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Paediatrics > Pass Medicine > Flashcards

Pass Medicine Flashcards

1
Q

Which defect is caused by lithium in pregnancy?

A

Ebsteins’ Anomaly

Tricuspid regurgitation and stenosis

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2
Q

Acynatoic heart disease in babies

A

VSD (most common)
ASD
PDA
Coarctation of the aorta

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3
Q

Cyanotic heart disease

A

Transposition of the great arteries (presents at birth)
Tetralogy of Fallot ( 1-2 months old)
Tricuspid atresia

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4
Q

Differential of neonatal hypotonia

A

Sepsis
Hypoglycaemia
Hypothyroidism
Prader -Willi - excessive appetite and weight gain in future

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5
Q

Pierre Robin Syndrome

A

1) Micrognathia (small jaw)
2) Posterior displacement of tongue —> airway obstruction
3) Cleft palate

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6
Q

What is the commonest childhood cancer? WHen is peak incidence

A

ALL

Peak - 2-5

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7
Q

Management of whooping cough

A

1) Oral azithromycin if within 21 days

2) Inform public health as notifiable disease

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8
Q

Where is the purpuric rash of HSP most likely to be?

A

Buttocks, extensor surfaces of arms and legs

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9
Q

Define neonatal death

A

Death in the first 28 days of life

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10
Q

Commonest meningitis organisms

A

1) <3 months old = Group B strep

2) otherwise = neisseria meningococcus/ strep pneumonia

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11
Q

First line medication for ADHD?

A

Methylphenidate

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12
Q

Other than prematurity, what are the RF for surfactant deficiency?

A

Male
DM mother
LSCS

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13
Q

Causes of nephrotic syndrome?

A

In children the vast majority are caused by minimal change glomerulonephritis

Proteinuria
Hypoalbuminaemia
Oedema

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14
Q

Where is the commonest site of Wilm’s tumour metastasis?

A

The lungs

Typically presents with an abdominal mass, haematuria and flank pain

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15
Q

Girls with Turner’s syndrome only have 1 X chromosome. This means they can get X linked diseases such as haemophilia

A

This is interesting

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16
Q

Asthma guideline in 10 year old

A 
1 = SABA
2 = SABA + ICS
3 = SABA + ICS + LTRA
4 = SABA + ICS + LABA (stop LTRA e.g. montelukast if it has not been beneficial)
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17
Q

What is the most common cause of inherited neurodevelopmental delay?

A

Fragile X

Associated with long face, protruding ward, recurrent otitis media and ADHD

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18
Q

Why is aspirin normally CI in children?

A

The risk of Reye’s syndrome

Rare but can cause permanent brain and liver damage

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19
Q

Kawasaki’s disease is a vasculitis normally seen in children. It is rare. What are the symptoms?

A

1) Fever for >5 days
2) Pharyngeal infection - Strawberry tongue and fissured lips
3) Cervical lymphadenopathy
4) Conjunictivits
5) Polymorphus rash (trunk)
6) Red palms/ soles of feet - skin can peel

The main complication is coronary artery aneurysm

Treat with aspirin/ immunoglobulin

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20
Q

Talk through the steps of neonatal resuscitation - from birth

A

1) Dry baby
2) Assesss APGAR - tone, colour, breathing, HR and movement
3) Open airway and give 5 inflation breaths if not breathing adequately
4) Reassess and move onto CPR/ IV drugs etc as appropriate

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21
Q

MMR is a live attenuated vaccine. When is it given?

A

First dose at 12 months

Second dose at 3 - 5 years

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22
Q

List some poor prognostic factors for ALL

A

1) Male
2) <2 or >10 at diagnosis
3) WBC >20 X10^9 at diagnosis

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23
Q

How would you differentiate between a caput succedaneum and cephalohaematoma?

A

Caput succedenum causes is a boggy swelling which crosses the suture line
A cephalohaematoa will not cross the suture line

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24
Q

How do you screen for coronary artery aneurysms associated with Kawasaki Disase?

A

Echo

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25
Q

Features of noonan’s syndrome?

A

Pectus excavatum
Short stature
Pulmonary stenosis
Webbed neck

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26
Q

Features of Edwards syndrome?

