Paeds from lectures Flashcards
(224 cards)
1
Q
What are the red flags for gross-motor development?
A
Not sitting by 12 months
Not walking by 18 months
It is important to rule out muscular dystrophy in boys who are not walking by 18 months
2
Q
What are the red flags for fine motor development?
A
Hand preference before 18 months
- could indicate a neurological condition such as cerebral palsy
3
Q
What are the red flags for speech and language?
A
No clear words by 18 months. commonly hearing problem but can be related to a learning disability, autism, or an isolated speech and language problem
4
Q
What are the red flags for social development?
A
No response to carers’ interactions by 8 weeks
No smiling by 3 months
Not interested in playing with with peers by 3 year
Lack of smiling might be a sign of visual impairment
Children who are later diagnosed with autism/LD may have shown signs of early social developmental delay
5
Q
What are the red flags for child growth and development?
A
- Regression of development
- Poor health/growth
- Significant family history
- Findings on examination e.g. microcephaly, dysmorphic features
- Safeguarding indicators - known to social care, unexplained injuries
6
Q
What must be checked in boys who fail to walk by 18 months?
A
Creatinine kinase - it is elevated following muscular injury, can be indicative of Duchenne’s
7
Q
What inheritance pattern is seen in Duchenne’s?
A
X-linked recessive
8
Q
How do you test for Duchenne’s?
A
- CK test
- Genetic test with blood sample
- Muscle biopsy may be required
9
Q
What is global developmental delay?
A
Delay in two or more developmental areas
10
Q
A boy is 20 months old and is not yet walking. What is on the list of differentials?
A
- Muscular dystrophy
- Rickets
- Cerebral palsy
- Hip dysplasia
- Neurological (spinal lesion causing mixed UMN, LMN)
- Environmental (neglect, safeguarding)
11
Q
What are the red flags for a vomiting child?
A
- Bile-stained vomit
- Haematemesis
- Projectile vomiting
- Abdominal pain on movement
- Blood in the stool
- Severe dehydration
- Headache or seizures
- Failure to thrive
12
Q
What is bile stained vomit indicative of?
A
intestinal obstruction
13
Q
What does haematemesis indicate?
A
peptic ulceration, gastritis, oesophageal varices
14
Q
What does projectile vomiting indicate?
A
Pyloric stenosis
15
Q
Abdominal pain on movement indicates what?
A
Surgical abdomen - eg appendicitis
16
Q
Blood in the stool indicates what?
A
intussusception, gastroenteritis, nec
17
Q
Which microorganisms are known to cause bloody stools?
A
E. Coli
Salmonella
18
Q
What is haemolytic uraemic syndrome?
A
Triad of:
- Thrombocytopenia
- Microangiopathic haemolytic anaemia
- Acute renal failure
Following infection with a particular strain of E.Coli, children may present with jaundice and pallour.
19
Q
Severe dehydration in a vomiting child might indicate what?
A
- DKA
- Severe gastroenteritis
- Systemic infection
20
Q
Headache and seizures when combined with vomiting are red flags for what?
A
raised ICP
21
Q
Failure to thrive and vomiting can be due to?
A
coeliac disease or GORD
22
Q
What are the cardinal findings in pyloric stenosis?
A
- Metabolic alkalosis
- Dehydration (with abnormal kidney function)
- Hypochloraemia
- Hypokalaemia
23
Q
What does metabolic alkalosis do to bicarbonate levels?
A
Metabolic alkalosis elevates bicarbonate levels`
24
Q
How do you diagnose pyloric stenosis?
A
- U+E
- ABG
- USS abdo (diagnostic)
25
How do you treat pyloric stenosis?
```
Rehydration and correcting electrolyte imbalance
Then pyloromyotomy (Ramstedt's)
```
26
What would you find on examination of abdo of child with pyloric stenosis?
Visible gastric peristalsis and palpable mass on test feed
27
How would GORD present in a baby?
Vomiting
feeding difficulties
failure to thrive
28
How is GORD investigated in child?
- pH impedence study
29
How is GORD managed in a child?
Conservatively
- smaller and more frequent feeds
- feed thickeners
- optimise position
30
How does CMPA present in children?
