Paeds Flashcards
(98 cards)
1
Q
Left to right shunts
A
Breathless
VSD
ASD
persistant arterial duct
2
Q
Right to left shunts
A
Cyanotic/blue
Tetralogy of fallot
Transposition of great arteries
3
Q
Outflow obstruction in a well child (symptomatic w/ murmur)
A
Pulmonary stenosis
Aortic stenosis
4
Q
Outflow obstruction in a sick neonate
A
Coarcatation of the aorta
5
Q
ASD key signs
A
Ejection systolic murmur, loudest at sternal edge
Fixed and widely split S2
Secundum - RBBB and R axis deviation
Partial AVSD - apical pan systolic murmur, Superior QRS )(-ve AVF)
6
Q
ASD associations
A
Foetal Alcohol syndrome Noonan Syndrome (PTPN11 mutation)
7
Q
ASD Rx
A
Secundum - catheterisation and occlusion device (close PFO)
pAVSD - Surgery
8
Q
Small VSD signs and treatment
A
Asymptomatic Loud Pansystolic murmur Quiet P2 Normal ECG Closes spontaneously
9
Q
Large VSD signs and treatment
A
Heart failure Breathless (L to R shunt) quiet/no pan systolic murmur Loud P2 Biventricular hypertrophy on ECG Pulm HTN - upright T wave, Eisenmenger syndrome Needs surgery
10
Q
VSD assocations
A
Foetal alcohol syndrome
Down’s
11
Q
Persistant ductus arteriosus signs, management and associations
A
Associated w/ Rubella
Continuous murmur below the left clavicle
Collapsing/Bounding pulse
Usually asymptomatic unless large - then acts like large VSD
Close w/ coil/occlusion device
12
Q
Tetralogy of fallot- 4 signs and the shunt
What is the murmur
A
Large VSD
Overiding aorta
Right Ventricular hypertrophy
Pulmonary stenosis
Right to left shunt - blue, cyanotic
ES murmur at left sternal edge
Hypercyanotic spells after sleep
Finger clubbing
Lets Voluntarily Open ouR ring pieces everyone! - Large VSD, Overriding aorta, right to left shunt, RVH, PS, ES murmur
13
Q
Tetralogy of fallot assocations
A
Foetal alcohol syndrome, diGeorge’s
14
Q
Tetralogyof fallot treartment
A
surgery at 6-9m
15
Q
Transposition of great arteries treatment
A
Maintain PDA with prostaglandins
arterial switching surgery in first few days of life
Can do balloon atrial septostomy to save life
16
Q
Transposition of great arteries signs
A
R to left shunt
Cyanosis
S2 loud and singular
often no murmur
17
Q
when do you review an undisseneded testis & when should they have orchoplexy by
A
3m review
surgery before 6m
18
Q
what are features of an innocent murmur
A
Varies w/ posture Soft blowing in the pulmonary area Short buzzing in the aortic area No diastolic component No radiation No thrill no added sounds
19
Q
What is the Rx for Enuresis
A
Star chart Toilet training reduce liquid and toilet before bed time Enuresis alarm if <7 Desmopressin if needed short term or don't want alarm >7
20
Q
When do all breech babies get to check for DDH and when
A
bilateral hip USS at 6 weeks
21
Q
ALL features
A
Presents between 2 and 5
anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae
And other features
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
fever is present in up to 50% of new cases (representing infection or constitutional symptom)
testicular swelling
22
Q
Signs of rubella in child
A
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
23
Q
Phimosis
A
Normal foreskin won’t retract from ~3 (don’t try and retract as a neonate, and half of one year olds wont retract)
This causes muzzling of the glans
Commonest cause is balantis xerotica obliteratans –> usually used to have a retractile foreskin
Circumsize
24
Q
Hyposapdias
A
ventral urethral meatus - usually on distal shaft or glans penis
Ventral curation of the shaft, more apparent on erection
Hooded appearance of the foreskin
25
what does a neuroblastoma affect and what are the features
Affects the neural crest tissue (in the adrenal medulla) and the sympathetic chain
Usually have an abdominal mass
Get's met features - LN, bone pain, bone marrow suppression etc
26
what is a wilms tumour and what does it affect
From embryonal renal tissue
Usually presents before 5, rarely seen after 10
Usually a large abdominal mass in an otherwise well child, can have haematuria
27
