Paeds New from PassMed Flashcards
(103 cards)
1
Q
what is the triad in shaking baby syndrome
A
Retinal haemorrhages, subdural haematoma and encephalopathy
2
Q
what is another word for exomphalos
A
omphalocele
3
Q
what occurs in omphalocele
A
Abdo contents protrude THROUGH the umbilical ring
they are covered by sac (amniotic membrane + peritoneum)
4
Q
what are RF for omphalocele
A
other syndromes (Down’s, Beckwith Wiederman)
low socioecon status
young maternal age
tobacco, alcohol
5
Q
what occurs in gastroschisis
A
bowel protrudes through defect in anterior abdo wall ADJACENT to umbilicus
no covering
6
Q
how do omphalocele and gastroschisis differ in terms of location
A
omphalocele is THROUGH umbilical ring
gastroschisis is ADJACENT to umbilicus
7
Q
what metabolic abnormality is pyloric stenosis associated with and why=
A
HYPOCHLORAEMIC HYPOKALAEMIC ACIDOSIS
HYPOCHLORAEMIC: vomiting up stomach contents which is acidic (hydrogen chloride - HCl),
HYPOKALAEMIC: Potassium is also lost in the vomitus.
ACIDOSIS: loss of hydrogen ions due to the vomiting up of stomach acid
8
Q
what is the appearance of the abdomen of a child with a diaphragmatic hernia
A
CONCAVE chest
as all the contents are displaced superiorly
9
Q
what kind of delivery do you do for omphalocele
A
ECS to prevent sac rupture
10
Q
What kind of delivery do you do for gastroschisis
A
Attempt vaginal
11
Q
Which one needs an urgent repair, omphalocele or gastroschisis
A
Gastroschisis
12
Q
describe the classical presentation of meckel’s diverticulum
A
PAINLESS rectal bleeeding (1-2yo)
LOTS of dark red blood
13
Q
what followup scan can you do if suspecting perthes and hip X ray is negative
A
MRI
14
Q
what kind of worms commonly cause anal itching in children
A
threadworms
15
Q
How do you manage faecal impaction in first line and second line
A
1 polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) using an escalating dose regimen as the first-line treatment
2. add a stimulant laxative e.g. SENNA if Movicol Paediatric Plain does not lead to disimpaction after 2 weeks
16
Q
What are fts of cows milk protein allergy
A
regurgitation and vomiting diarrhoea urticaria, atopic eczema 'colic' symptoms: irritability, crying wheeze, chronic cough rarely angioedema and anaphylaxis may occur
17
Q
what are investigations you can get for cows milk prot allergy
A
Dx is clinical (e.g. improvement with cow’s milk protein elimination). Investigations include:
skin prick/patch testing
total IgE and specific IgE (RAST) for cow’s milk protein
18
Q
Describve roseola infantum esp spread of rash
A
high fever > maculopapular rash
- rash starts on chest
- spreads to limbs
Nagayama spots: papular spots on the uvula and soft palate
febrile convulsions
diarrhoea and cough
19
Q
What virus causes roseola infantum
A
HSV6
20
Q
What is a rare complication of roseola infantum
A
encephalitis and febrile fits (after cessation of the fever)
21
Q
what are the criteria for admission with bronchioloitis
A
- Apnoea
- Oxygen sat <90 in room air
- Insuff fluid intake <50% normal
- severe resp distress (grunting, chest recession, resp rate >70)
22
Q
What age is a child with bronchiolitis
A
<1
23
Q
what is the condition called where bronchiolitis causes permanent airway damage
and what virus causes it
A
bronchiolitis obliterans
adenovirus
24
Q
What gender is Hirscprungs more common in and by how much
A
MALES 80%
females 20%
25
What percetage of Hirschprung is assoc with Downs
2%
26
Explain sx of measles
| describe spread of rash
Prodrome: irritable, conjunctivitis, fever
Koplic spots (white spots on buccal mucosa)
Rash: starts behind ears, then to whole body. Maculopapular
27
Explain sx of mumps
fever, malaise, muscular pain
| Parotitis (earache, pain on eating) - unilateral then bilateral
28
Explain sx of rubella, especially spread of rash\
Pink maculopapular rash - initially on face then to whole body
fades in 3-5days
Lymphadenopathy
29
Explain rash in Erythema infectiosum
Red rash SLAPPED CHEEK (red on both cheeks, white pallor in mouth), spreads to arms and extensor surface
30
Explain rash and other symptoms in scarlet fever
Fever, malaise, tonsillitis
Strawberry tongue
Rash - fine punctuate erythema around the mouth
31
Hand, mouth and foot disease sx
mild systemic upset
sore throat
fever
vescicles in mouth and soles of feet
32
Explain features of Fragile X
```
FMR1 gene
Repeat CGG
Autism
Giant brain, testes (macrocephaly, macroorchidism)
Intellectual disability
Long face, large jaw
Eveerted yes
X linked
```
33
Explaain features of Noonan syndrome
PEWS
Pulmonary stenosis
Pectus excavatum
Webbed neck
Short stature
34
Pierre robin sequence
Microagnathia
Glossoptisis
Cleft palate
35
Prader WIlli
Hypotonia
Hyopogonadism