- chronic vomiting
- eczema
- flatulence
- bloody stools
- diarrhoea/constipation
31
How is CMPA investigated?
skin prick/specific IgE antibody test
32
how do you treat CMPA in child?
cow's milk elimination from diet
hypoallogenic infant formula
mother avoids cow's milk
33
how does intestinal obstruction present in a child?
acute on chronic vomiting - bilious vomit,
constipation
abdo pain
34
what can cause intestinal obstruction?
- malrotation (esp in first week of life)
- hirschprung's
- meconium ileus
- necrotising enterocolitis
35
How is malrotation diagnosed?
symptoms include bilious vomiting,
| Urgent upper GI contrast study with barium
36
Why is malrotation dangerous?
Can lead to volvulus and infarction of midgut
SMA blood supply to small intestine can be compromised - infarction
37
How is malrotation treated
surgical
38
What is hirschprung's
absence of ganglionic cells from myenteric plexus of large bowel - results in narrow contracted segment of bowel
39
How does hirschprung's present?
failure to pass meconium within 48hrs of life
40
what is hirschprung's associated with?
down's
41
what are the clinical features of hirschprung's?
abdo distension
later, bile stained vomit
can lead to enterocolitis from C. Diff infection
42
how is hirschrpung's diagnosed?
suction rectal biopsy
43
How is hirschprung's treated?
Enema
| Surgical resection of affected colon
44
What is meconium ileus?
blockage of the distal ileum due to abnormally thick and impacted meconium. usually due to CF
45
how might meconium ileus present?
- failure to pass meconium in the first 48hrs
- bilious vomit
- abdo distension
46
how is meconium ileus diagnosed?
XRay Abdo
47
how is meconium ileus treated?
stop feeding, drain bile, enema, if enema fails to disimpact stool, surgery
48
what is necrotising enterocolitis? (NEC)
portion of bowel dies. allows pathogenic colonisation of normal commensal bacteria. can be linked to E. Coli usually occurs in premature infants
49
how is nec treated?
Nil PO
Prevention: breastfeeding and probiotics
antibiotics, surgery
50
How does NEC present?
blood in stool
abdo distension
problems feeding
51
what does bile stained vomit in first week of life indicate?
malrotation until proven otherwise
52
What is the difference between marasmus and kwashiorkor?
marasmus is malnutrition of all nutrients. insufficient energy intake. symptoms include weight loss, failure to thrive etc
kwashiorkor is insufficient protein intake with adequate energy intake
53
what is intusussception?
telescoping of proximal bowel into distal bowel
| commonly, ileum moves into caecum via ileocaecal valve
54
when does intuss usually present?
3months to 2 years, more common in boys
55
what are symptoms of intus?
- severe paroxysmal pain
- draws knees up to chest, pale
- vomiting - may become bilious
- redcurrant jelly stool (blood and mucus)
- sausage shaped RUQ mass (upper quadrant!)
56
how is intuss investigated?
ultrasound abdo diagnostic (doughnut/target sign)
xray abdo would show distension with absence of air in large bowel
57
how is intuss treated?
rectal air insufflation(aka pneumatic reducation enema) . analgesia, IV fluids if shocked, laparotomy sometimes
IV antibiotics
58
what is meckel's diverticulum?
presence of vitelline duct (usually involutes during foetal development)
59
how does meckel's present?
```
can be asymptomatic
can cause
- GI bleeding
- volvulus
- intusussception
- umbilical discharge
```
60
how is meckel's treated?
surgical resection
61
what is the vitelline duct?
joins the yolk sac to the lumen of the midgut in the foetus
62
what is toddler's diarrhoea?
chronic non-specific diarrhoea in toddlers
63
how does toddler's diarrhoea present
colicky pain
loose stool with undigested food ("peas carrots")
inc flatus
abdo distension
64
how is toddler's diarrhoea managed?
reassurance
increased fat and fiber intake
reduced milk intake
loperamide may be necessary
65
what is biliary atresia?
progressive fibrosis and oblitertion of intra and extrahepatic biliary tree
66
why is biliary atresia bad?
chronic liver failure and death within 2 years
67
how does biliary atresia present?
fine in first 2 days of life, then jaundice (obstructive) = pale stools, dark urine
68
does biliary atresia cause conjugated or unconjugated bilirubinaemia?
conjugated bilirubinaemia
69
what are two risk factors for biliary atresia?
down's or CFC1 mutation
70
how is biliary atresia investigated?
