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Peads Flashcards

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1
Q

3 most common ways a child with JIA will present

A

Swelling
Stiffness (morning)
Loss of ROM

Deformity
Pain
Warmth colour change

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2
Q

5 differentials for JIA

A 
Septic arthritis
Reactive arthritis
No accidental injury
Malignancy
Transient synovitis
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3
Q

5 illnesses under the umbrella of JIA

A 
Polyarticular JIA
Oliarticular JIA
Ethesitis related arthritis
Psoriatic arthritis
Systemic arthritis
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4
Q

What joints are commonly affected in oligoarthritic JIA

A

Lower limb joints (knees , ankles)

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5
Q

What joints are commonly affected in polyarticular JIA

A

Small joints (hands and feet)

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6
Q

What joints are commonly affected in ethesitis related arthritis

A

Feet- plantar fasciitis

Sacroiliac

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7
Q

What adult rheumatological disease is analogous to ethesitis related arthritis

A

Ankalysing spondylitis

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8
Q

Three signs of psoriatic arthritis

A

Nail pitting
Dactylitis
Painful joints
Psoriatic plaques

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9
Q

What disease of the eye is common in JIA

A

Chronic anterior uveitis

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10
Q

Which paediatric malignancy has the strongest genetic predisposition

A

Retinoblastoma

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11
Q

Delayed puberty is most common in which gender and what is the likely cause

A

Makes

Constitutional delay in growth and puberty

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12
Q

What are the two types of precocious puberty?

A

Gonadotropin dependent

Gonadotropin independent

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13
Q

What condition may several cafe au lait spots indicate

A

Neurofibromatosis

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14
Q

What is the commonest cause of pneumonia

A

Influenza

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15
Q

What pathogen is most commonly responsible for viral exacerbations of asthma

A

Rhinovirus

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16
Q

Two differentials for acute stridor

A

Acute epiglotitis

Croup

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17
Q

Two causal organisms of croup

A

Parainfluenza virus

RSV

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18
Q

Treatment of croup

A

Oral dexamethasone

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19
Q

Seal barking cough is characteristic of what illness?

