Paeds Flashcards
1
Q
What fluid type is used for maintenance?
Bolus?
Neonates?
A
0.9% NaCl + 5% glucose.
Bolus: just 0.9% NaCl
10% glucose solution.
2
Q
How much is given as a bolus normally, and in DKA?
A
Normally 20mL/kg, DKA = 10mL/kg.
3
Q
List the tests screened on the Guthrie heel prick.
A
- CF.
- Sickle cell disease.
- Congenital hypothyroidism.
- Phenylketonuria.
- MCADD.
- MSUD.
- IVA.
- GA1.
- HCU.
4
Q
List the components of a paediatric septic screen.
A
- Bloods.
- Cultures.
- Urine culture.
- Stool culture.
- CXR.
- LP.
5
Q
What is the prophylaxis for meningitis in household contacts?
A
Oral Rifampicin or Ciprofloxacin.
6
Q
Sx and Tx for:
Otitis externa.
Otitis media.
Otitis media with effusion.
A
Inflamed ear canal +/- oedema and discharge.
Gentamycin and hydrocortisone topical.
Red and bulging tympanic membrane.
Amoxicillin.
Fluid level. Speech/language delay due to hearing issues.
Grommets.
7
Q
What does a bilateral ‘ground glass’ appearance on CXR in a neonate suggest?
A
RDS.
8
Q
What are 4 features of RDS and how long after birth do they present?
A
4 hours after birth:
- > 60 breaths/min.
- Sternal/subcostal recession, nasal flaring.
- Expiratory grunts.
- Cyanosis if severe.
9
Q
When would resus in RDS not be attempted?
A
A baby <24 weeks.
10
Q
Describe the Tx pathway for RDS
A
- Face mask with oxygen.
- CPAP (nasal canula.)
- Intubation.
- Add artificial surfactant if need invasive ventilation.
11
Q
What are 4 common causes of RDS in term babies?
A
- Transient tachypnoea of the newborn.
- Meconium aspiration.
- Spontaneous pneumothorax.
- Milk aspiration.
12
Q
Causative organism of acute epiglottitis?
Clinical features?
Ix?
Mx?
A
- Haemophilus influenzae b.
- Acute stridor, muffled cry, absent/quiet cough, toxic looking child, tripoding, drooling.
- DO NOT examine throat.
Ask about Hib vaccination. - Keep child relaxed and calm, and call immediately for anaesthetist to intubate.
13
Q
What are the infective and non-infective causes of stridor?
A
Infective: croup, epiglottitis, bacterial tracheitis.
Non-infective: aspiration, laryngomalacia, anaphylaxis.
14
Q
Causative organism of croup?
Clinical features?
Ix?
Mx?
A
Parainfluenza.
Peak age 2.
Preceded by coryza.
Cough: barking, seal life, paroxysmal, worse at night. Stridor.
Rule out epiglottitis, don’t examine throat in case it is that.
Oral dexamethasone.
15
Q
Commonest causative organism of pneumonia?
Clinical features?
Ix?
Mx?
A
S. pneumoniae.
Cough, fever, tachypnoea, resp Sx.
Course crackles.
CXR - consolidation.
Treat as sepsis:
- CXR, Bloods MC&S, FBC, sputum culture, throat swabs, PCR (viral.)
Neonates: broad spectrum Abx.
Older: Amoxicillin (2nd line erythromycin.)
16
Q
Commonest causative organism of bronchiolitis?
Clinical features?
Ix and reason for admission?
Mx?
A
Respiratory syncytial virus.
> 1 year.
Winter months.
Coryza, dry cough peaks at day 4/5.
High threshold for Ix.
<1/2 of usual feeds, resp distress, low sats (<92%)
Conservative: fluids and oxygen.
17
Q
What is the prevention for RSV infection and who is it given to?
A
IM Palivizumab.
High risk:
- preterm.
- CF.
- Congenital cardiac conditions.
18
Q
Causative organism of Whooping Cough?
Clinical features?
Ix?
Mx?
Prevention in pregnancy?
A
Bordetella pertussis.
Week of coryza, then:
- cough: worse at night, ends in vomiting, causes cyanosis.
- Inspiratory whoop.
- 10-14 weeks of Sx.
Nasal swab (PCR and serology.)
<6/12 = admit. IS A NOTIFIABLE DISEASE. Oral macrolide (mycins) if cough started within previous 21 days
Household contact prophylaxis.
