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Y5 Specialties Incorrects > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Neonatal hypoglycemia management?

A

asymptomatic
encourage normal feeding (breast or bottle)
monitor blood glucose

symptomatic or very low blood glucose blood glucose of <1mmol/L
admit
intravenous infusion of 10% dextrose

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2
Q

differentiate between
caput succedaneum
and cephalohematoma

A

caput succadenum -> present at birth, forms over the vertex and crosses suture lines, resolves within days. fluid collection

cephalohematoma -> develops several hours after birth, most common in parietal region, does not cross suture lines, takes months to resolve. blood collection

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3
Q

A newborn infant is noted to have a posterior displacement of the tongue and a cleft palate. What is the most likely diagnosis?

A

Pierre-Robin Syndrome -> micrognathia (undersized jaw), glossoptosis (posterior displacement of the tongue) and cleft palate

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4
Q

Differentiate between acute epiglottitis and croup

A

Acute epiglottitis = tripod positioning, drooling!!. Stridor. Caused by Hib -> now seen more commonly in adults due to vaccination program. Diagnosis by direct visualization by senior staff. call anesthetist for intubation! Do not examine throat. Thumb print sign on x ray. IV antibiotics

Croup - stridor!! , SOB. Viral prodrome!! - Parainfluenza virus. Most common cause. Steeple sign on X-ray/supglottiv narrowing. Croup = barking Cough that may sound like a seal. managed with oral dex. SINGLE dose

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5
Q

Symptoms seen

A

Cyanosis/ tet spells
collapse in first month of life, Ejection systolic murmur

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6
Q

symptoms of noonan syndrome?

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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7
Q

A 2-week-old infant with a small chin, posterior displacement of the tongue and cleft palate has what syndrome?

A

pierre robin syndrome

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8
Q

Management for ophthalmia neonatorum (infection of newborn eye)

A

Same day ophthalmology referral

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9
Q

What happens in necrotising enterocolitis?

management?

A

bowel of premature infants becomes ischaemic and infected.

dilated asymmetrical bowel loops AND pneumatosis intestinalis (intramural gas).!!

abdominal distension. bloody stools may be present

total gut rest and TPN, babies with perforations (eg free fluid in in abdomen) will require laparotomy

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10
Q

If a man has a mitochondrial disease, which family member is most likely to be affected?

A

Brother or sister - maternal inheritance

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11
Q

what is infantile colic?

A

benign condition characterised by irritability and excessive crying
tends to be worse in the evenings or at night. starts around 6-8 weeks old and most resolve by 6 months

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12
Q

First sign of puberty in boys?

A

Increase in testicular volume

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13
Q

What is transient tachypnoea of the newborn?

Diagnostic findings?

risk factor!!

Management?

A

commonest cause of respiratory distress in the newborn period.. rapid breathing, grunting, and mild intercostal recession. caused by delayed resorption of fluid in the lungs

Chest x-ray - hyperinflation of the lungs and fluid in the horizontal fissure.

c section!!

Observation/supportive care. O2 may be needed

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14
Q

Whooping cough symptoms?
Management?

A

Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.

Macrolide antibiotics- clarithromycin, azithromycin

school exclusion until 2 days after starting antibiotics

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15
Q

Important contraindication to lung transplant in CF?

A

chronic infection with Burkholderia cepacia

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16
Q

A normal pCO2 in an acute asthma attack indicates?

A

Life threatening attack - respiratory exhaustion - not blowing off co2

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17
Q

distinguish between pathological and physiological jaundice and prolonged jaundice

name causes of each

A

pathological = in first 24 hours. rhesus disease&hemolytic jaundice, blood group incompatibility. hypothyroidism. Coombs test important
tretaments - phototherapy, iV immunoglobulin, exchange transfusion

physiological = days 2-14 eg less developed liver, more rbcs, breast milk

prolonged = beyond 14 days. biliary atresia, hypothyroidism, galactosemia, UTI, breast milk

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18
Q

in a patient that present with acute asthma attack which improves with o2 and salbutamol, what else must be prescribed?

A

oral prednisolone, 40mg for 3-5 days

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19
Q

hemophilia A has what mode of inheritance?