1. Measure transcutaneous bilirubin - conjugated bilirubin would be raised.
2. LFT's would be abnormal.
3. ERCP imaging would fail to outline a normal biliary tree.
71
how is biliary atresia treated?
Kasai procedure
72
What does coffee-bean sign on abdo x ray indicate?
sigmoid volvulus
73
How might a strangulated hernia appear in a child?
bilious vomiting
74
what are the signs of inguinal hernia in a child?
can't get above it, reducible, often indirect in children. needs surgical repair
75
what are two types of hernias that present in children?
diaphragmatic and inguinal
76
how are hernias treated?
surgically
77
how do diaphragmatic hernias present?
tachypnoea, tachycardia, failure of the lungs to develop correctly,
cyanosis
78
what investigations would you do for IBD
1. endoscopy with biopsy
2. low serum albumin (protein loss)
3. microcytic anaemia
4. high ESR, CRP
79
how can crohns and uc be differentiated macroscopically?
crohn's = skip lesions, cobblestoning, strictures
uc = continuous, mucosal ulceration
80
microscopic differences between uc and crohns
crohns = non-caseating granulomas, transmural inflammation
uc = no granulomas, submucosal
81
How is Crohn's treated?
```
Enteral nutrition (eg Modulen) for 6-8 weeks
glucocorticoids
```
82
How is remission maintained in Crohn's
Azathioprine or mercaptopurine
83
How is UC treated?
```
glucocorticoids
aminosalicylates (mesalazine) (used in remission maintenance)
```
84
what is coeliac disease?
AI response by GALT to gliadin
85
which antibodies are found in Coeliac disease?
Anti-TTG
endomysial antibodies
anti-gliadin
86
how is coeliac diagnosed?
serum anti-TTG/endomysial.
| if positive, endoscopy and biopsy (must have 6 weeks of gluten in diet)
87
what are the common viruses that cause gastroenteritis?
rotavirus
adenovirus
norovirus
enterovirus
88
what are common bacterial causes of gastroenteritis?
Campylobacter
salmonella
shigella
e coli
89
how does gastroenteritis present?
```
acute onset d+v,
fever
lethargy
abdo pain
poor feeding!!!
dehydration!!!
```
90
how is gastroenteritis managed?
- oral rehydration soluition
- continue breastfeeding
- NG tube fluids
- hospitalisation if shocked
91
what can develop after gastroenteritis?
post-infective lactose intolerance
92
what is mesenteric adenitis?
swollen lymph glands in abdomen - causes pain
| usually due to viral infection (can be bacteria)
93
what are the symptoms of mesenteric adenitis?
```
pain
fever
d+v
prodromal sore throat/cold
cervical lymphadenopathy
```
94
how is mesenteric adenitis treated?
analgesia and hydration
95
list 3 differential diagnoses in a vomiting child?
- inguinal hernia
- irritable bowel syndrome
- abdominal migraine
96
how might an inguinal hernia present?
- reducible lump in groin
| - if strangulated - severe pain, nausea, vomiting, off food
97
how is inguinal hernia investigated?
clinical exam - rule out testicular torsion
98
how does irritable bowel syndrome present?
pain relieved on defecation, bloating, mucus in stool, lethargy, clinical diagnosis (after ruling out other diagnoses)
99
how is IBS treated?
small regular meals, eliminate triggering foods
100
what is abdominal migraine?
pain lasting 2-72 hours, nausea, vomiting, anorexia, pallour
101
how is abdo migraine treated?
analgesia, avoid triggers, prophylaxis
102
abdo migraine investigations?
search for triggers, rule out DDs
103
what is kernicterus?
high levels of unconjugated bilirubin deposit in basal ganglia.
104
what does kernicterus cause?
encephalopathy with seizures
choreoathetoid cerebral palsy
105
what 2 categories of disorders cause pathological jaundice in first 24 hrs?
congenital infection
| haemolytic disorders
106
which haemolytic disorders can cause jaundice in first 24hrs?
```
rhesus incompatibility
ABO incompatibility
G6PD
spherocytosis
pyruvate kinase deficiency
```
107
which congenital infections can cause jaundice in first 24 hrs?
