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Y5: Paediatrics > PPQ Facts > Flashcards

PPQ Facts Flashcards

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1
Q

Hx of eczema -> Painful + itchy rash on face/neck. Punched out lesions.

A

Eczema herpetiformis
HSV 1 or 2

Tx = Oral aciclovir

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2
Q

16yo girl with short stature, short ring finger, webbed neck, high-arched palate, widely spaced nipples.
NO breast development or periods.

O/E Crescendo-decrescendo ejection systolic murmur, radiates to carotids. OR peripheral pulses absent/ radio-femoral delay/ ‘click’ over aortic valve/

A

Turner’s syndrome 45X (Deletion of an X)

Murmur is due to Bicuspid aortic valve causing aortic stenosis

Peripheral pulses absent = Co-arctation of aorta (less common than bicuspid)

Associated with Gastroschisis/Omphalocele

Tx = oestrogen replacement, Growth hormone replacement

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3
Q

Causes of delayed puberty with short stature

A
  • *Turners** - 45X
  • *Prader-Willi** (Imprinting - Fat & floppy - obesity + hypotonia)
  • *Noonan’s** (AD condition - Web neck, pectus excavatum, pulmonary stenosis - ESM louder on inspiration)
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4
Q

Causes of delayed puberty with normal height

A

PCOS
Androgen insensitivity
Kallman’s
Klinefelters

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5
Q

How do you differentiate the causes of normal-stature delayed puberty?

A

Klinefelter’s - 47 XXY. Lack of secondary sexual characteristics, small firm testes. HIGH LH + LOW testosterone.

Kallman’s (X-linked) = LOSS OF SMELL (anosmia). Hypogonadotrophic so LOW LH + low testosterone

Androgen Insensitivity (X-linked) = Resistance to testosterone. ‘Girl’ presents with delayed puberty and bilateral groin masses = undescended testes. HIGH LH + Normal/high testosterone.

Testosterone-secreting tumour = LOW LH + High testosterone

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6
Q

Rheumatic fever

A

Group A b-haemolytic Strep (GAS) or Scarlet Fever

5-15yo

2-6wks post-throat infection

Then you get triad of PPE:

  • Polyarthritis (joint swelling or pain)
  • Pericarditis (endo/myo/pericarditis)
  • Erythema marginatum (map-like outlines)

Major criteria = CASES
Carditis, Arthritis, Subcutaneous nodules, Erythema marginatum, Sydenham’s chorea

Minor criteria = FRAPP

Fever, Raised ESR/CRP, Arthralgia, Prolonged PR, Previous Hx

Diagnosis = 2 major OR 1 major + 2 minor

Mx:

  • 1st line = High-dose aspirin
  • Amoxicillin if evidence of persistent infection
  • Corticosteroids if fever/inflammation doesn’t resolve rapidly

Prophylaxis after the episode = Benzathine penicillin

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7
Q

Infective Endocarditis

A

Most common cause WITH heart abnormality = Strep viridans

Most common cause WITHOUT heart abnormality = Staph aureus

Tx = IV amoxicillin for 4-6wks (initial)

BenPen (if you know its viridans)

Fluclox (if you know its Staph aureus)

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8
Q

Fragile X

A

Long, thin face + Macrognathia (large mandible)

Associated with mitral valve prolapse

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9
Q

GORD Tx

A
  1. Small frequent feeds
  2. Thicken feeds
  3. Alginate trial
  4. PPI trial
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10
Q

Physiological changes in pregnancy

A

CVS = CO increase

Renal = GFR increases 30-60%, meaning glucose and protein losses in urine

Liver = Raised ALP, low albumin

Haem = Hb + Pt decreases (dilutional).

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11
Q

Cyst in midline of neck/ external angle of eye/ posterior pinna of ear with hair follicles visible in it?

A

Dermoid cyst

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12
Q

Ondansetron use in pregnancy?

A

Small risk of cleft palate if used in first trimester

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13
Q

Commonest cause of ovarian enlargement in women of reproductive age

A

Follicular cyst

  • Commonest type of ovarian cyst
  • due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
  • commonly regress after several menstrual cycles
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14
Q

Mx of Perthes?

