8-year-old girl with arthritis has some routine blood tests taken
by the general practitioner. She is currently on methotrexate for her
arthritis. Her mother is worried she is a fussy eater and does not enjoy
eating meat. On examination, she has some ulceration at the corners of
her mouth.
Her full blood count reveals:

Hb 8.9 g/dL (range 9.5–14.0)
MCV 109 fL (range 85–105)

What is the best treatment for her?
A. Intramuscular vitamin B12
B. Oral ferrous sulphate
C. Oral folic acid
D. Oral vitamin B12
E. Multivitamin tablet
A

folic acid due to methotrexate

Vitamin B12
deficiency is treated with intramuscular injections of hydroxocobalamin
(a natural analogue of vitamin B12) rather than oral forms.

24
Q

CI to MMR

A

high dose steroids

severe HIV

25
Q

CI to yellow fever influenza (food)

A

egg

26
Q

HIV cant have which vaccine

A

yellow fever BCG

27
Q

sodium valporate side effects

A

Recognized side effects of sodium valproate
include transient hair loss, weight gain, liver damage and blood dyscrasias.
Sodium valproate is also associated with a higher risk of fetal malformations
if taken in pregnancy, particularly neural tube defects.

28
Q

septic arthritis management

A

blood culture uss esr crp, joint aspirations and culture

Joint aspiration followed by IV antibiotics,
continuing for 4 to 6 weeks
Intravenous antibiotics may
be converted to a high-dose oral version after 2 weeks if the infection is
under control, but close monitoring of compliance and clinical progress
is required. In addition, septic joints need to be drained. This can be done
via repeated joint aspirations (wash out), but surgical drainage may be required.

29
Q

Recommended imaging schedule for infants younger

than 6 months

A

All infants with UTIs (<6 months) need to have a renal USS. If they have
had a simple UTI which responds to antibiotics, this can be performed
as an outpatient in 6 weeks and no further imaging is required. If this is
abnormal, however, an MCUG is recommended.

If they have an atypical
UTI or recurrent UTI, a USS should be performed as an inpatient along
with a DMSA and MCUG as an outpatient

30
Q

Recommended imaging schedule for infants and children

6 months or older but younger than 3 years

A

None is required unless UTI is atypical or recurrent (such as this case);
then, a USS followed by a DMSA scan should be performed as an outpatient.
An MCUG should not be routinely performed unless any ofthe following features are present: dilation on ultrasound, poor urine
flow, non-E. coli infection or a family history of vesicoureteric reflux.

31
Q

Recommended imaging schedule for children 3 years or older

A

No imaging is required if they have a simple UTI that responds well to
antibiotics. Children with atypical UTIs should have a USS as an inpatient,
and those with recurrent UTIs should have a USS as an outpatient
followed
by a DMSA in 4 to 6 months.

32
Q

recurrant uti definition

A

2upper uti
1 upper 1 lower uti
3 lower uti

33
Q

atypical uti definition

A

seriously ill, poor urine flow, abdominal/bladder mass, raised creatinine, septicaemia, failure to respond to treatment in 48h. non e.coli organism

34
Q

You are called to see a 12-hour-old baby. On examination, the baby is
jittery, lethargic and has very blue peripheries. You are concerned about
sepsis and so perform a blood culture. Blood tests show haemoglobin
17 g/dL, haematocrit 0.69 and C-reactive protein <5 mg/L. A chest X-ray
is normal, as is a nitrogen washout test.
What is the most likely cause of this baby’s clinical features?

A

Polycythaemia

Cyanosis is detected clinically when there is >5 g/dL of deoxygenated
haemoglobin.
Polycythaemia is defined as a central venous haematocrit
of >0.65. Haematocrit is a measure of blood viscosity and is also known as the packed cell volume (PCV). Hyperviscosity can present with
jitteriness,
lethargy, hypotonia, hyperbilirubinaemia, hypoglycaemia,
seizures, stroke, renal vein thrombosis and necrotizing enterocolitis.
Because the haemoglobin level is so high in polycythaemia (17 g/dL in
this case), it is very easy for these infants to achieve >5 g/dL deoxygenated
haemoglobin
and therefore appear cyanosed

35
Q

polysylllabic babble (non specific)

A

7 months

36
Q

polysylllabic babble mama dada

A

10-12months

37
Q

16 months hearing test

A

visual reinforcement audiometry

38
Q

two step commands

A

2.5years

39
Q

cp presentation age

A

0-12months motor development

40
Q

how does cataracts present

A

white or milky pupil, opacification of lens, red reflex absent
rubella

41
Q

most common down syndrome inheritance

A

non dysjunction

kierans cards (5 decks)

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