A 
Trisomy 18
Low set ears
Rocker bottom feet
Micrognathia
Overlapping finger
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27
Q

What features necessitate 999 if child has suspected bronchiolitis?

A

1) Cyanosis
2) Severe Respiratory distress e.g. RR> 70, grunting, marked chest recession
3) Apnoea

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28
Q

Most likely diagnosis in a baby born with a big tongue (micro-glossia), macrosomia and hypoglycaemia

A

Beckwith Wiedemann syndromes

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29
Q

A 10 year old child is in for a cosmetic mole removal. His parents have consented but he is adamant that he does not want it. What do you do?

A

Inform your consultant and recommend that they cancel the procedure

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30
Q

Define precocious puberty?

A

Development of secondary sexual characteristics before age 8 in girls and 9 in boys

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31
Q

What is thelarche and adrenarche?

A 
Thelarche = development of breast buds
Adrenarche = development of pubic hair
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32
Q

Give 5 features of hypernatraemia?

A

1) Jitteriness
2) Increased tone
3) Confusion/ coma
4) Hyperreflexia
5) Convulsions

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33
Q

Teenage girl with intermittent anterior knee pain, swelling and locking

A

Osteochondritis dissecans

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34
Q 
Children should have: 
Head control at 3m
Roll over/ sitting at 6m
Crawling/ standing at 9m
Cruising at 12 months
Walking unsupported by 15 m
A

Remember some children don’t crawl - they bottom shuffle. This is a normal variant

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35
Q

Testicular pain worse on elevation and absent cremasteric reflex

A

Most likely testicular torsion

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36
Q

What vaccines are given a 8 weeks?

A

6 in 1
Pneumococcal
Rota virus
Men B

6PRM

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37
Q

What conditions are covered by the 6-in-1 vaccine?

A 
Diptheria
Pertussis
Polio
Hep B
His 
Tetanus
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38
Q

What vaccines are given at 3 months?

A

6 in 1
Rotavirus

6R

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39
Q

What vaccines are given at 4 months?

A

6 in 1
Pneumococcal
Men B

6PM

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40
Q

What is the commonest cause of nose bleeds in children?

A

Nose-picking
Advise to stop!

A short dose of chlorhexidene (disinfectant) and neomycin (antibiotic) is recommended

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41
Q

2 year old presents to GP with mild croup. Management?

A

Give a dose of dexamethasone 0.15mg/kg/ PO

Helps relieve symptoms temporarily!

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42
Q

Features of intussusception?

A

Paroxysmal colicky pain
Bilious vomit
Blood PR - ‘red currant stool’
US will show ‘target lesion’

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43
Q

When is the APGAR score measured?

A

1, 5 and 10 minutes
<3 = very low score
4-6 = moderate low
7-10 = good condition

44
Q

Delayed/ absent puberty and impaired sense of smell

A

Kallman’s syndrom

45
Q

10% of retinoblastoma is hereditary. It typically presents with a white pupil (luekocoria). What is the prognosis?

A

Excellent, >90% survive to adulthood

46
Q

What does the heel prick test at day 5-9 test for?

A 
PKU
Metabolic conditions
Congenital hypothyroid
MCADD
CF
47
Q

What is a pavlik harness used for?

A

An orthotic used to correct DDH in a child <4-5 months

48
Q

Which heart defects are associated with Turners syndrome?

A

1) Coarctation of the aorta
2) Bicuspid aortic valve
3) Aortic stenosis

All present with a systolic murmur, loudest over the aortic valve

49
Q

A baby has a machine like murmur. What is the diagnosis and treatment?

A

1) PDA
2) Continuous murmur with subclavicular thrill
3) Use indomethacin to close

50
Q

Rate of compressions in child CPR?

A

1) Open airway
2) Give 5 reduce breaths
3) Check for signs of circulation
4) 15:2 at a rate of 100-120bpm

51
Q

Management of a baby <3 months old with suspected meningitis?

A

IV cefotaxamine + amoxicillin (need cover against listeria)

52
Q

At what age should a child be able to:

1) Sit unsupported
2) Run
3) Ride a tricycle

A

1) 7-8 months
2) 1.5-2 years
3) 3 years

53
Q

Parents with a son who has CF asks what chance there is that their next child will be a carrier/ affected?