Offered vaccine at 16 weeks in pregnancy.
19
Q
Differentials for a wheeze?
A
- Viral induced wheeze.
- Asthma.
20
Q
What is seen on examination is asthma?
A
Harrison sulci.
Wheeze.
Hyperinflated chest.
21
Q
What is the PFR in a moderate, severe, and life-threatening asthma attack?
A
> 50%, <50%, <33%.
22
Q
What are the features of a life-threatening asthma attack?
A
Silent chest. Poor resp effort. Altered consciousness. Cyanosis. Sats <92%. PEFR <33%. CO2 normal, if raised = near fatal.
23
Q
What is the management of an acute asthma attack?
A
- Sats <94%, give high flow oxygen.
- Up to 10 puffs of SABA via spacer.
- Addition of nebulised SAMA.
- Oral pred for 3 days/IV hydrocortisone.
24
Q
Asthma management pathway in children over 5.
A
- SABA.
- Next step/newly diagnosed with >/=3 Sx a week/waking at night: SABA + low dose ICS.
- LTRA.
- LABA (stop LTRA if didn’t help, or keep if it did.)
- SABA + low dose ICS MART
- SABA + moderate dose ICS MART/ moderate dose ICS with LABA.
- SABA + high dose ICS (fixed or in MART), trial theophylline.
Refer.
25
Asthma management pathway in children under 5.
1. SABA.
2. Next step/newly diagnosed with >/=3 Sx a week/waking at night: SABA + moderate dose ICS trial for 8 weeks.
- Not resolved: alternative Dx.
- Resolved then recurred in 4 weeks: restart low dose ICS.
- Resolved then recurred in >4 weeks: repeat 8 week trial.
3. SABA + low dose ICS + LTRA.
4. Stop LTRA and refer.
26
Diagnostic criteria for asthma with spirometry.
FEV1:FVC ratio <70% and >12% increase in PF after SABA.
27
Type of genetic disorder in CF?
Clinical Fx?
Ix?
Mx for neonatal issues, resp, nutritional, and stage?
Autosomal recessive.
- Salt baby.
- Meconium ileus.
- Recurrent chest infections.
- Poor growth.
- Male infertility.
- Steatorrhea.
- Persistent, loose cough, purulent mucus, hyperinflation of chest, crepitations and wheeze, clubbing.
1st line: sweat test.
Confirmation - genetic.
Meconium ileus: enema, surgery.
Resp: prophylactic Abx, rescue Abx. Older = spirometry. BD physio.
Pancreatic enzyme replacement, high calorie, high fat diet, DM control.
Bilateral lung transplant for end stage.
28
Ix for coeliac disease?
IgA tissue transglutaminase (IgA-tTG)
Jejunal biopsy - villous atrophy.
29
What is the 1st and 2nd line Tx for CMPA
Switch to extensive hydrolysed formula.
Try amino-acid based formula.
30
What are the 2 different types of food allergy and how are they different?
IgE mediated; immediate response.
Non-IgE mediated: delayed (>48hr) response.
31
A child presents with abdominal pain and enlarged cervical lymph nodes with a PMHx of resp tract infection. What's the likely diagnosis?
Mesenteric adenitis.
32
What are the types of dehydration that can present in gastroenteritis? What do they lead to?
Isonatraemic: total body deficit of water AND sodium.
Hyponatraemic: drink lots of water, so net loss of sodium. Leads to movement of fluid from extra to intracellular compartments = brain swelling.
Hypernatraemic: water loss exceeds sodium loss (rare) i.e. fever or dry environment. Shifts from intra to extracellular compartments = brain shrinking.
33
Ix and Mx of gastroenteritis
If unwell and blood, no improvement after 7 days = culture stool.
No dehydration: prevent with oral rehydration solution (ORS.)
Clinical dehydration: ORS and maintenance fluids.
Shock: bolus.
34
Common complication after recoerving from gastroenteritis? Tx?
Post-gastroenteritis syndrome: temporary lactose intolerance.
ORS for 24 hours and avoid lactose for a few weeks.
35
Definitive diagnosis for IBD? Which one is more common in paeds?
Biopsy.
Crohn's.
36
Tx for Crohn's?
- Remission by EEN nutrition.
- Relapse: Azathioprine, Methotrexate.