A

<6yo = Observe - good prognosis

>6yo = Surgery

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15
Q

Define Oligoarticular (pauciarticular) JIA

A

Affects up to 4 joints

Typically large joints (Knee, elbow, ankle)

Systemic JIA = FEVERS

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16
Q

Otitis media

A

Admit if:

  • Severe systemic infection
  • Complications: Meningitis, Mastoiditis, facial nerve palsy
    • Mastoiditis = “Honeycomb” structure + discharge behind ear

Without effusion:

  • Paracetamol/ibuprofen, should resolve in 1wk
  • Immediate Amoxicillin if sytemically unwell or <2yo

With perforation = PO Amoxicillin 5 days, review in 6wks

With effusion “Glue ear”

  • Conductive hearing loss
  • Can interfere with speech development
  • Otoscopy: Eardrum is dull + retracted ± fluid level visible
  • Ix
    • Tympanometry, Pure tone audiometry
  • Mx
    • Co-existing cleft palate, Down’s, hearing loss = Refer to ENT
    • Otherwise:
      • Active observation for 6-12wks
      • 2x Pure tone audiometry tests (3 months apart)
      • Persisting past 6-12wks = Refer to ENT
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17
Q

Developmental milestones referral points

A
  • Doesn’t smile at 10 weeks
  • Can’t sit unsupported at 12 months
  • Can’t walk at 18 months

Hand preference before 12 months = ?Cerebral palsy

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18
Q

Which ovarian cancer increases risk of endometrial hyperplasia?

A

Granulosa-theca cell

Secretes oestrogen

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19
Q

Rubella in pregnancy

A

Risk high (90%) in first 8-10wks GA

Low risk to foetus after 16wks

Congenital Rubella = CHD (PDA), Eye problems (cataracts, “salt & pepper” chorioretinitis, Deafness

Suspected cases of rubella in pregnancy should be discussed with the local Health Protection Unit

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20
Q

Williams syndrome

A

Elfin facies

Bubbly outgoing personality

Learning difficulty

Short stature

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21
Q

Shaken baby syndrome triad?

A

Retinal haemorrhages

Subdural haematoma

Encephalopathy (Seizures, LOC)

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22
Q

When is the booking visit and what is usually done?

A
  • 8-12wks (ideally <10wks)

Consists of:

  • General info e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
  • BP, urine dipstick, check BMI
  • Booking bloods/urine:
    • FBC, ABO blood group, Rhesus status, red cell alloantibodies, haemoglobinopathies
    • HIV, Hep B, Syphilis
    • URINE CULTURE for asymptomatic bacteriuria (even if dipstick is normal)
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23
Q

Medical management of miscarriage?

A

Vaginal misoprostol ONLY

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24
Q

Baby born to mum with Hep B surface antigen +ve OR high risk.

What is Tx for baby?