A

Croup

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20
Q

Stridor
Fever
Cold peripheries
Drawling

What could this be

A

Acute epiglottis

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21
Q

What two conditions does meningococcus commonly cause

A

Meningitis

Septicaemia

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22
Q

What three conditions does H. Influenza B (HiB) commonly cause

A

Epiglottitis
Meningitis
Pneumonia

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23
Q

What three factors should make you consider pneumonia in a child under 3YOA

A

Fever >38.5
Recession
RR>50

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24
Q

X-ray findings for pneumonia

A

Fluffy consolidations

Bronchograms

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25
What two organisms commonly cause paediatric pneumonia
Pneumococcus | HiB
26
If the pneumonia doesn’t respond to amoxicillin what should you consider and what medication would you change to
Causal organisms of mycoplasma pneumoniae Clarythromycin
27
Differentials for cough caused by pneumococcus
Fatigue & poor sleep - bronchitis | High resp rate - pneumonia
28
Tx for rhesus incompatibility
IV IG
29
Tx for neonatal jaundice
Phototherapy | Exchange transfusion
30
What might the diagnosis be for a neonate that is hypertensive but who’s lower limbs are poorly perfused
Coarctation of the aorta
31
What needs to be closely monitored in coarctation of the aorta ?
Urine output (representative of renal perfusion)
32
What age would you see gastroenteritis in?
<5s (around 2)
33
What is the most common pathogen responsible for gastroenteritis ?
Rotavirus
34
How much wt loss would you expect in shock
10%
35
What signs might you see in hypernatremic dehydration
``` Fidgety Hypertonia Hyperreflexia Transient hypoglycaemia Depressed fontanelle ```
36
What is a complication of hyponatremic dehydration
Seizures
37
What happens to brain volume in hypernatremic dehydration
Decrease in brain volume
38
What bloods should you take when giving IV fluids
Glucose Plasma electrolytes Urea Cr
39
Treatment of clinical dehydration (before shock)
Oral rehydration solution Replace fluid deficit Maintenance fluids
40
Treatment of shock from dehydration
``` Fluid bolus (can be repeated) Correct deficit over 24hours Maintenance fluids ```
41
Signs of clinical dehydration progressing to shock
TachyC TachyP Altered responsiveness
42
A 4 year old child is on salbutamol and beclamethasone and asthma is not controlled what is the next step in asthma tx
LTRA I.e. montelukast
43
A 9 year old is on salbutamol and budesonide and needs the next stage up in asthma tx , what is this
+LABA inc salmeterol, formeterol
44
A 12 year old is on a SABA, ICS and a LABA what is the 4th stage in escalating asthma tx
Increase ICS | If on max dose add oral steroid
45
Oral steroids in asthma treatment requires careful monitoring of what?
Growth
46
How do you manage a moderate acute exacerbation of asthma?
Up to 10puffs of Salbutamol | + oral pred 3-7days
47
How do you manage a severe acute exacerbation of asthma ?
Puff or neb salbutamol Oral/IV pred Inhaled ipratropium
48
How do you treat a life threatening asthma attack
Neb salbutamol IV pred Neb ipratropium +/- IV Sal/Mg
49
In a life threatening asthma exacerbation they have not responded to salbutamol, ipratropium or pred what do you do next?
``` Contact PICU CXR Confirm it’s asthma Blood gases Consider ventilation ```
50
What will VEW respond to
Bronchodilators such as ipratropium bromide (won’t respond to sabas)
51
2 differentials for CMPA
Toddlers diarrhoea | Gastroenteritis
52
How might a neonate with hyperthyroidism present?
``` Irritable TachyC Wt loss Diarrhoea Exophthalmos ```
53
How do you treat hyperthyroidism in an infant?
Carbamazepine
54
What congenital infections might a foetus acquire?
``` CMV Rubella Syphilis B19 Toxoplasmosis Varicella zoster ```
55
What is the treatment for a neonate with syphilis
Penicillin
56
What is the treatment for an infant with CMV
Gancyclovir
57
What is the treatment for maternal varicella zoster near delivery
Acyclovir + zoster Ig
58
What impact might rubella have on the foetus
Cataracts Deafness Congenital heart defect
59
What effect might cmv have on the neonate
Hepatosplenomegally Sensorineural hearing loss Cerebral palsy Epilepsy
60
What effect might toxoplasmosis have on a neonate
Retinopathy Cerebral calcification Hydrocephalus
61
What is the test for coeliac disease
Upper GI endoscopy + biopsy | TGA-IGA
62
Treatment of giardia and c diff
Metronizadole
63
Endocrine causes of faltering growth
Low GH Low IGF-1 Hyperthyroidism
64
Treatment of turners causing faltering growth
GRowth hormones | + oestrogens
65
Symptoms of chrones
Abdo pain Diarrhoea Wt loss