Obesity
36
What are features of WIlliams syndrome
```
Weight low at birth, slow to gain
Iris (stellate)
Large philtrum
Large mouth
Increased calcium
Aortic stenosis SUPRAVALVULAR
Mental retardation (learning difficulties, friendly, extrovert)
Swelling around eyes
```
37
Cri du chat syndrome
```
characteristic cry (due to larynx and neuro problems)
feeding difficulties, poor weight gain
learning difficulties
microcephaly, microagnathism
hypertelorism (far set eyes)
```
38
what is cri du chat due to
5p deletion
39
what are features that occur with de George
CATCH 22
```
Cardiac anomalies (interrupted aortic arch, TOF)
Abnormal facies
Thymic hypoplasia
Cleft palate
Hypocalcaemia
22q11
```
40
what are abnormal facies with diGeorge
smooth philtrum
| small chin
41
Explain Turners syndrome (genotype and phenotype)
45X
Phenotypically female, with CLOWNS
```
Cardiac abnormalities
Low set ears
Ovaries underdeveloped (streak gonads)
Webbed neck
Nipples far apart
Short stature
```
42
How does Downs syndrome occur
Trisomy 21, due to:
- non-dysjunction
- translocation
- mosaic
43
What is the biggest RF for Downs
high maternal age
44
What are the most important complications assoc with downs
AAAA
duodenal Atrasia, Hirschoprung
Atrioventricular septal defect
AML/ALL
Alzheimers early onset
45
What are the facial features of Downs
Upward slanting palpebral fissures, epicantheal folds
Eyes: strabismus, cataracts, hypertelorism, brushfiends spots
Broad, flat nasal bridghe
high arched palate
46
What are other physical features of Downs
Transverse palmar creasee
Sandal gap
Short stature
47
What are other non-physical fts of downs
Motor and intellectual disability
Milestones reached at double the age of healthy children
Intellectual - also have autism, ADHD, conduct disorder
48
What investigations do you do for Downs
screening: combined test / quadruple test
(low hCG, low PAPP-A, high inhibin A. Low oestriol, low AFP)
Confirm with amniocentesis, CVS, umbilical cord sampling > karyotyping
49
what is a reflex anoxic seizure
fit resulting from a brief stoppage of the heart through excessive activity of the vagus nerve
syncopal episode (or presyncope) that occurs in response to pain or emotional stimuli.
caused by neurally-mediated transient asystole in children with very sensitive vagal cardiac reflexes.
50
Who do reflex anoxic seizures occur in
young children - 6 months to 3 years
51
what are typical features of reflex anoxic seizures
very pale
falls to floor
secondary anoxic seizures are common
rapid recovery
52
What is the typical preesentation of pityriasis versicolor
lots of light brown macules and confluent patches on back and chest.
more noticeable after spending time in the sun -as healthy skin becomes darker, the white/light brown patches become more prominent.
53
How do you manage pityriasis versicolor
ketoconazole shampoo / topical antifungal
54
what are features of a simple febrile seizure
< 15 minutes
generalised
no recurrence within 24 hours
complete recovery within an hour
55
what are RF for neonatal hypo
```
preterm birth (< 37 weeks)
maternal diabetes mellitus
IUGR
hypothermia
neonatal sepsis
inborn errors of metabolism
nesidioblastosis
Beckwith-Wiedemann syndrome
```
56
what heart complication is fragile X associated with
mitral valve prolapse
57
what other condition has similar presentation to appendicitis but is not malignant
Mesenteric adenitis - inflamed mesenteric lymph nodes
commonly post-viral
needs no mx
58
When do you give VZIG vs acyclovir for chickenpox
give VZIG if patient has had exposure but no symptoms yet!! e.g. pregnant/immunosuppr/neonate
give acyclovir if symptomatic
59
what is the method of inheritance of prader willi? explain
IMPRINTING
deletion of gene from paternal chromosome
60
what would occur similar to prader willi if the imprinting i.e. gene removal occurred from the mother
angleman syndrome
61
what must you do if neonate has glucose <1
IMMEDIATE transfer to ICU and 10% dextrose IV
62
How do you manage threadworms
oral mebendazole
63
what is the first sign of puberty in boys
testicular growth
64
at what age does puberty in boys usually start
12
65
what testicular volume indicates onset of pubery
>4ml
66
what are findings for DDH on inspection + gait assessment
Inspection: asymmetry of skinfolds, shortening of one leg
Gait: positive trendelenberg (sways towards healthy side), waddle
67
when should you treat DDH
ALWAYS - aim to treat EARLY to maximise prognosis
the earlier the child is treated, the better the prognosis
68
what is delayed puberty in boys
no testicular growth by age 14
69
when is delayed puberty in girls
no breast development age 13
| no menarche age 15
70
what are RF for DDH that require USS at 6 weeks