Congenital adrenal hyperplasia features (21a hydroxylase)
Insufficient cortisol and aldosterone --> Raised ACTH
Can have salt loosing crisis - 1w to 3w of age, usually males, with vomiting, weight loss, hypotonia and circulatory collapse
Increased production of testosterone:
Virilisation of external genitalia in females - clitoral hypertrophy, variable fusion of the labour
In males can have enlarged penis and pigmented scrotum but usually only seen after diagnosis
Muscular build, adult body odour, pubic hair, acne - precocious pubarche
28
Rx of congenital adrenal hyperplasia
```
Lifelong glucorticoids (hydrocortisone) to suppress ACTH --> additional with illness or surgery
FLudorcortisone if there is salt loss
Monitor growth, skeletal maturity, plasma adrongens, 17a progesterone
```
29
what diet can be used in chrons
Whole protein modular feeds (polymeric diet) for 6-8 weeks
| Use steroids and immunosuppression if this fails to cause remission
30
facial features of Down's
```
round face
flat nose
Epicanthic folds
Brushfield spots in iris
Small mouth
Protruding tongue
small ear
```
31
Other features of down's (not facial) in baby
```
Single palmar crease
wide sandal gap
Incurving and short 5th finger
VSD
ASVD
hypotonia
duodenal artesia
Hirschsprung disease
```
32
premature pubarche age
8 in girls
| 9 in boys
33
Delayed puberty age
14 in girls
| 15 in boys
34
Causes of short stature
```
Familial (check mid parental height)
Constitutional - variation of normal growth (will end up growing normal, just delayed)
Turner's syndrome
Noonan Syndrome
Russel-Sliver syndrome
Coeliac
Crohn;s
CKD
Psychosocial deprivation
Hypothyroidism
Growth hormone deficiency
Cushing syndrome
```
35
Causes of premature puberty
```
Females:
Gonadotrophin independent - (Low FSH and LH) - Excess androgens from congenital adrenal hyperplasia or adrenal tumour (virilisation of genitalia before breast development) or ovarian tumour
Gonadotrophin dependent (high FSH and LH) - Pituitary adenoma, hypothyroidism, , Neuro issues e.g hydrocephalus, post-irritadation, tumours (craniophayngioma, neurofibromatosis)
```
Males:
gonadotrophin dependent (bilateral testicular enlargement) Intracranial tumour or rarely ßHCG secreting liver tumour
Gonadotrophin independent (small testicles) - Congenital adrenal hyperplasia or adrenal tumour
Check for testicular tumour
36
Signs of Turners syndrome and abnormality
```
45X
wide spaced nipple,
low posterior hair line,
ovary dygenesis,
short,
neck webbing,
spoon shaped nails,
pigmented moles,
coarctation of the aorta,
bicuspid aortic valve
wide carrying angle,
recurrent otitis media
hypothyroidism
lymphedema of the hands and feet in the neonate
```
37
Noonan Syndrome features
PTNP11 mutation
-characteristic faces - wide set eyes, ptosis, proptosis, large head, high hairline, broad forehead, low set backwards rotated ears
occasional mild learning difficulties
short webbed neck with trident hair line,
pectus excavatum,
short stature,
Pulmonary stenosis and ASD
38
how long do you have to wait after a live vaccine to give the MMR
4 weeks
39
Diarrhoea, with undigested food and no other systemic symptoms, what is the diagnosis
Toddler's diarrhoea
| They have faster transit of food through the GIT
40
Risk factors for developmental dysplasia of the hip
```
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
```
41
Does caput seccudeum cross the suture lines
Yes
| superficial scalp oedema associated w/ prolonged labour
42
Does Cephalohaematoma cross the suture lines
No
| bleeding between the periosteum and skull, most common parietaly
43
what increases risk of cleft lip/palate
How is it inherited
How do you treat it and when
```
maternal anti-epileptic use
polygenic inheritance
repair cleft lip at 3m
Repair cleft palate at 6-12m
N.b cleft palate can making feeding more difficult and can increase the risk of acute otitis media (avoid an adenectomy as it will exacerbate feeding problems and nasal quality of speech)
```
44
what is covered in peritoneum, an Omphalocele or gastroschisis
how do you manage both?