66
Symptoms of UC
Bloody stool Abdo pain Urgency
67
Areas affected in chrones and UC
Chrones - all over , mainly terminal ileum | UC- rectum
68
Depth of pathology in : Chrones UC
Chrones - transmural | UC- sun mucosal / mucosal
69
Treatment for chrones
Infliximab | Steroids - pred, bude, hydrocort
70
Investigations to order in faltering growth
``` TGA-IGA - coeliac TSH - hyperT Nutritional bloods FBC- anaemia / infection ESR/CRP - chrones U&E -CKD Kariotype - congenital X-ray- skeletal maturation / skeletal dysplasia ```
71
What factors indicate RSD
Cyanotic Laboured breathing TachyP+ bradyC
72
Signs of laboured breathing
Nostril flaring Recession Grunting
73
Complications of IVH
Hydrocephalus | Cerebral palsy- bilateral peri ventricular leukomakacia (cystic lesions) = 90% spastic diplegia
74
Treatment of RDS
Surfactant therapy Raised ambient O2 (Ventilation)
75
Complication of ventilation for RDS
Pneumothorax in 10%
76
Signs of pneumothorax
Hyperinflation of one lung | Reduced breath sounds in one lung
77
What is meant by an episode in neonatal medicine
BradyC and desaturation that don’t correct in 30s
78
Causes of neonatal episodes
``` Immature resp center -can stimulate into breathing Anaemia HypoG HF Seizures Electrolyte disturbances Infections ```
79
Signs that a neonate has NEC
Bloating (see on X-ray) Off feeds Vomiting +/- bile Blood stained stool
80
Management of NEC
Benpen + gent Parenteral nutrition CV support Surgery - comp short bowel syndrome +/- ventilation
81
Neonatal triad of hypo
Hypoglycaemia Hypoxia Hypothermia
82
What conditions (7) are premature babies at risk of :
``` RDS IVH Cerebral palsy PDA HIE Retinopathy of prematurity Bronchopulmonary dysplasia ```
83
What is retinopathy of prematurity
At the vascularising junction, risk of retinal detachment and blindness
84
What factor increases the risk of retinopathy of prematurity
High O2 concs
85
What is bronchopulmonary dysplasia
Requiring O2 after 36w
86
What would a CXR show in bronchopulmonary dysplasia
Areas of opacification + cystic changes
87
Complication of Bronchopulmonary dysplasia
Resp failure with infection ie. broncholitis
88
Which direction does the o2 sats curve shift for foetal hb?
To the left
89
Why does the pressure in the left atria increase at birth
Pulmonary resistance drops | More blood flow through lungs
90
Why is transient TachyP of the newborn more common in Csections
No squeezing of fluid out of lungs | No catecholamines which stim resorb of alveolar fluid
91
When and where would you hear a PDA
In a baby with RDS Under L clavicle Systolic cont into diastole
92
Differential for PDA
Venous humm
93
Name two innocent murmurs
Stills murmur | Venous humm
94
Characteristics of an innocent murmur
``` 5Ss Soft Systolic Assymptomatic Positional Left eternal edge No thrills Less than grade 3 ```
95
What is the most common presentation of a congenital heart defect?
Poor feeding
96
Explain how essenmengers syndrome can happen in a L to R shunt
Blood flows from a high pressure system to a low pressure system causing pulmonary hypertension
97
4 categories of congenital heart defect
``` Breathless Blue Breathless & blue Assymp + murmur Sick + murmur ```
98
What could be the causes of an assymptomatic neonate w/ murmur
Pulmonary stenosis | Aortic stenosis
99
Name 3 ICS
Budesonide Beclamethasone Fluticasone
100
Side effects of ICS (3)
Adrenal suppression Osteoporosis Growth suppression
101
Most common viral cause of bronchiolitis
RSV
102
Most common bacterial cause of pneumonia
Strep pneumoniae
103
Most common viral causes of pneumonia
RSV | Influenza (HiB)
104
Treatment for pneumonia caused by influenza
Co-amox
105
Treatment for comm aq’ pneumonia
Amox + macrolide (claryth) if not responding to amox
106
What time of year is croup most common
Spring / autumn
107
What age is the peak incidence of croup
2YO
108
What is the treatment for croup
Dexamethasone 150mcg/kg
109
List some early features which may be suggestive of cerebral palsy
``` Delayed milestones Abnormal gate Hand preference before 12yoa Small head Feeding difficulties Abnormal tone ```
110
Name two other neuro features you would expect to see in spastic CP
Hyper reflexia | Extensor plantar response
111
What is the most common pathogen to cause croup
Parainfluenza
112
Tripod stance + drewling+ fever and flushed | What do you need to rule out
Epiglottis
113
Stridor + very unwell child =?
Epiglottis
114
What disease/ illness is the precursor to bronchiectasis
Persistent bacterial bronchitis
115
What pathogens can cause PBB (persistent bacterial bronchitis)
- strep pneumonia/pneumococcus - h.influenza - moraxella catarrrhalis
116
What is the treatment for persistent bacterial bronchitis
Physio | Coamox
117