A

x linked recessive

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20
Q

explain the law around medical consent by children under the age of 16 in UK

A

patients less than 16 years old may consent to treatment if they are deemed to be competent (an example is the Fraser guidelines, previously termed Gillick competence), but cannot refuse treatment which may be deemed in their best interest

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21
Q

non bullous impetigo treatment?

A

hydrogen peroxide cream 1%. exclusuion from school till lesions are crusted and healed

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22
Q

how do you differentiate between infantile spasms (siezures) and infantile colic?

what investigation is needed?

A

In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the ‘spasms’

eeg - rule out hypsarrhythmia commonly seen in West syndrome

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23
Q

in a viral induced wheeze, if SABA is not effective, next step in management?

A

ICS or monteleukast

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24
Q

febrile siezures typically stop at what age?

medication for recurrent febrile siezures?

A

5 years

benzodiazepine

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25
Q

3-year-old boy. last 12 hours bilious vomiting on multiple occasions. assed one stool which contained small amounts of blood.

what is the likely diagnosis?
investigation?
management?

A

intusscueption

USS = first line = target sign

reduction by air insufflation

during paroxysm the infant will characteristically draw their knees up and turn pale

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26
Q

how can you distinguish between intussuception and necrotising enterocolitis?

diagnostic test in NE?

A

both have abdominal distension, bilious vomiting and bloody stool

NE more commonly encountered in premature infants! than young children like intussuception

Abdominal x-ray

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27
Q

a distended abdomen and bilious vomiting in a 2-week child is highly suggestive of?

diagnosis?

A

intestinal malrotation and volvulus. the obstruction here causes bilious vomiting

upper GI contrast study and USS

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28
Q

name red flag symptoms in pediatric traffic light system

A

respiratory rate >60 breaths/minute

reduced skin tugor

moderate intercostal recession

age <3 months!!

temp >38 !!

weak, high pitched or continous cry

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29
Q

scarlet fever symptoms?

management?

A

rash ->. spares palms and soles. ROUGH or sandpaper like texture, sore throat, strawberry tongue may be present

oral penicillin 5 for 10 days

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30
Q

meningitis treatment in children< 3 months

A

IV amoxicillin in addition to cefotaxime to cover for Listeria

> 3 months is IV cefotaxime or ceftriaxone. note ceftriaxone contraindicated in children <3 months

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31
Q

APGAR scoring

A
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32
Q

A 4-year-old boy is noted to have macrocephaly and learning difficulties. What is the most likely diagnosis?

A

Fragile X syndrome. also large ears, macro-orchidism

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33
Q

why is oligohydramnios a risk factor for DDH?

A

it restricts foetal movement and thus normal development of the hip joint.

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34
Q

symptoms of SCFE?

A

hip, groin, medial thigh or knee pain. inability to weight bear

loss of internal rotation of the leg in flexion

may present following acute trauma or chronically

commonly in obese boys.

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35
Q

in neonates with hypoxic injury, what is done to reduce the chances of HIE?

A

therapeutic cooling

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36
Q

poor prognostic factors for ALL?

A

male sex
presenting <2 years or >10 years; having B or T cell surface markers; and having a WCC > 20 * 10^9/l at diagnosis.

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37
Q

ALL symptoms?

A

anaemia, neutropaenia (infections eg cough) and thrombocytopaenia

Others: splenomegaly, hepatomegaly, bone pain

*note high number of white cells produced so high wcc!! -> but they do not function properly

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38
Q

Perthes disease presentation?

(idiopathic avascular necrosis of the femoral head)

management?

A

pain and a limp, reduced tange of hip movements movements.

observation. only surgery if fracture or joint collapse

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39
Q

transient synovitis presentation?

A

1-2 weeks after an upper respiratory tract infection or gastrointestinal infection.

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40
Q

what type of pulse is seen in a patent ductus arteriosus?

