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Dan's Copy > Paeds Peer Teaching 2 > Flashcards

Paeds Peer Teaching 2 Flashcards

1
Q

List the VACTERAL association.

A
  • Vertebral (scoliosis / hypoplasia)
  • Anal atresia (imperforate anus)
  • Cardiac (VSD / ASD / Tetralogy)
  • Trachea-Oesophageal fistula
  • Oesophageal atresia
  • Renal / radial aplasia
  • Limb defects (hypoplastic thumb, polydactyly, syndactyly)
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2
Q

List the ‘CHARGE’ associations.

A
  • Colomboma (pupil defect)
  • Heart defect
  • Choanal atresia (blockage of nasal passage)
  • Retardation of growth / development
  • Genital hypoplasia
  • Ear anomalies
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3
Q

Who’s involved in the MDT if a child has a cleft lip / palate?

A
  • Surgeon
  • Orthodontist
  • SALT
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4
Q

A child had a cleft lip / palate. When would repairs be carried out?

A

Lip repair: 3 months

Palate repair: 9 months

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5
Q

List 4 things which contribute to morbidity in a child with cleft lip / palate.

A
  • Poor feeding
  • Milk aspiration
  • Speech delay
  • Conductive hearing loss
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6
Q

What is ‘spina bifida’?

A

Failure of neural tube to close in first trimester.

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7
Q

What causes spina bifida?

A
  • Insufficient folic acid

- Drugs (valproate, carbamazepine)

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8
Q

What are the 3 grades of defect seen in spina bifida?

A
  • Occulta: hidden defect, hairy lower back, often asymptomatic
  • Meningocele: meninges protrude but not exposed, spinal cord intact
  • Myelomeningocele: open lesion, severe weakness and disability.
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9
Q

What is the pathophysiology of DDH?

A
  • Shallow acetabulum doesn’t cover femoral head -> dislocatable
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10
Q

Which 2 tests are used for DDH?

A
  • Barlow’s: dislocation

- Ortolani: relocation

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11
Q

Risk factors for DDH?

A
  • Breech presentation
  • Family History
  • Prematurity
  • Twins
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12
Q

Treatment for DDH?

A
  • Pavlik harness

- Surgical reduction

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13
Q

Late signs of undiagnosed DDH?

A
  • Unilateral limp
  • Leg dragging
  • Restricted movement
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14
Q

What are the 4 classes of developmental milestones?

A
  • Gross motor
  • Fine motor / vision
  • Speech / language
  • Social
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15
Q

A child of 6 weeks should be able to:

A
  • Stabilise head
  • Social smile
  • Eye tracks movement
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16
Q

A child of 6 months should be able to:

A
  • Sit unsupported

- Palmar grasp at 5 months

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17
Q

At what age should a child be walking?

A

9 - 18 months

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18
Q

Define cerebral palsy.

A

Permanent, non-progressive movement disorder due to a lesion of the developing brain.

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19
Q

What are the pre-natal risk factors for cerebral palsy?

A
  • Cerebral malformation
  • Infection (TORCH)
  • Metabolic
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20
Q

What are the perinatal risk factors for cerebral palsy?

A
  • Hypoxia
  • Intrapartum trauma
  • Prematurity complications
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21
Q

What are the post natal risk factors for cerebral palsy?

A
  • Head trauma
  • Stroke
  • Meningitis
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22
Q

How would a child with Cerebral palsy present?

A

Spasticity (70% = UMN signs)

  • rigidity
  • hypereflexia / tonic
  • Weakness
  • Delayed milestones
  • poor co-ordination
  • Persistent primitive reflexes
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23
Q

What are the 4 types of Cerebral Palsy?

A
  • Hemiplegic
  • Diplegia
  • Ataxia
  • Athetoid (dyskinetic)
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24
Q

List some problems associated with Cerebral Palsy.