2nd = TNF (Inflixamab)
37
Management pathway for constipation.
1. Macrogol (Movicol)
2. Stimulant (Senna, Sodium picosulfate)
3. Osmotic laxative (Lactulose.)
38
GORD
Sx.
Diagnosis
Management
Recurrent, non-bilious, non-projectile vomiting after feeds.
FTT.
Aspiration.
Seizure/troticollis due to pain.
Positioning on feeds.
Thicken feeds.
H2 blocker or PPI.
Surgery: fundoplication.
39
Pyloric stenosis
Sx and age.
Diagnosis
Management
Male, 2-7 weeks.
Recurrent, projectile, non-bilious vomiting.
Hypochloraemic, hypokalaemic metabolic acidosis.
USS, firm lump in abdo, chemistry screen.
Surgical pyloromyotomy.
40
Hirschprung
Sx.
Diagnosis
Management
Failure to pass meconium ileus in 24-48 hours.
Abdominal distention.
Bilious vomiting.
DRE = releases stool.
Rectal biopsy definitive.
Colostomy and anastomoses of innervated bowel to anus.
41
Intussusception
Cause
Sx and age.
Diagnosis
Management
Enlarged Peyer's patch after viral illness.
After the neonatal period (6-9 months.)
Severe pain, pallor, vomiting.
Doughnut on imaging, sausage on palpation, redcurrant jelly stools.
USS: target sign (doughnut.)
Air enema.
42
Meckel's diverticulum
Sx.
Diagnosis
Management
```
Bright red massive GI bleed.
2% of population.
Under 2.
2x more likely in males.
2 types of mucosa affected.
2 feet from ileocecal junction.
2 inches long.
```
Technetium scan.
Surgical resection.
43
Malrotation with volvulus
Sx.
Diagnosis
Management
Bilious vomiting.
Peritonitis or ischaemic bowel.
Upper GI contrast.
Surgical correction: Ladd's procedure.
44
NEC
Sx.
Diagnosis
Management
Necrotising enterocolitis
Newborn, especially premature.
Won't feed, distended abdomen, bilious vomiting/blood in stools.
X-ray shows intramural gas.
Broad spectrum Abx.
45
Congenital diaphragmatic hernia
Sx.
Diagnosis
Management
RDS.
Apex beat on R instead of left.
Poor air entry on L.
X-ray shows bowel above diaphragm.
46
# Define exomphalos (omphalocele) and gastrochisis.
Associations and Tx.
1. abdominal contents protruding through umbilical ring covered by transparent sac.
2. Near umbilicus, no covering sac.
1. Associated with congenital abnormalities.
2. Wrap in clingfilm, NGT for continuous aspiration then surgical repair.
47
Define kernicterus and the risk.
Encephalopathy resulting from high levels of unconjugated bilirubin in basal ganglia and brainstem.
Athetoid subtype CP.
48
What are the causes of jaundice under 24 hours? What type of bilirubin is it?
```
Unconjugated:
- Haemolytic:
Rhesus incompatibility.
ABO incompatibility.
G6PD deficiency.
Spherocytosis.
Pyruvate kinase deficiency.
```
Congenital infection
49
What are the causes of jaundice between 24 hrs to 2 weeks? What type of bilirubin is it?
Unconjugated
Often physiological, breast milk.
Bruising.
50
What are the causes of jaundice > 2 weeks? What type of bilirubin is it?
Unconjugated as before.
| Conjugated: bile duct obstruction BILIARY ATRESIA, hepatitis.
51
What is the Tx for jaundice at what level?
>350 = phototherapy.
| Severe (>450) = transfusion.
52
Sign in duodenal atresia?
Double bubble sign.
53
Jaundice for >2 weeks?
Biliary atresia.
54
Sx of toddler's diarrhoea?
Variable consistency of stool.
Undigested vegetables in it.
Child is well and thriving.
Stops by age 5.
55
Define and give the causes of cerebral palsy
Damage occurring up to 2 years leading to non-progressive abnormality of posture and movement.
Majority antenatal.
Hypoxic-ischaemic brain injury during delivery (preterm = Periventricular leukomalacia, intraventricular haemorrhage.
Post natal:
- Kernicterus.
Head trauma.
56
Give 2 developmental features of cerebral palsy
Hand preference <12 months old.
Delayed milestones.
57
List the types of cerebral palsy and what they present as.