- toxoplasmosi
- CMV
- rubella
- syphilis
- herpes
- hepatitis
(TORCH infections)
108
what is physiological jaundice?
from 24 hrs to 2 weeks, due to breakdown of fetal haemoglobin
109
how is physiogical jaundice treated?
phototherapy
| exchange transfusions
110
what is the type of jaundice that occurs in first 24 hrs?
pathological
always unconjugated
can be caused by SEPSIS
111
what can sepsis cause in a newborn?
jaundice, esp if first 24hrs
112
what are the TORCH infections?
```
Toxoplasmosis
other (eg syphilis)
rubella
cytomegalovirus
hepatitis/herpes
```
113
what are the causes of jaundice after 14 days?
```
biliary atresia
hypothyroidism
galactosaemia
UTI
gilbert syndrome
```
114
what can pyloric stenosis also cause?
jaundice
115
how is pathological jaundice investigated?
torch screening
| coomb's test
116
how does phototherapy work?
light converts bilirubin to water soluble pigment
117
give 3 causes of unconjugated hyperbilirubinaemia
```
physiological jaundice
breast milk jaundice
infection
hypothyroidism
haemolytic cause
```
118
give 2 causes of conjugated hyperbilirubinaemia
biliary atresia
| neonatal hepatitis syndrome
119
what is the triad of symptoms for choledocal cyst?
intermittent abdo pain
jaundice
RUQ mass
120
if untreated, what do choledocal cysts cause?
cirrhosis and enlarged liver
- ascites
- signs of portal hypertension
121
what are choledocal cysts?
cystic dilatation of bile ducts
122
what is neonatal hepatitis syndrome?
caused by viruses/metabolic syndromes
123
what does neonatal hepatitis cause?
hepatomegaly and splenomegaly
124
how does neonatal hepatitis present?
jaundice, failure to thrive, dark urine (conjugated)
125
what is the difference in presentation between neonatal hepatitis and physiological jaundice
physiological jaundice is unconjugated therefore normal urine
hepatitis presents with dark urine
126
Is PKU AD or AR?
Autosomal recessive
127
What are the symptoms of PKU?
- Seizures
- Skin rashes
- Microcephaly
- Musty odour to breath, skin, urine
- Fair hair/blue eyes
128
How is PKU diagnosed?
Heelprick (Guthrie test)
129
What is the treatment for PKU?
Low protein diet and amino acid supplements.
Regular phenylalanine level checks
No aspartame as this is converted into phenylalanine.
130
What does the heelprick test test for?
- Sickle Cell
- CF
- Hypothyroidism
- Metabolic conditions (PKU etc)
131
What can cause wheezing in a child?
- Asthma
- Bronchiolitis
- Viral induced wheeze
- Pneumonia
132
What can cause stridor in a child?
- Croup
- Epiglottitis
- Bacterial tracheitis
- Diptheria
- Laryngomalacia
- Inhaled foreign body
- Angioedema/anaphylaxis
133
What is head bobbing a sign of?
respiratory distress
134
What changes happen to the airway in asthma?
- bronchospasm
- mucosal swelling and inflammation
- increased mucous production
135
how does asthma present?
- intermittent dyspnoea
- wheeze
- cough
- diurnal variation
- decreased exercise tolerance :/
- decreased sleep quality
136
how is asthma diagnosed?
- clinical
- FEV1/FVC <0.7
- reversibility with bronchodilator
- FeNO >=35ppb
137
What are the signs of severe asthma attack
- unable to talk
| - use of accessory muscles
138
signs of life threatening asthma attack?
- silent chest
- bradycardia
- poor resp effor
- altered consciousness
- cyanosed
139
how is an asthma attack managed acutely?
- ABCDE
- High flow O2
- Nebulised Salb
- IV hydrocortisone
- ipratropium bromide nebs
- MgSO4
- salbutamol IV
140
what must be monitored if you give IV salbutamol?
cardiac monitoring for hypokalemia
141
How is hyperkalaemia treated?
insulin and dextrose
142
how is chronic asthma managed in >5
1. salbutamol (SABA)
2. low dose ICS
3. salmeterol (LABA)
4. increase ICS
5. montelukast (oral leukotriene receptor antagonist)
6. increase ICS to high dose
143
how is asthma managed in <5
salbutamol, ICS, oral montelukast
144
what pathogen causes bronchiolitis
most common LRTI in children
| usually RSV, or parainfluenza virus
145
how does bronchiolitis present?
coryza - runny nose congestion etc
breathlessness
poor feeding
146
what are the signs of bronchiolitis?