A

collapsing pulse

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41
Q

classify the types of cerebral palsy and structures damaged in each

A

spastic (70%)
subtypes include hemiplegia, diplegia or quadriplegia
increased tone resulting from damage to upper motor neurons!!!

dyskinetic
caused by damage to the basal ganglia and the substantia nigra!!!
athetoid movements and oro-motor problems (drooling)

ataxic
caused by damage to the cerebellum!! with typical cerebellar signs. struggle with fine motor skills! eg building a tower

mixed

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42
Q

when is the first dose of MMR vaccine given?

A

at 12-13 months

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43
Q

what is an umbilical granuloma?

A

overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.

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44
Q

what features make penumonia more likely than bronchiolitis?

A

high fever (over 39°C) and/or
persistently focal crackles.

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45
Q

name 3 oral live attenuated vaccines

A

polio
rotavirus
typhoid

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46
Q

in the first ___ minutes of life suboptimal SP02 readings can be expected from a healthy neonate

A

10 minutes

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47
Q

features seen in achondroplasia?

A

trident hand deformity (short, stubby fingers with separation between the middle and ring fingers), short limbs (rhizomelia), lumbar lordosis and midface hypoplasia.

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48
Q

A 16-year-old female presents with chronic left knee pain. The pain is typically felt after jogging. There is also intermittent swelling and locking of the same joint. What is the most likely diagnosis?

A

osteochondritis dissecans

Osgood-Schlatter disease rarely causes pain at rest. with activity pain is localised at tibial tuberosity. swelling can occur

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49
Q

VSD increases risk of what condition?

A

endocarditis

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50
Q

what medical condition is associated with fragile x syndrome?

A

mitral valve prolapse

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51
Q

which complication of ALL can lead to recurrent nosebleeds and easy bruising?

A

DIC

52
Q

hirschprungs disease management?

A

initially: rectal washouts/bowel irrigation
definitive management: surgery

53
Q

risk factors for neonatal RDS?

CXR findings?

A

prematurity
maternal diabetes -> insulin inhibits surfactant production
c section

ground-glass’ appearance with an indistinct heart border

54
Q

developmental milestones times

A
55
Q

name some complications of measles

A

Otitis Media for Measles. not externa

pneumonia
encephalitis
conjuctivitis
myocarditis

56
Q

a benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles is?

A

venous hum

57
Q

a 14 year old girl has hemophilia, what other condition does she likely have?

A

turners syndrome

hemophilia is x linked recessive so is expected to only occur in males

58
Q

most common cause of cardiac arrest in children?

A

hypoxia -> may be choking incident

59
Q

what are the most common causes of cyanotic heart disease?

A

tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia

60
Q

4 year old with bedwetting management?

A

Children under the age of 5 years who have nocturnal enuresis can be managed with reassurance and advice

61
Q

18 month old girl with acute limp and coryzal symptoms. management?

A

urgent specialist assesment as <3 years with acute limp

transient synovitis uncommon in age group,. septic arthritis more common

62
Q

what are risk factors for RSV and thus warrant administration of Pavalizumab?

A

Premature infants
Infants with lung or heart abnormalities
Immunocompromised infants

63
Q

JIA symptoms?

A

pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis

64
Q

intestinal malrotation is associated with which medical conditions?

A

exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia

65
Q

differentiate findings in ITP, HSP and meningtis

A

ITP - non blanching rash, no fever, viral prodrome

HSP -> non blanching rash, athralgia, abdominal pain

Meningitis -> non blanching rash, fever, other signs of being unwell

66
Q

ASD auscultation findings

A

ejection systolic murmur, fixed split S2

67
Q

Partial siezures at night, marked by -> hemifacial paraesthesias, oropharyngeal manifestations (e.g. strange noises) and hypersalivation is characteristic of?

A

benign rolandic epilepsy

68
Q

Umbilical hernia management?

A

Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic peform elective repair at 4-5 years of age.

69
Q

Causes of microcephaly?

A

normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis

70
Q

Patient with suspected transient synovitis eg viral infection before symptoms. But temp is 38. Management ?

A

Urgent referral due to presence of fever! Must rule out septic arthritis

71
Q

In pediatric BLS, how many rescue breaths given intially? Why?

A

5

Main cause of arrest in kids is hypoxia.