Breech >36 weeks regardless of presentation at delivery
Breech delivery <36 weeks
first degree relative with DDH/hip problem
71
what do you need to make a diagnosis of CF
ALL THREE
1. Typical pulmonary and/or gastrointestinal tract manifestations
2. A family history
3. A positive ‘sweat-test’
72
OUTLINE the CONSEQUENCES of CF - based on which ORGAN
Intestine:
- meconium ileus (vomiting, abdo distension, failure to pass meconium)
- rectal prolapse
Pancreas: pancreatic insufficiency (ducts bocked by thick secretions)
- DM
- recurrent pancreatitis
- pancreatic enzyme deficiency, malabsorption
LIVER:
- chronic hepatitis
- cirrhosis
NUTRITIONAL:
- failure to thrive
MALE UROGENITAL:
- obstructive azoospermia
73
what is the average life prognosis for CF
50-55
74
what is the percentage of caucasians who are CF carriers
1:100
75
Summarise Tay Sachs disease
```
Developmenntal regression in late infancy
exaggerateed startle responnse to noise
visual inattention
sociaal unresponsiveness
severe hypotonia, enlarged hear
CHERRY RED SPOT in macula
```
76
what is Tay Sachs MoI and WHAT POPULATION is it more common in
AUTOSOMAL RECESSIVE
| ashkenazi jews
77
summarise gaucher disease presentation
splenomegaly, hepatomegaly, bone marrow suppression, bone involvement
NORMAL IQ
78
Who is gaucher disease more common in
Ashkenazi jews
79
what two diseasees have cherry red spot in macula
Tay Sachs
| Niemann-Pick
80
what are the 5 types of Autism Spectrum Disorder
```
Autism
Asperger's
Rett
Child Disintegrative DIsorder
Pervasive Developmental Disorder not Otherwise Specified
```
81
Which type of ASD is most common
Pervasive Developmental Disorder not Otherwise Specified
82
What GI condition has a DOUBLE BUBBLE APPEARANCE
duodenal atresia
83
What investigations must you get for Hirschprung's
Full thickness rectal biopsy
| Anorectak mamometry / contrast barium study
84
why is meningococcal septicaemia a contraindication for LP
apnoea risk
| deranged clotting
85
expain most common features of Wilms tumour
abdominal mass (most common presenting feature)
painless haematuria
flank pain
86
what are medical conditions ASSOCIATED WITH (not caused by) cystic fibrosis
```
short stature, delayed puberty
diabetes mellitus
rectal prolapse (due to bulky stools)
nasal polyps
male infertility, female subfertility
```
87
when in meningitis must you never give corticosteroids?
if UNDER 3 MONTHS
88
what is persistent pulmonary HTN of newborn
high pulmomary vascular resistance
leads to right to left shunting of blood > cyanosis
89
What are causes of persistent pulmonary HTN of newborn
birth asphyxia
meconium aspiration
septicaemia
RDS
90
What investigations for persistent pulmonary HTN of newborn
CXR: normal sized heart
Echo: exclude congenital heart defect
91
How do you manage persistent pulmonary HTN of newborn
- inhaled nitric oxide (vasodilator)
- sildenafil (viagra, also a vasodiltor)
- high freq oscillatory ventilation
- extracorporeal membrane oxygenation (ECMO)
92
what is an umbilical granuloma
overgrowth of tisue occurring during healing process on belly button
it prevents involutiuon of umbilicus
93
how do you manage umbilical granuloma
silver nitrate cream
| ligature to stump
94
what sound is indicative of an inhaled foreign body
MONOPHASIC WHEEZE
95
what is the centor score used for
used to assess likelyhood of bacterial cause of tonsillitis
96
What are criteria of CENTOR score, and what do you do with the results?
Each point scores 1:
- Tonsillar exhudate
- Tender anterior cervical lymphadenopathy
- Fever >38
- no cough
if score 3/4, there is up to 50% chance that it is due to bacteria > prescribe antibiotics
97
what are complications of measles
Neuro:
- febrile convulsions
- encephalitis
- subacute sclerosing panencephalitis
Resp:
- pneumonia
- otitis media
Cardiac:
- myocarditis
98
what is - subacute sclerosing panencephalitis
RARE BUT DEVASTATING
7 years after measles infection
loss of neurological function, dementia, death
99
what med can you use for measles in immunocompromised pt
ribavarin
100
What are indications for antibiotics in OM?
1 perforated eardrum
2 years old or less, with OM on both sides
3 months old or less
4 days duration or longer
101
how do you confirm constitutional growth delay?
hand/wrist X ray to assess bone age
102
What are indications for commencing intensified phototherapy
- serum bilirubin rising >8.5 micromoles/ L/ hour
- serum bilirubin within 50 micromoles/L below exchange transfusion threshold
- serum bilirubin levels static or rising after 6 hours of commencing phototherapy.
103
list infective causes of bloody diarrhoea in children
CHESS-Y: Champylobacter, histolytica entamoeba, e.coli, shigella, salmonella, yersinia