A 
Carrier = 50%
Affected = 25%

It is autosomal recessive inheritance
The carrier rate of CF is 1 in 25

54
Q

Which organism causes Scarlett fever?

A

Group A strep

usually strep pyogenes

55
Q

What are the 4 established complications of chickenpox?

A

1) DIC
2) Pneumonia
3) Encephalitis
4) bacterial infection

56
Q

What vaccinations are given at 1 year?

A

MMR
MenB/ C
Pneumococcal

MMMP

57
Q

What is the pneumonic for remembering vaccine

A

6RPM
6R
6PM
MBMCMP

58
Q

Risk Factors for Sudden infant death?

A 
Sleeping on tummy
Parental smoking
Prematurity
Head covering
Hypothermia
59
Q

Baby with hyperchloraemia hypokalaemic alkalosis + poor weight gain

A

Pyloric stenosis is most likely diagnosis

60
Q

What do you do with a child who has a squint?

A

Refer to the ophthalmologist

They will probably be referred to the orthoptist but after opthalmology consultation

61
Q

What are the monitoring requirements for methylphenidate?

A

1) Growth

2) Psychiatric symptoms

62
Q

A micturating cystourethrogram is used to diagnose vesicoureteric reflux

A

A DMSA scan is used to look for renal scarring

63
Q

5 week old baby with a small red growth in the centre of the umbilicus. It is covered in clear mucus and is leaking yellow fluid. Diagnosis?

A

Umbilical granuloma

Very common - part of the healing process

64
Q

Diagnosis and management of pertussis?

A 
Diagnosis = nasal swab for culture
Management = clarithromycin or erithryomycin (if onset <21 days)
65
Q

What is the first sign of puberty in boys and girls?

A

Boys - increase in testicular volume (>ml = puberty starting)
The growth spurt is at 14

Girls - breast development
Height spurt at 12

66
Q

White spots in mouth?

A

Koplik spots
Associated with measles
The prodrome is characterised by fever, irritability and conjunctivitis

67
Q

Fever, malaise and pain on eating?

A

Probably mumps due to parotitis

68
Q

Pink maculopapular rash starting on face then spreading to entire body?

A

Rubella

69
Q

Vesicles on mouth and palms/ soles. Mild systemic upset

A

Hand, foot and mouth

Coxsackie

70
Q

Commonest cause of headache in children?

A

Migraine

71
Q

What is the commonest cause of death in children > 1 year old?

A

Accidents

72
Q

Crescendo decrescendo murmur in the upper left sternal border?

A

Coarctation of the aorta

73
Q

Machine murmur in upper left sternal border?

A

PDA

74
Q

Ejection systolic murmur in upper left sternal border?

A

Pulmonary stenosis

75
Q

Ejection systolic murmur and splitting of the second heart sound?

A

ASD - usually asymptomatic bit can cause SOB, lethargy and poor appetite/ weight gain

76
Q

What language development should a child have by age 2?

A

Say 20-50 words and can join 2 words e.g. want juice

77
Q

What is the risk of Down’s?

A 
Depends on mothers age
20 = 1 in 1500
30 = 1 in 800
 40 = 1 in 100
45 = 1 in 50
78
Q

Causative agent in rosella infantum?

A

Human herpes 6

Presents with fever, maculopapular rash and possibly febrile convulsions

79
Q

Management of UTI in children?

A

Lower UTI - trimethoprim for 3 days

Upper UTI = 10 day treatment with IV amox and gent

80
Q

All children <3 months old with suspected UTI should be admitted to hospital

A

All children <3 months old with suspected UTI should be admitted to hospital

81
Q

What is plagiocephaly?

A

Skull deformity due to young children spending lots of on their back. Common and harmless. Reassurance is all that is needed.
Helmets are not helpful

82
Q

Advice for parent about sending child to school with hand, foot and mouth?

A

She can go back as soon as she is feeing better

83
Q

Which type of squint is most common in children?