A

Hep B vaccine + 0.5ml HBIG within 12hrs of birth

Hep vaccine at 1-2 + 6 months

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25
Drugs contraindicated in breastfeeding?
* Abx: Ciprofloxacin, Tetracycline (**Doxycycline**), Chloramphenicol, Sulphonamides * Psych: Lithium, BDZs, Clozapine * **ASPIRIN** * **CARBIMAZOLE** (hyperthyroidism) * **AMIODARONE** * Methotrexate * Sulphonylureas
26
Whooping cough
* Cough for 2wks or more * Vomiting after coughs * Inspiratory whoop * Apnoeic attacks in infants * **ADMIT if:** * **\<6m** * Apnoea, cyanosis, severe paroxysms * Complications: Seizures, pneumonia Cough onset within **21 days** = **MACROLIDE** (Azithromycin or Clari) Return to school **48hrs after commencing Abx**
27
Measles vs Rubella vs Roseola
* Measles * Prodrome = Fever + **_Conjunctivitis_ (±febrile convulsions)** * Rash starts **_BEHIND THE EARS_** * **_KOPLIK SPOTS_** (white) * **_NO lymphadenopathy_** * Rubella * Prodrome = MILD fever * **PINK rash** * **_Suboccipital/Post-auricular_ Lymphadenopathy** * **Forcheimer spots** (Red spots on soft palate) * * Roseola * Classically **HIGH Fever (3 days) THEN RASH appears** * **PINK** macular rash * FEBRILE CONVULSIONS * Nagayama spots (uvula + soft palate
28
You are called to assist in the resuscitation of a neonate who has just been born at 38 +6 weeks but is showing signs of respiratory distress. On auscultation of the precordium you note the heart sounds are absent on the left hand side but can hear tinkling sounds. The infant is also cyanosed.
Left-sided **congenital diaphragmatic hernia** Left sided = most common **Tinkling** sounds = **BOWEL sounds** **Immediate Mx = _INTUBATE + VENTILATE_**
29
beta hCG facts
* Hormone first produced by the **embryo** and later by the **placental trophoblast** * Main role = to **prevent the disintegration of the _corpus luteum_** * **_Doubles every 48hrs_** in first few wks of pregnancy
30
Eclampsia: when should magnesium be stopped?
**24hrs** after **last seizure**
31
Neonatal resus steps
1. **Dry** baby and maintain temperature 2. **Assess** tone, respiratory rate, heart rate 3. If gasping or not breathing give **5 inflation breaths** 4. **Reassess** chest movements 5. If the heart rate is **not improving** and **_\<60bpm_** start **_compressions and ventilation breaths at a rate of 3:1_**
32
Head lice
* pediculosis capitis * Diagnosis = Fine-tooth combing of hair * Treatment = ONLY if living lice are found * 1st line = Malathion * Household doesn't need Tx unless they are also affected
33
Stress Incontinence
1. Pelvic floor exercises Medical = **Duloxetine** Surgical = **Retropubic mid-urethral tape procedures**
34
Urge incontinence
1. **Bladder retraining** 2. Anti-muscarinics: **Oxybutynin**, Tolterodine, Darifenacin IN FRAIL ELDERLY WOMEN: **Mirabegron** (Beta-3 agonist)
35
Retinoblastoma
Autosomal dominant Sx: Absence of red reflex, strabismus, visual problems \>90% survive into adulthood
36
A mother brings her 5-week-old newborn baby to see you. She reports that she has noticed that his belly button is always wet and leaks out yellow fluid. On examination, you note a small, red growth of tissue in the centre of the umbilicus, covered with clear mucus. The child is otherwise well, apyrexial and developing normally.
**Umbilical granuloma** **O**vergrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the **first few weeks of life**.
37
Immunisation schedule at 12 months?
Hib/Men C + Men B + MMR + PCV
38
When is Men B vaccine given?
2, 4, 12 months
39
Neonatal blood spot screening (heel prick)
At 5-9 days of life * congenital hypothyroidism * cystic fibrosis * sickle cell * phenylketonuria * medium chain acyl-CoA dehydrogenase deficiency (MCADD) * maple syrup urine disease (MSUD) * isovaleric acidaemia (IVA) * glutaric aciduria type 1 (GA1) * homocystinuria (pyridoxine unresponsive) (HCU)
40
Phimosis Mx?
\<2yo = NORMAL i.e. Review at 2yrs if present
41
Pathological CTG findings