In an under 3yo what three factors would make you consider pneumonia
Fever >38.5 RR>60 Recession
118
Complications of pneumonia
Pleural effusions Empyemas Abscesses
119
Chronic causes of cough
``` CF Asthma PBB Foreign body TB GORD ```
120
In CF what does the CFTR protein code for
AMP dependent chloride channel
121
CF is a autosomal recessive disorder. What chromosome is effected?
Chromosome 7
122
Why in CF do you get steatrrhoea
Effects the pancreases - enzyme deficiencies
123
Differentials for wet cough with purulent sputum
Bronchiectasis | CF
124
How might a baby with CF present
Meconium ileus
125
Tx for CF
Ivacaftor | Lumicaftor
126
What are the respiratory findings in CF
Hyperinflation due to air trapping Coarse insp creps Exp wheeze
127
Investigation for CF
Sweat test- high conc of chloride
128
What is characteristic of CF stool
Pale, greasy, low feacal elastase
129
What prophylactic abx would you give in CF
Fluclox
130
Loose stool+ faltering growth+recurrent chest Infections | What are you suspicious of?
CF
131
What could be the causes of a sick neonate with murmur
Coarctation of aorta | Left hypoplastic heart syndrome
132
When is an innocent murmur more likely to be heard and why
When the child is ill due to increased CO
133
4 features of TOF
Overriding aorta VSD Pulmonary stenosis R ventricular hypertrophy
134
Treatment of TOGV
IV PG to increase mixing until surgical repair
135
Treatment of coarctation of the aorta
Balloon angioplasty
136
What sign is seen on X-ray with coarctation of the aorta
3 sign
137
What syndrome do you classically see coarctation of the aorta in
Turners
138
Treatment of VSD
Diuretics
139
What congenital heart defect is most commonly seen in downs
AVSD
140
What injection is given at birth
Vit K to prevent haemorrhagic disease of the newborn
141
What test is done for coeliac
Anti-tTG
142
3 signs of neurofibromatosis
Cutaneous neurofibromas High bp Cafe au lait patches
143
Inheritance pattern of neurofibromatosis
AD
144
What is the insulin dose calculation in DKA
0.05units per kg
145
What is the calculation for fluid deficit ?
Wt x %dehydration x 10 | Correct over 48hours
146
What is the risk of giving fluids too quickly
Cerebral oedema
147
What fluid should you give in DKA
Initially 0.9NaCl +K Cl | Once glucose <14mmol add 5% glucose
148
What is the biochemical triad in DKA
Acidosis HyperKetoneamia Hyperglycaemia
149
What is the treatment for HIE
Therapeutic cooling
150
What is the threshold for glucose in DKA
11mmol
151
What is the definition of chronic lung disease (BPD)
O2 requirement after 36w
152
What is the pH threshold for DKA
<7.3
153
What is the threshold for blood ketones in DKA
>3mmol
154
How long should you wait after fluids to give insulin
1-2hours
155
When do you give a fluid bolus
In DKA | Or in shock
156
When do you not subtract the fluid bolus from the total fluid requirement ?
Anyone in shock
157
How many mls fluid bolus do you give | 1) DKA shock
20mls/kg | Up to 40mls
158
How many mls fluid bolus do you give | 1) no DKA+ shock
20mls/kg | Up to 40mls/kg
159
How many mls fluid bolus do you give | 1) no DKA +no shock
No bolus
160
How many mls fluid bolus do you give | 1) DKA + no shock
10mls /kg
161
What are the 3 sections of fluid you need to address
Bolus Deficit Maintanence
162
How do you calculate maintenance fluids
1st 10kg- 100mls/kg/day 2nd 10kg- 50mls/kg/day Remainder -20mls /kg/day
163
What is the feed calculation for a baby over 5days old
150ml/kg/day
164
How much maintenance fluid would a child weighing 20kg need
10x100 10x50 -1500ml/day
165
What are the signs of DKA
Dehydration Kussmal breathing Pear drop breath
166
What are the symptoms of DKA
TTTCPUVA ``` Tired Tachyponea Thirsty Confusion Passing out Urinating Abdo pain Vommiting ```
167
Causes of faltering growth
- Congenital abnormalities - Endocrine -GH /IGF deficiency/ hyperthyroidism - Social - small birth weigh/ preterm - GI causes - iatrogenic - steroids - systemic illness - CHD/ CF/ CKD
168
What is the most common gear defect
VSD
169
How would a child with a L to R cardiac shunt present
Breathless | Feeding problems
170
What is a complication of a L to R cardiac shunt
Esseinmengers syndrome
171
What 4 features does TOF have
VSD Over riding aorta Pulmonary stenosis R V hyperteophy
172
What murder presents with a machinery like murmur under the L clavicle
PDA
173
What CHD is most common on Down’s syndrome
AVSD
174
What sign will you see with coarctation of the aorta on X-ray
3 sign
175
What HLA type is associated with coeliac disease
DQ2 and DQ8
176
What antibodies are associated with coeliac disease
anti-tissue transglutaminase (tTG) endomysial antibodies (EMA) deamidated gliadin peptide (DGP) antibodies.

Phase 3a (7 decks)

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