Spastic: damage to UMN = clasp knife spasticity (faster moved = more resistance.)
Dyskinetic: uncontrolled movement.
Ataxic.
58
What is the gender and age growing pains are most common in?
What are the 3 key features?
Female aged 3-12 years.
Wakes from sleep.
Bilateral, symmetrical, lower limb.
No limp.
59
Osteomyelitis
```
Define.
Causative organisms?
Clinical features?
Ix?
Tx?
What can it lead to?
```
Infection of metaphysis of long bone (usually distal femur, proximal tibia - i.e. both at the knee.)
S. aureus, H. influenzae.
Painful, immobile limp.
Febrile.
Swelling and tenderness.
Cultures.
X-ray: 7-10 days = new bone.
IV Abx then oral.
Surgical drain.
Can lead to septic arthritis.
60
Perthes Disease
```
Define.
Age and gender common in?
Clinical features?
Ix?
Tx?
```
Avascular necrosis of UFE.
Boys ages 5-10 (before puberty.)
Limp and hip pain develop slowly.
X-ray, loss of abduction and IR of hip.
Good prognosis in <6 with bed rest and traction.
Severe = osteotomy.
61
Septic arthritis
```
Define.
Age common in?
Causative organisms/cause?
Clinical features?
Ix?
Tx?
```
Infection of joint space.
Under 2.
Spread from osteomyeltitis.
Neonates: GBS.
Adolescent: STI.
S. aureus.
Warm and tender, acutely unwell. Hip/knee common.
Joint aspiration under USS to culture.
X-ray: joint destruction.
Prolonged Abx for 6-12 weeks
Surgical drainage.
62
Reactive arthritis
```
Define.
Causative organisms?
Clinical features?
Ix?
Tx?
```
Follows systemic infection.
Salmonella, shigella, campylobacter, yersinia.
Transient joint swelling (<6 weeks.)
CRP normal or mildly raised.
NSAIDs.
63
Transient synovitis.
```
Commonest age.
Causative organisms?
Clinical features?
Ix?
Tx?
```
2-12 years.
Post-strep.
Following viral infection.
Sudden onset.
No pain on rest.
Afebrile, not unwell.
Rule out septic arthritis.
Bed rest.
64
DDH
```
Define.
Common age and gender?
Clinical features?
Ix?
Tx?
```
Developmental dysplasia of the hip.
Female, neonates.
Ortolani's/Barlow's test.
Leg length discrepancy in older.
```
<6m = USS.
>6m = x-ray.
```
Watch and wait until 6w.
<6m = harness.
6-18m = closed reduction, cast.
>18m = open reduction.
65
SUFE
```
Define.
Common gender and age group?
Clinical features?
Ix?
Tx?
```
Displacement of UFE.
Obese boys 10-15: puberty growth spurt.
Limp/hip pain.
Confirm on X-ray
Loss of abduction/IR of hip.
Surgical correction.
66
Osteogenesis imperfecta
Define, and inheritance pattern?
Types and their clinical features?
Tx?
Autosomal dominant collagen defect.
1: commonest. Blue sclera, fractures in childhood, hearing loss.
2: lethal.
Bisphosphonates to reduce fracture risk.
67
Rickets
```
Define.
Aetiology?
Clinical features?
Ix?
Tx?
```
Failure of mineralisation in growing bone.
Nutritional (primary): not much sun, darker skin, decreased exposure to light, maternal deficiency, late exclusive breastfeeding, strict diet.
Malabsorption: coealic.
Ping pong ball sensation of skull: craniotabes.
Rachitic rosary: palpable costochondral junction.
Harrison sulci.
Bowed legs.
Seizures.
Bloods: low/normal calcium, low phosphorous, increase alk phos, low 25-hydroxyvitamin D, PTH high.
Wrist x-ray: cupping and fraying, widened plates.
Dietary advice, daily D3.
68
# Define diagnosis of JIA?
Main clinical features?
List the 5 types.
What may be present on Ix?
Treatment options?
Onset before 16 with no underlying cause. Persistent joint swelling for at least 6 weeks.
Unwell with limp or joint pain for >6 weeks.
Salmon pink rash.
Leg stiffness worse in morning.
Anterior uveitis.
1. Oligoarticular: up to 4 joints.
2. Polyarticular: 5+ joints.
3. Psoriatic.
4. Enthesis-related.
5. systemic: acutely unwell.