An omphalocele
An omphalocele is a defect with umbilicus
Manage omphalocele with gradual repair, starting immediately and completed over 6-12m to prevent respiratory complications
Gastroschsis is a defect lateral to the umbilicus
Cover a gastroschsis with clingfilm to prevent dehydration and protein loss, pass an NG tube and surgical repair straight away
45
was is the Pierre robin sequence
Micoganthia (small jaw)
& posterior displacement of the tongue
+ Midline cleft of soft palate
Can cause obstruction, cyanotic episodes, feeding difficulties
46
what is ebsteins anomaly and what is the main risk factor
```
"atrialisation" of the right heart
Tricuspid valve moved downward w/ tricuspid regard (early systolic murmur)
right ventricular conduction defects
can get Wolf_parkinson_white syndrome
use of lithium during pregnancy
```
47
Rx for UTI in kids
infants less than 3 months old should be referred immediately to a paediatrician
children aged more than 3 months old with an upper UTI should be considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days
children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours
48
Rx for Necrotising Enterocolitis
Treatment is with total gut rest and TPN, babies with perforations will require laparotomy
49
Signs and Rx of Intrusussception
Telescoping bowel
Proximal to or at the level of, ileocaecal valve
6-9 months of age
paroxysmal, severe, Colicky pain,
diarrhoea
bilious or non bilous vomiting (depends on location), sausage-shaped mass,
red jelly stool.
Treatment: reduction with air insufflation- 3 attempts due to risk of perforation --> then go for surgical reduction
50
Signs of hypernatraemia dehydration
```
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
```
51
What are signs of PDA and how do you close it
```
left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
```
Close with indomethacin/NSAIDS
52
what is Congenital dermal melanocytosis
commonly called Mongolian blue spot.
These are purplish-blue flat macules on the lower back, buttocks and lower limbs.
They are usually found in darker skinned babies, including those of African and Asian descent, though can be found in Caucasian babies.