- fine end respiratory crackles
- high pitched wheeze
- cyanosis (on feeding)
147
How is bronchiolitis diagnosed?
PCR analysis of nasal secretions
| CXR may show hyperinflation
148
what does wheeze and inspiratory crackles indicated?
bronchiolitis!!!
149
what causes airway narrowing and alveolar collapse in bronchiolitis?
mucus production and inflammation
150
what conditions make bronchiolitis worse?
Aged less than 2y with:
- down's
- CF
- prematurity
151
a baby with bronchiolitis has <75% normal intake of milk. is this bad?
<75% is bad
<92% sats is bad
152
how is bronchiolitis prevented in at-risk children?
palivizumab, once monthly vaccination
153
what is palivizumab
monoclonal antibody against RSV
- CF
- Down's
- Premature
- Immunodeficient
- Chronic lung disease
154
how is bronchiolitis treated?
- nebulised saline
- NG/orogastric feed
- humidified oxygen
- IV fluids
155
what does hepatosplenomegaly, pallour, fever suggest?
leukaemia and anaemia
156
what does hepatosplenomegaly and high WCC indicate?
leukaemia
157
which leukaemia is more common?
Acute lymphoblastic leukaemia
| Acute myeloid leukaemia is less common
158
what blood test results indicate aplastic anaemia?
pancytopaenia
159
what substances are elevated in tumour lysis syndrome
PULP:
Potassium
Uric acid
Lactate dehydrogenase
Phosphate
160
what happens in acute leukaemia?
In acute leukaemia the white cells undergo a genetic change causing failure of differentiation, dysregulated proliferation and clonal expansion. The bone marrow fails to produce normal cells such as HB, neutrophils or platelets.
161
how are patients with ALL with high WCC treated?
priority is to prevent tumour lysis syndrome
- hyperhydration
- allopurinol
- platelet transfusion
162
a child with ALL develops a fever. Which is the best antibiotic?
broad-spectrum
| = gentamycin/Piptazobactam
163
what is CFTR?
membrane protein/chloride channel
| found in lungs and pancreas
164
which mutation causes CF?
DeltaF508 on chromosome 7
165
what are the key signs and symptoms of CF?
Thick pancreatic and biliary secretions - causes blockage of the ducts
Congenital absence of vas deferens
meconium ileus
166
why are CF patients more likely to have recurrent infections?
thick secretions - reduced clearance - bacterial colonisation
167
what might you see on examination of patient with CF?
- nasal polyps
- finger clubbing
- failure to thrive
- salty tasting baby
- foul smelling floaty stool
168
what is the gold standard for CF diagnosis?
chloride sweat test
169
what genetic testing is available for CF in fetus?
genetic testing for CFTR gene via amniocentesis
170
which bacteria are CF pts particularly susceptible to?
Staph, pseudomonas
171
how is staph treated in CF?
prophylactic fluclox
172
how is pseudomonas treated in CF?
nebulised Abx - tobramycin
| Oral ciprofloxacin
173
How are pancreatic enzymes replaced in CF?
creon tablets and high calorie diet
174
what is dornase used for?
break down of DNA material in secretions, makes secretions less viscous and easier to clear
175
how is male infertility treated in CF?
testicular sperm extraction
176
what is epiglottitis caused by?
haemophilus influenzae B
177
what are the signs of epiglottitis?
```
drooling
sore throat
dysphagia
stridor!!
fever
sepsis
```
178
how does epiglottitis look like with laryngoscopy?
beefy red stiff epiglottis
179
how does epiglottitis present on XR of neck?
thumb sign
180
how is epiglottitis treated?
ITU to protect the airway
- nasotracheal tube insertion
IV ceftriaxone + dexamethasone
181
which antibiotic is used for epiglottitis?