72
Q

Changes in the peripheries such as oedema or peeling.
Bilateral nonpurulent conjunctivitis
Polymorphic rash.
Cervical lymphadenopathy.

Investigation to screen for complications?

A

Echo

73
Q

What test is contraindicated in meningococcal septicemia?

A

Lumbar puncture.

Sepsis - bp, heart rate etc

74
Q

children with an unexplained enlarged abdominal mass in children - possible Wilm’s tumour - arrange paediatric review with 48 hours

A
75
Q

Hand foot and mouth disease management

A

Symptomatic treatment only

76
Q

Signs differentiating between early (compensated) shock and late (decompensated) shock*:

A

early shock
- normal bp
Tachycardia
- tachypnea
Pale and mottled
Urine output reduced

late shock
hypotension
bradycardiaacidotic (Kussmaul)
blue extremities
urine output absent

77
Q

in infants with vague signs such as poor feeding, grunting, lethargy
What should be considered

Risk factors?

A

Neonatal sepsis- resp distress also most common symptom

Premature
Birth weight less than 2.5kg
GBS
Chorioamnionitis

78
Q

AD conditions list them

A

Achondroplasia

79
Q

Cough and wheeze in <1 year old, in a background of viral illness is most likely?

when is this condition severe?

A

Bronchiolitis

O2 if sats less than 92

Stridor not present!!

severe if for example signs of reps distress eg grunting!!, marked chest recession

80
Q

What is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?

Diagnosis?k

A

Meckels diverticulum
Technetium scan

81
Q

14 year old after holiday abroad light brown macules and confluent patches affecting most of his back and chest. management?

A

Ketoconazole. Patient has pytiriasis versicolor

82
Q

What is the corrected age for developmental milestones in a premature baby?

A

Normal age to meet developmental milestone + number of weeks born premature. Normal birth is at 40 weeks .

83
Q

A 4-year-old boy was discharged from the hospital six weeks ago after an episode of viral gastroenteritis. He now has 4-5 loose stools each day which has been present for the past four weeks. Cause ?

A

Lactose intolerance - complication of viral gastroenteritis

84
Q

2 year old a small smooth cyst is identified which is located above the hyoid bone. On ultrasound the lesion appears to be a heterogenous and multiloculated mass. most likely cause?

A

Dermoid cyst

85
Q

Passage of meconium after x is a red flag

A

48 hours

86
Q

when should dexamethasone be considered for patients with meningitis?

A

Over 3 months old!!

And any of

frankly purulent CSF
CSF white blood cell count greater than 1000/microlitre
raised CSF white blood cell count with protein concentration greater than 1 g/litre
bacteria on Gram stain

87
Q

what is cradle cap (seborrhoeic dermatitis)?
management?

A

yellow scales on the scalp but can also affect the face, ears and neck in newborns

baby shampoo and oil

88
Q

when can children with scarlet fever return to school?

A

24 hours after commencing antibiotics

89
Q

coeliac disease presentation?

A

failure to thrive
diarrhoea
abdominal distension/pain
older children may present with anaemia

90
Q

in infants, what is the typical distribution of atopic eczema?

A

Face and trunk.

91
Q

what is the most likely cause of worsening neurological function in a premature infant born at 34 weeks gestation.

A

IVH. may occur spontaneously

92
Q

gold standard test for vesico-ureteral reflux

gold standard test to look for renal scarring = a complication of vesico-ureteral reflux?

A

Micturating cystourethrogram. This is an imaging test that involves filling the bladder with a contrast material and then taking x-rays while the patient urinates to visualise any reflux

Radionuclide scan using dimercaptosuccinic acid (DMSA).

93
Q

learn immunisation schedule

A
94
Q

patau syndrome affects chromosome?

A

13

95
Q

which syndrome in children is associated with supravalvular aortic stenosis?

A

Williams Syndrome

96
Q

retinal hemorrhage, encephalopathy and what is seen in shaken baby syndrome?

A

subdural hematoma

97
Q

treatment for pneumonia in children?

A

Amoxicillin is first-line for all children with pneumonia

Macrolides should be used if mycoplasma or chlamydia is suspected

98
Q

one reason for an urgent ct scan after head trauma is at least x episodes of vomiting

A

when is the menB vaccine given, when is the HPV vaccine given
what vaccines are given at 3-4 years?