ANA-positive Ab.
DMARDs: Methotrexate.
NSAIDs.
Steroid injections.
Biologics: Inflixumab.
69
# Define UTI.
Commonest aetiology?
Ix?
When to investigate further and how?
When to admit?
Tx?
>10^5 organisms/mL.
E. coli.
Clean catch urine dip.
MC&S if positive dip/ under 3 months.
Atypical/recurrent (2+ episodes with Sx, 3+ without)
- USS.
- DMAS (dye for scarring.)
- MCUG (check for vesicoureteral reflux.
< 3 months.
Systemically unwell.
Significant risk factors.
<3 months/ Sx:
- IV Cefuroxime for 7 days, then oral Trimethoprim.
70
What are the three causes of a swollen child?
Nephrotic syndrome.
Nephritic syndrome.
Henoch-Schonlein Purpura.
71
What is the cause of steroid sensitive and resistant nephrotic syndrome?
Minimal change disease, glomerulopathies.
72
Triad of nephrotic syndrome? Tx?
Heavy proteinuria.
Hypoalbuminaemia and hyperlipidaemia.
Oedema.
Pred every day for 4 weeks then every other day for a further 4.
Loop diuretics.
73
Triad of nephritic syndrome?
Causes?
Macroscopic haematuria.
Proteinuria.
HTN, decreased GFR, oedema.
IgA nephropathy from HSP.
Post-strep glomerulonephritis.
74
# Define HSP.
Clinical features.
Mx?
Type of vasculitis.
Raised, palpable rash on back of legs and buttocks.
Arthritis, PR bleed, nephritis.
Corticosteroids.
Penicillin to clear strep.
75
What are electrolyte levels like in a salt wasting crisis in CAH?
Mx of salt wasting crisis?
Mx of CAH long term?
In surgery/illness what is given?
What is the aetiology and so Ix?
Low Na, high K, metabolic acidosis.
IV glucocorticoids.
Life-long gluco and mineralocorticoid (aldosterone) replacement: Hydrocortisone and Fludroscortisone.
3x dose of glucocorticoid (hydrocortisone.)
21-hydroxylase deficient.
Ix = high 17-hydroxyprogesterone.
76
Diagnosis of DM?
- Symptoms + random glucose of >11.1 + glycosuria + ketonuria.
- Fasting glucose >7/HbA1C >6.5%
77
What metabolic issues are seen in DKA?
Severe metabolic acidosis.
Glucose >11
78
Mx of mild/moderate and severe hypo?
3-5 glucose tablets/juice, long acting carbs. (glucogel if too unwell.)
SC glucagon 0.5 or 1mg
79
Commonest cause of congenital hypothyroidism in UK?
Why is it important to recognise?
Sx and Tx?
Maldescent of thyroid or athyrosis.
Preventable cause of LD.
Hypotonia, prolonged jaundice, big tongue.
Levothyroxine lifelong.
80
Ix for suspected testicular torsion?
Tx and time?
Main differential and differences?
Surgical exploration.
Surgical repair, and fix other testicle (<6 hours.)
Torsion of hydatid of Morgagni: less painful, blue dot sign, analgesia and resolve on own.
81
Triad of hypospadias? What is epispadias?
CI?
Ventral urethral meatus.
Hooded dorsal foreskin.
Chordee.
When urethral meatus on on dorsal (top) aspect.
Circumcision.
82
When should a foreskin retract by and what might it form if it doesn't?
By 16.
Smegma pearls.
83
Inguinal hernia.
Epidemiology and location?
Tx and risk?
Main DDx and differences?
Male L>R sided.
If reducible: wait 48 hours then surgery.
If not: emergency.
Risk of incarceration and strangulation.
Hydrocele: asymptomatic and trans illuminate.
84
Types of cryptorchidism.
When is it an emergency?
Ix and when?
Mx and when?
Retractile.
Palpable.
Impalpable. If BILATERAL, may be CAH = emergency.
Still undescended in 6 months, laparoscopy.
At this time, orchidopexy to repair it.
85
List the 4 types of common bleeding disorders in children and their Fx.
Idiopathic thrombocytopenic purpura: following viral illness.
Von Willerbrand disease.
Haemophilia A
Haemophilia B
- A = 8 or B = 9 deficiency.
- X-linked recessive; effects males.