IV Ceftriaxone
182
with what antibiotic are close contacts of epiglottitis given prophylaxis?
rifampicin
183
a child from a foreign land, drooling, unable to speak or swallor, INSPIRATORY STRIDOR, symptoms improve by sitting upright and leaning forward. what is this/
epiglottitis
184
would you do a throat exam in a child with croup or epiglottitis?
no!!!
185
what is croup?
laryngo-tracheo-bronchiolitis
186
how does croup present?
```
children 6m-6y
stridor
barking cough
hoarse voice
coryzal
```
187
what virus causes croup?
parainfluenza virus causes an URTI and oedema in the larynx
188
how is croup treated?
dexamethasone 0.15mg/kg
Oxygen
nebulised budesonide
nebulised adrenalin
189
how does pneumonia present?
```
cough
fever
tachypnoea
signs of resp distress
hypotension, confusion, shock
```
190
what is the most common cause of pneumonia?
strep pneumoniae
191
which is the most common cause of pneumonia in neonates and unvaccinated infants?
Group B strep in neonates!!
192
when might Hib cause pneumonia?
unvaccinated child
193
what are the xray findings of staph aureus pneumonia?
pneumatoceles - round air filled cavities
| consolidations in multiple lobes
194
which bacteria (causative of pneumonia) may also present with erythema multiforme?
mycoplasma pneumonia
| - may develop red circular rash
195
what is the most common type of intussusception?
ileo-colic/ileo-caecal
196
what can act as a lead point in intussu?
lymph nodes
polyps
appendix
197
with what conditions is intus associated?
HSP
gastroenteritis
lymphoma
198
what would PR exam of patient with intuss show?
blood on glove (apparently pathognomonic)
199
what investigations would you do for pneumonia?
CXR - look for consolidation
| Blood cultures
200
how do you treat pneumonia in neonates?
IV broad spectrum Abx
201
how do you treat pneumonia in older children?
1st line: amoxicillin (co-amox if complicated)
| 2nd line - erythromycin
202
how is mycoplasma pneumoniae treated?
mycoplasma = intracellular, must use macrolides eg erythromycin (covers atypical)
203
what is viral induced wheeze?
RSV/rhinovirus caused inflammation and oedema in the airway causes wheeze
204
how do you differentiate asthma from viral induced wheeze?
- less than 3 years of age
- no atopic history
- only occurs during viral infections (coryza, fever, cold like symptoms)
205
how is viral induced wheeze treateD?
supplementary oxygen
salbutamol
oral montelukast or steroid if salb not working
steroids if history of asthma
206
which organisms cause otitis media?
Strep pneumoniae
| Hib
207
what are the symptoms of otitis media?
- fever
- pain
- otorrhoea
- generally unwell
208
what are the extracranial complications of otitis media?
mastoiditis
| tympanic membrane perforation
209
what are the intracranial complications of otitis media?
meningitis
| abscess
210
how is otitis media treated?
Analgesia,
| Abx - amox/co-amox
211
how is recurrent otitis media treated?
grommet - keeps middle ear aerated and prevents fluid build up
212
When might a grommet be indicated?
recurrent otitis media
chronic otitis media and effusion
eustachian tube dysfunction
213
what is glue ear?
otitis media + effusion
214
what are the 3 types of hearing loss?
1. conductive
2. sensorineural
3. mixed
215
what causes conductive hearing loss?
1. glue ear
2. ear wax
3. perforated drum
4. otitis media
216
how is sensorineural hearing loss treated?
hearing aids
cochlear implants
refer to paeds for tx
217
How is mixed hearing loss managed?
treat conductive cause and then offer hearing aid
218
what is mastoiditis?
middle ear inflammation leads to destruction of air cells in mastoid bone and abscess formation
219
how does mastoiditis present?
tender mastoid
| protruding ear
220
how is mastoiditis treated?
hospitalisation
IV Abx
myringotomy (allows draining of fluid from middle ear)
mastoidectomy
221
what are the risks of mastoiditis?
meningitis
sinus thrombosis
it is a medical emergency
222
how is duchenne's muscular dystrophy inherited?
x linked
223
what does sore throat in unvaccinated child and stridor suggest?
epiglottitis, caused by hib
224
what LFT result helps in the diagnosis of biliary atresia?
elevated conjugated bilirubin
| other liver enzymes and bile acids are raised, but can't be used to differentiate between different types of bilirubin