99
Q

what is Pauciarticular JIA?

what is systemic onset JIA?

A

JIA where 4 or less joints are affected

JIA with regular and intermittent fevers

100
Q

primary ovarian failure can be seen in girls with what condition?

A

Turners Syndrome

101
Q

Cyanotic congenital heart disease presenting within the first days of life is?
Cyanotic congenital heart disease presenting at 1-2 months of age is?

A

TGA
TOF

102
Q

hand preference before ___ months is abnormal and could be an indicator of ___

A

12 months
cerebral palsy

103
Q

what is growing pains?

A

pain in legs of child with no obvious cause

Features of growing pains
never present at the start of the day after the child has woken
no limp
no limitation of physical activity
systemically well
normal physical examination
motor milestones normal
symptoms are often intermittent and worse after a day of vigorous activity

104
Q

exomphalos vs gastroschisis management?

A

Exomphalos should have a gradual repair to prevent respiratory complications. Gastroschisis requires urgent correction as no membrane covering

105
Q

Rubella symptoms

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

106
Q

At what age would the average child start to play alongside, but not interacting with, other children?

A

2 years
parallel play = 4 years

107
Q

treatment for patients with CF that have an infection with Pseudomonas aeruginosa

A

oral ciprofloxacin

108
Q

whihc rescue medication can be prescribed for recurrent febrile siezures?

A

(rectal diazepam or buccal midazolam)

109
Q

features of hypernatremic dehydration?

A

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma

110
Q

GORD treatment in infants

A

1st line = alginate/gaviscon if breastfed, feed thickener if bottle fed

unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
distressed behaviour
faltering growth

111
Q

first line treatment for constipation in kids?

A

macrogols (e.g. Movicol) is first-line
if insuffeicient add a stimulant laxative -> senna

112
Q

unborn child with exomphalos management?

A

c section at 37 weeks

113
Q

DDH 1st line investigation?

A

ultrasound is generally used to confirm the diagnosis if clinically suspected
however, if the infant is > 4.5 months then x-ray is the first line investigation

114
Q

name a vaccine that is offered to pregnant women

A

pertussis

115
Q

at what age would the average child acquire a good pincer grip?

A

12 months

116
Q

perthes can present with short stature and pain specifically on internal rotation, not limited internal rotation seen in SUFE. if x rays are normal when perthes is suspected -> mri hip

A
117
Q

when is hypospadias surgery performed?

A

at 12 months old

118
Q

name a genetic syndrome associated with autism

A

fragile x

119
Q

perthes disease management?

A

observation

120
Q

compression ventilation ratio in newborns?

A

3 to 1

121
Q

Kawasaki management?

A

high dose aspirin and a single dose of IVIG

122
Q

when would a bone marrow biopsy be indicated for ITP

A

if atypical findings present eg splenomegaly, bone pain, and diffuse lymphadenopathy. high wcc, which may suggest an underlying myeloproliferative malignancy.

123
Q

why should you avoid NSAIDs in chickenpox?

A

increased risk of necrotising fascitis

124
Q

what maternal drug increases risk of orofacial clefts?

A

antiepileptics

125
Q

necrotising enterocolitis pathogenesis?

symptoms?

managment?

complications

A

invasion of gas producing bacteria in gut wall of premature or VLBW infants -> necrosis

feeding intolerance (bilious emesis), tender distended abdomen, GI bleeding (hematemesis, hematochezia), pneumatosis intestinalis (air in bowel wall)

bowel rest
- discontinuation of feeds
- gastric decompression, parenteral nutrition
- blood cultures and antibiotics!!!

septic shock
bowel perforation -> free intraperitoneal air -> laparotomy required!!

126
Q

describe some signs and complications of Downs syndrome

A

respiratory and ear infections -> hearing loss risk and hearing tests required

OSA, epilepsy

expressive language delay

hirschprungs, duodenal atresia

typical face/body signs

127
Q

what are the components of the capacity act?

A

Y5 Specialties Incorrects (4 decks)

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