A
  • Epilepsy
  • Audiovisual development
  • Respiratory problems
  • Poor growth
  • Intellectual disability
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25
Risk factors for Cerebral palsy?
- Preterm birth - Twins - Maternal infection - Difficult delivery
26
How is cerebral palsy diagnosed?
``` Clinical diagnosis - CT / MRI indicated if ?cause or ongoing conditions eg.: ? hydrocephalus ? SDH ? AVM ? Malignancy ```
27
Treatment for Cerebral palsy?
- Early MDT involvement - Physio - Paediatrician - Orthopod - OT - Dietician - Community Liaison
28
Vaccinations: | What should you do if child is feverish or younger than indicated?
- Delay the vaccine
29
What kind of vaccine should be given to the immunocompromised?
- Live attenuated vaccine
30
What is in the 6 in 1 vaccine, and when should it be given?
Given at 2 / 3 / 4 months - Diphtheria - Tetanus - Pertussis - Polio - HiB - Hep B
31
What kind of vaccine is the MMR vaccine? | When should it be given?
Given at 1y and 3yrs+4m - Live attenuated vaccine - Maternal Ig protection for approx 1 year. MMR should be given at 6 months if there is an outbreak.
32
Describe Measles.
- Maculopapular rash - Fever - URTI - > complicated encephalitis
33
Describe Mumps.
- Swollen parotids - Fever - Subfertility in men.
34
Describe rubella.
- Mild fever - Rash Maternal infection = fetal abnormalities.
35
List some signs of moderate / severe dehydration.
- Tachycardia - >2 Cap refill time - Weak pulses - Mottling - Cold - Cyanosis - Coma * Hypotension is a late finding and may occur after coma
36
What fluid should you give STAT if moderate / severe dehydration?
10 - 20ml/kg of 0.9% Saline bolus
37
What fluid should you give as maintenance fluid in kids?
0.9% saline + 5% dextrose + 10mmol KCl
38
What are the total daily fluid requirements?
1st 10kg = 100ml/kg/day 2nd 10kg = 50 ml/kg/day Remainder = 20ml/kg/day
39
In a 27kg child, what amount of fluid should you give them for maintenance fluids?
1st 10kg = 100 x 10 = 1000 2nd 10kg = 50 x 10 = 500 3rd 7kg = 20 x 7 = 140 = 1640ml/day (68ml/hr)
40
Neck swelling history.
Fever, duration and onset - Thyroid screen - Vaccination Hx
41
How should you examine a kid's neck swelling.
Infected - mobile + tender Malignant - fixed and matted Look in the mouth and throat - don't poke anything down the throat if airway. Common sites = lymph nodes (anterior chain), parotid, thyroid, mastoid.
42
Investigations for a neck swelling?
- FBC: raised WCC in infection, atypical lymphocytes if EBV - Throat culture if ?Group A Strep - Amylase if ?Mumps - TFTs if ?thyroid
43
Describe Mastoiditis.
- Medical emergency -> meningitis, sinus thrombosis - Ear pushed out / previous otitis media - IV ABx + mastoidectomy
44
Describe Parotitis (Mumps)
- Parotid swelling - Fever + malaise - Scrotal pain - Raised amylase - IgG / IgM antibodies - Fluids + analgesia - ?Subfertility
45
Describe IgG and IgM levels in infection.
Recent infection: High IgG and high IgM Previous infection or vaccination: High IgG + Normal IgM No previous exposure: Normal IgG + Normal IgM
46
How does ?Hodgkin's Lymphoma present?
- Firm, non-tender lymphadenopathy. - Fevers, night sweats, weight loss, fatigue - Hepatosplenomegaly
47
What is Hodgkin's lymphoma associated with?
- Immunosuppression | - Previous EBV
48
What investigations should you do if ?Hodgkin's lymphoma?
- Lymph node biopsy: Reed-Sternberg cells - FBC - Staging CT / MRI
49
What treatment should you give for Hodgkin's Lymphoma?
- Radiotherapy - Chemotherapy - MAB (eg. Rituximab, a CD20 antagonist)
50
A premature baby might have an intraventricular haemorrhage. What signs might they have?
- Seizures | - Bulging fontanelle
51
A premature baby has Retinopathy of Prematurity. Why?
- Exposure to O2 is a cause
52
A prem baby has Respiratory distress syndrome. Why? What would you seen on CXR? What would you do?
- Underdeveloped lungs - Ground glass XR - Give surfactant / O2 / CPAP
53
Prem baby has NEC. What signs do they have? Prevention of NEC? Management?
- Failure to thrive - Breast milk is preventative - Supportive Mx + surgery
54
Prem baby has sepsis. What are you going to do?
- Full workup including: - Bloods - Urine - CSF: ?Group B Strep / E. coli - Give Abx -> gentamicin / BenPen
55
Kawasaki's pneumonic?
CRASH and BURN (Fever > 5 days) - Conjunctivitis (bilateral and non-purulent) - Rash - Adenopathy (cervical and unilateral) - Strawberry tongue + cracked lips - Hands + feet: erythema + desquamation
56
Treatment for Kawasaki's?
- Aspirin - IV Ig - ECHO + Cardio referral (risk of coronary artery aneurysm)
57
Describe Perthe's disease.
- 4-8yo boys | - Avascular necrosis of the femoral head
58
Describe SUFE.
- Obese - Adolescent male - Groin pain
59
Describe Septic Arthritis.
- Red, hot, swollen, tender, mono arthritis, systemic upset | - Urgent Abx + aspirate + wash out + orthopod opinion
60
Describe JIA
- Persistent swelling - Can't walk up stairs - Extra-articular involvement
61
Describe Osgood-Schlatter disease.
- Young, athletic teens | - Swelling below knee
62
Describe Duchenne's.
- Proximal weakness - Boys - Gower's sign - Respiratory involvement
63
What might make you suspicious of NAI?
- History incompatible with injury / unclear Hx - Delay in seeking medical attention - Multiple fractures, retinal haemorrhage, torn frenulum - Injury in a non-ambulatory / totally dependent child
64
What fractures increase the index of suspicion for NAI?
- Metaphysical corner fracture (shaking) - Rib fracture - Skull fracture
65
What bruises increase the index of suspicion for NAI?
- Ear - Cheeks - Buttocks - Forearms - Neck

Dan's Copy (19 decks)

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