53
Threadworm Signs and Rx
Threadworm infestation is asymptomatic in around 90% of cases, possible features include:
perianal itching, particularly at night
girls may have vulval symptoms
CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
54
treating Kawasaki disease
High dose aspirin
IVIG
echocardiogram to look for coronary artery aneyrysms
55
Rx for small, recurrent, epistaxis with no sister features
short course of topical chlorhexidine and neomycin, and discourage the child from picking his nose
56
what is a common complications of viral gastroenteritis
Transient lactose intolerance, presenting with diarrhoea
57
Features of West Syndrome
infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents in the first 4 to 8 months of life and is more common in male infants. They are often associated with a serious underlying condition and carry a poor prognosis
Features
characteristic 'salaam' attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap
Investigation
the EEG shows hypsarrhythmia in two-thirds of infants
CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)
Management
poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used
58
what do you use to treat mycoplasma pneumonia
A macrolide
59
Features of juvenile idiopathic arthritis
```
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
```
60
Achondroplasia Features
Achondroplasia is an autosomal dominant disorder associated with short stature. It is caused by a mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene. This results in abnormal cartilage giving rise to:
short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
'trident' hands
lumbar lordosis
61
when is the Guthrie test performed
between 5 and 9 days
62
treatment for spastic CP
treatments for spasticity include oral diazepam,
oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy
anticonvulsants, analgesia as required
63
Necrotsing enterocolitis signs (and X-ray signs) and Rx
```
Often preterm neonates
Feed intolerance
Vomiting (may be bile stained)
Distended abdomen
Stool with fresh blood
Shock
```
Thickening of the bowel wall with intramural gas
Distended loops of bowel
gas in the portal tract
NBM, Total parenteral nutirtion
Broad spec ABx
Surgery for perforation
64
Jaundice causes <24 hours
Haemolytic stuff - Rh, ABO G6PD, spherocytosis, pyruvate kinase deficiency
Sespsi
65
Jaundice cause at 24hr to 2 weeks
Physiological )and breast milk jaundice -=-> dehydration can excaerbate
infection or haemolysis
Bruising
polycythema
Crigler-Najjar - rare, glucrunoyl transferase is missing - high unconjugated bilirubin
66
Persistant jaundice >2weeks
```
Unconjugated:
Pyloric stenosis
Infection - UTI
Hypothyroidism
Haemolytic anaemia
```
Conjuagated (>25)
Bile duct obstruction
Hepatitis
67
Rx for neonatal jaundice
Plot on serial bilirubin chart
Phototherapy (450nm blue light) - can cause macular rash and bronzing of the skin
Exchange transfusion
68
what is the risk of high unconjugated bilirubin
Kernictus --> encephalopathy
69
Meconium aspiration pathophysiology and signs
Meconium results in obstruction + is an irritant (chemical pneumonitis) + predisposes to infection
Passed in response to hypoxia
Tachypnoea (>60), laboured breathing (recessions) nasal flaring, expiratory grunting, cyanosis
Lungs are overinflated w/ areas of consolidation and colapse
```
#Rx = mechanically ventialte
No evidence sucking out meconium does anything
```
70
what SSRI is most commonly associated with persistent pulmonary hypertension
Sertraline
71
Oesophgeal artesia signs
Rx
Assoc with polyhyrdramnios
Absent stomach bubble on antental USS
Persistant salivation and drooling from the mouth
Cough and choke on feeds
Aspiration of saliva, milk, acid
Most will have VACTREL malformations
Pass a wide calliber NG tube
Continuous suction
Surgical correction
72
What conditions can Staph cayse
Impertigo - honey crusted skin
Boils
Perioribital cellulitis
Staph scalded skin syndrome - exfoliative toxin causes seperation of the epidermis --> fever, malaise, pruluent crusting around eyes/nose/mouth and then Nikolsky sign positive, erythema tenderness of the skin
73
Measles signs
```
Fever
cough
runny nose
marked malaise
Koplik spots (white spots on tongue)
Keratoconjuctivits
Coryza
Maculopapular red rash, spreading downwards from behind ears --> becomes blotych and confluent, then can desquamate
```
complications - pneumonia, enecphalitis (1 in 5000),
subacute sclerosising panenecphalitis (1 in 100,000)- 7 years after measles infection - loss of neurological function, progressing to dementia and death