**Late decelerations** = doesn't return to normal until 30s after end of contraction. Indicates **_foetal distress_**. Need **_foetal blood sampling_** **Variable decelerations = _?Cord compression_** Early deceleration = Innocuous, indicates head compression **Bradycardia (\<100)** = **Maternal b-blocker use**, increased foetal vagal tone **Tachycardia (\>160)** = **Maternal fever**, **chorioamnionitis**, hypoxia, premature Loss of baseline variability (\<5) = Prematurity, hypoxia
42
Endometriosis diagnosis and management?
Dx = Laparoscopy Mx: 1. NSAIDS ± paracetamol (1st line) 2. COCP 3. GnRH analogues - 'pseudomenopause' Fertility is an issue -\> SURGERY (e.g. laparoscopic excision)
43
Placental abruption RFs mnemonic
ABRUPTION Abruption (previous) BP (HTN, pre-eclampsia) Ruptured membranes (premature/prolonged) Uterine injury (Trauma) Polyhydramnios Twins (multiple pregnancy) Infection (chorioamnionitis) Old age \>35 Narcotics (**_COCAINE_**, speed, smoking)
44
Pregnant woman with BP \>160/110. No proteinuria
IMMEDIATE assessment + ADMIT
45
Precocious puberty + small testes in a boy is likely to be?
Adrenal cause - tumour or **Adrenal hyperplasia**
46
Precocious puberty + enlarged testes?
Bilateral = Gonadotrophin dependent (LH/FSH) Unilateral = Gonadal tumour
47
Cause of precocious puberty in girls?
McCune Albright syndrome
48
Undescended testicle Mx?
Unilateral = **Review/refer at 3m**, ideally seen by surgeon before 6m. Orchidoplexy around 1yo Bilateral = **Paediatric review within 24hrs**, may need urgent endo/genetic investigation
49
Placental abruption mx?
Fetus alive \<36wks: * Fetal distress = Immediate C-section * No distress = steroids Fetus alive \>36wks * Fetal distress = Immediate C-section * No distress = Vaginal delivery Fetus dead = Induce vaginal delivery
50
Important NICE paediatric red flags
* Pale, mottled, cyanotic * Appearing unwell to paediatric healthcare professional * High-pitched/weak cry * Grunting * **RR \>60** * Reduced skin turgor * **Age \<3m with temp. ≥38**
51
When can you do expectant Mx for ectopic?
* **Unruptured** embryo (no Sx of pain/bleeding) * **\<35mm** in size * **NO fetal heartbeat** * **Asymptomatic** * **B-hCG \<1,000 and declining**
52
Endometritis Mx?
Puerperal pyrexia = \>38C in the first 14 days post-partum ## Footnote **ADMIT + IV Clindamycin + gentamicin**
53
Causes of meconium ileus?
* Hirschprung's * Cystic Fibrosis
54
Causes of bilious vomiting in neonate?
* **Very premature** baby (*At least* \<37wks or 3wks before EDD) with **Fever + abdo distension** = **NEC** * **\<6hrs** after birth = Duodenal atresia (Abdo XR -\> "double bubble") * **\<24hrs** = Jejunal/ileal atresia * **1-2 days** = Meconium ileus (think **_Cystic fibrosis or Hirschprung's_**) * **3-7 days** = Malrotation/volvulus (**_Urgent_ Upper GI contrast** + USS)
55
How long can urine pregnancy test be positive for after TOP?
**4 weeks** \>4 weeks indicates **incomplete** TOP or **persistent trophoblast**
56
What factor is associated with decreased incidence of hyperemesis?
Smoking
57
RFs for hyperemesis?
* multiple pregnancies * trophoblastic disease * hyperthyroidism * nulliparity * obesity
58
Hyperemesis Mx?
1. **Anti-histamine** - **Cyclizine or Promethazine** PO 2. **Anti-emetic - Ondansetron or Metoclopromide** PO * Ondansetron = Small risk of **_cleft lip/palate in 1st trim_** * Metoclopramide = Risk of **_EPSEs_**. **_Do not use \>5 days_** ADMIT if: * Continued N+V and is **_unable to keep down liquids or oral antiemetics_** * Continued N+V with **_ketonuria and/or \>5% weight loss_** despite **anti-emetics** * A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)​
59
Seborrhoeic dermatitis
1st line = Regular washing w/ baby shampoo ± emulsifying ointment 2nd line = Topical imidazole cream (e.g. clotrimazole) 3rd line = Mild topical steroids (1% hydrocortisone)
60
Nappy rash
Irritant = spares skin folds Candida = Satellite spots / superficial pustules Seborrheic = cradle cap, skin folds, bilateral salmon pink patches Management * Asymptomatic = **Zinc & Castor oil ointment** barrier preparation * Discomfort + \>1m old = **Hydrocortisone 1%** * **Candidal = Topical imidazole** * **Bacterial = oral fluclox**

Y5: Paediatrics (6 decks)

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