A

Convergent

eye is in and moves out

84
Q

In a baby <3 months old what should you do if the temperature is 38.5 degrees?

A

Refer for same day paediatric assessment

85
Q

A 2 day old baby has not passed meconium and has abdominal distension. Most likely diagnosis and investigation?

A

Hirschprung disease

Congenital absence os ganglionic cells - detected by rectal biopsy

86
Q

Children under 16 can consent to treatment but cannot refuse if there is a consenting parent

A

Children under 16 can consent to treatment but cannot refuse if there is a consenting parent

87
Q

How often is the polio vaccine given?

A

5 times

3 times in the 6 in 1 (2, 3, 4 months) twice in the 4 in 1 (pre-school and secondary school)

88
Q

Neonatal jaundice at 15 hours…

A

Always abnormal within 24 hours
Seek paediatric assessment
E.g sepsis, rhesus haemolytic disease, ABO incompatibility

89
Q

Child with high fever, maculopapular rash on chest and enlarged occipital lymph nodes?

A

Most likely roseola infantum (caused by herpes 6 virus)

90
Q

What is the cause of hand, foot and mouth disease?

A

Coxsackie virus

Very contagious —> nursery outbreaks

91
Q

What do you advice parents about the vaccination schedule for premature babies? E.g. born at 32 weeks

A

Vaccinate as per usual schedule

92
Q

All children in the UK have a hearing test at birth. What test is used?

A

Otoacoustic emission tests (small computer generated click is played through small earpiece. Soft echo = healthy cochlea….

Auditory brainstem response test is done in newborns who have an abnormal result in the autoacoustic emission test

93
Q

Patau syndrome is trisomy 13. How does it present?

A

Microcephalic, cleft lip, extra fingers

94
Q

Edward’s syndrome is trisomy 18. How does it present?

A

Small jaw (micrognathia), low set ears, rocker bottom feet and overlapping fingers

95
Q

Which signs warrant immediate referral to hospital for bronchiolitis?

A

1) Apnoea - must ask
2) Sats <92% persistently
3) central cyanosis
4) RR>70
5) Marked grunting or chest recession

96
Q

A 5 year old child presents to the GP with an itchy bottom. It is worse at night. What is the most likely diagnosis?

A

Threadworms
Treat with good hygiene, and mebendazole for the whole family

Repeat treatment after 2 weeks may be required

97
Q

Newborn who develops cyanosis. This is much worse when he is feeding and much better when he is crying. Most likely diagnosis?

A

Choanal atresia - the back of the nasal passage is blocked due to abnormal bony development

Very bad as babies are obligate nasal breathers

Can be unilateral or bilateral

98
Q

If a boy with precocious puberty has a larger penis but normal testes size then CAH is the most likely cause.

A

Other causes such as a idiopathic precocious puberty and tumours would cause large testes and penis

99
Q

Which antibiotic is used for mycoplasma pneumonia?

A

A tetracycline such as erythromycin (penicillins do not work as mycoplasma does not have a cell wall)

100
Q

What is included in the 6 in 1 vaccine?

A 
Diptheria
Tetanus
Polio
Pertussis 
HIb 
Hep B
101
Q

At what age can the average child say mamma and dada>

A

9 months

Children should have 2-6 words by age 12-15 months

102
Q

What is the most likely diagnosis in a neonate who has not passed meconium and has bilious vomit at 48 hours old?

A

Sounds like a meconium ileus

The most likely cause is CF

103
Q

Infantile spasm

A

Type of epilepsy that occurs at around 4 months
More common in males
Linked with other underlying conditions —> bad prognosis
Hypsarrhythmia on EEG and characteristic salaam attacks

104
Q

Severe croup requires high flow oxygen and nebulised Adrenalin as well as steroids

A

Severe croup requires high flow oxygen and nebulised Adrenalin as well as steroids

105
Q

Sandpaper rash + strawberry tongue = Scarlett fever

A

Sandpaper rash + strawberry tongue = Scarlett fever

106
Q

Supra valvular aortic stenosis

A

A characteristic finding of Williams syndrome

107
Q

What causes a normal childhood squint?

A

Imbalance in the power of the extraocular muscles

Paediatrics (2 decks)

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