74
Signs of mumps
fever
Maliase
Parotitis (one side, but then bilateral over the next few days) --> ear ache, pain on eating and dinking
infective for 7 days afterr parototis
unilateal transient hearing loss
Plasma amylase raised
Can cause orchitis - but infertility is unusual
75
signs of rubella
mild/lowgrade fever prodrome
Rash - initially on face then spreading centrfugially to whole body
Postauricular and suboccipital LN
76
signs of scarlet fever
Strep throat/pahrynigits (exudative and enlarged tonsils, Cervical LN, sore throat)
White strawberry tongue, which desquamates leaving red strawberry tongue
SANDPAPER red rash, appears first on trumk, small papulles resembling goosebumps - palms and soles left univlved
rash more pronounced in skin creases
flsuehd face
Pastia’s Lines which are petechiae arranged in a linear pattern
desqumates about a week later leaving a sunburnt appearance
77
red current jelly stool
Intussusception
78
sausage shaped mass
Intussuception
79
what are the signs of intussuception
Paroxysmal, severe, collicaly pain - draws up legs, become pale
May refuse feeds
Vomit - might be bile stained depending on site
Sausage shaped mass palpable
Recurrant jelly stool - blood and mucus
Abdominal distension and shock
80
What are the AXR signs of intussuception
Distended small bowel
| Absence of gas distally
81
What is the Rx for intussuception
rectal air insuffliation by a radiologisr
| Surgery
82
GORD signs
Regurgiation and vomiting
faltering growth from severe vomiting
Osophagitis - haematemesis, iron deficency anaemia
recurrent pulmonary aspiration - pneumonia, wheeze, cough,
Dystonic neck posturing - Sandifer syndrome
83
GOR
```
regurg and vomiting
Put on weight though and otherwise well
Normally resolves by 12m as lower sphincter matures
Give reassurance
Add feed thickner - Carobel
Smaller and more frequent feeds
```
84
Signs of pyloric stenosis
Projectile vomiting after feeds
Hunger until dehydrated
weight loss
hypocholareamc metabolic alkalosis with low Na and K
Gastric peristalisis seen moving as a wave from left to right after a feed
olive mass in RUQ
Rx - pylomyotomy
85
Condition that can be asymptomstic or present with severe rectal bleeding (which is neither malaenia nor bright red)
Meckel's diverticulum
86
Non-projectile bilious vomiting and Dx
Malrotation/Volvus
| need urgent laprotomy
87
Causes of SI obstruction in the neonate
Artesia of the duodenum - double bubble sign on xray with absence of air distally (will probably have down's)
Meconium Ileus - CF
Meconium plug
Malrotation w/ volvus
88
Signs of SI obstruction in the neonate
Persistant vomiting - bile stained if below ampulla of vater
Mecnium passage delayed or absent with no transition to normal stool
Abdo distension
High lesions present soon after birth
Distal lesions may not present for days
89
```
Boy with moderate-severe learning difficulties
Macrocephaly
Macroorchadism
Long face
Large everted ears
Broad forehead
```
Fragile X
90
Signs of fragile X
```
Mod-severe learning difficulties
Macrocephaly
Macroorchidism
Long face
Large everted ears
prominent mandible
braod forehead
mitral valve prolapse
joint laxity
scoliosis
autism
hyperactivity
```
91
```
low birthweight
prominent occupit
small mouth and chin
flexed overlapping finger
rocker bottom feet
cardiac and renal malformations
```
Edwards (t18)
92
Edwards syndrome
```
T18
low birthweight
prominent occupit
small mouth and chin
flexed overlapping finger
rocker bottom feet
cardiac and renal malformations
```
93
```
Structural defect of brain
scalp defect
small eyes and other eye defect
cleft lip and palate
polydactyl
Cardiac and renal malformations
```
Patau (t13)
94
Signs of Patau syndrome
```
Structural defect of brain
scalp defect
small eyes and other eye defect
cleft lip and palate
polydactyl
Cardiac and renal malformations
```
95
what is eisenmenger syndrome
in left to right shunt (high pulm blood flow) that ins't treated
Pulmonary arteries become thick walled and resistance to flow increases
Then at age 10-15, shunt reverses and the teenager becomes cyanotic
This is porgressive and they die in their 4th of 5th decade
96
when is phimosis normal until
2 years
97
what condition is associated with pathological phimosis and how do you treat it?
Blanatis Xerotica Obliterans
presents with erythema, oedema and generation of purulent material from distal phimotic foreskin
Circumcisionn
98
JIA symptoms
```
Features of systemic onset JIA include
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
```
