Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Revision > Flashcards

Revision Flashcards

1
Q

Define preterm

A

Prior to 37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define very pre-term

A

Prior to 32 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define extremely pre-term

A

Prior to 28 weeks

Fetus only viable from 23/24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define low birth weight

A

<2500g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define very low birth weight

A

<1501 G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define extremely low birth weight baby

A

<1001g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does small for gestational dates mean?

A

<10th centile for expected weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does large for gestational dates mean?

A

> 90 th centile for expected weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What proportion of births are at term?

A

94%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RF for pre-term birth?

A

1) Multiple pregnancy
2) Infection
3) Fetal abnormality
4) Smoking/ drugs/ alcohol
5) Chronic disease e.g. HT, DM etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of pre-term baby at birth?

A

1) Pause for 1 min before cord clamping to allow transfusion
2) Keep Warm
3) Manage airway/ breathing e.g. suction, inflation breaths etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the common concerns in pre-term babies?

A

1) Temperature regulation - high surface area to body mass and little fat/ activity
2) Breathing - surfactant etc
3) Hypoglycaemia
4) Jaundice
5) Problems of prematurity e.g. PDA, IVH, necrotising entercolitis etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is gestational correction for a baby born at 30 weeks?

A

Gestational correction = 40- gestational age = 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How long do you continue using gestational correction for in premature babies?

A

Born 32-36 week = 1 year

Born < 32 = 2 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Organisms most likely to cause infection in a neonate?

A

1) Group B strep

2) Gram -ve e.g. e.coli and Klebsiella
3) Gram +ve e.g. coagulate negative staph, SA etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the major cause of death in prematurity?

A

RDS

Affects 75% of babies born <29 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 5 features of respiratory distress syndrome?

A

1) Cyanosis
2) Tachypnoea
3) Intercostal recession
4) Grunting
5) Nasal flaring

Normal course is worsening until 2-4 days then gradual improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In a premature neonate, why do we aim for sats of 85-93%?

A

Persistent, high oxygen levels can lead to retinal damage - retinopathy of prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The best way to prevent RDS is to give a steroid to pregnant women at high risk of RDS. WHen should this be given?

A

From 23-24 weeks to women who are at high risk of premature brith / in established labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the differential of respiratory distress in a premature neonate?

A

1) RDS
2) TTN
3) Meconium aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The fetus has 2 umbilical arteries (deoxygenated blood) and 1 umbilical veins (oxygenated blood). What does the ductus arteriosus do?

A

It is a connection between the arch of the aorta and pulmonary artery which allows the lungs to be bypassed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does the ductus venosus do?

A

A connection between the umbilical vein (oxygenated blood) and IVC to allow oxygenated blood to bypass the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Features suggestive of a PDA?

A

Machine like murmur
FTT
CCF
Pneumonia’s

Dexamethasone in pre-term labour or ibuprofen/ indamethacin after birth can encourage closing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is IVH? What are the major risk factors?

A

A bleed that begins in the germinal matrix which can progress to an intraventricular bleed

Prematurity and RDS are the major risks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What must be considered in a pre-term infant who deteriorates rapidly after birth?

A

IVH
US should be done on all neonates so it is not missed

Remember up to 50% are clinically silent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is pneumatosis intestinalis diagnostic of?

A

Necrotising entercolitis - a life threatening inflammatory bowel necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Features of necrotising enterocolitis?

A

Abdominal distension
Lethargy
Bloody stool
Bradycardia, apnoea etc

Must liase with surgeons ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Management of necrotizing entercolitis?

A 
Stop oral feeding
Stool culture
Give ABx
Crossmatch
Eagerly surgical involvement e.g. avoid perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Haemorrhaging disease of the newborn?

A

Vit K deficiency leads to impaired clotting due to action of 11, V11, 1X and X

Easing bruising/ bleeding

Treat with Vit K supplementation -often given prophylactically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the weight classification for an overweight and obese child?

A

Use growth chart to plot BMI

Overweight >91st centile
Obese > 98th centils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

GIve a few bits of advice to a parent whose 8 year old is obese

A

1) At least 1 hr physical activity/ day
2) MAX 2 hours screen time / day
3) Balanced meals
4) Set an example

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What can a 6 week old baby do?

A

1) Vertical head control (GM)
2) Social smile (S)
3) Still to voice (L)
4) Follow torch with eyes (FM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What can a 3 month old do?

A

1) Head control (GM)
2) Hands in midline (FM)
3) Laughs (L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What can a 6 month old do?

A

1) Roll over (GM)
2) Palmar grasp/ objects from hand to hand (FM)
3) Babbles (L)
4) Still OK around strangers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can a 9 month old baby do?

A

1) Sit unaided, stands holding furniture (GM)
2) Points with indies finger (FM)
3) Imitates sounds (L)
4) Anxious around strangers, plays peek a boo (S)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What can a 12 month old baby do?

A

1) Cruises round furniture/ first steps (GM)
2) Good fine pincer grip (FM)
3) Knows and responds to name (L)
4) Waves bye-bye / drinks from cup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What can an 18 month old baby do?

A

1) Run/ climb on adult chair (GM)
2) Hand preference, 3 block tower (FM)
3) Knows 5-20 words, points to body parts (L)
4) Social play e.g. feeding teddy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How many bricks can a 2 and 3 year old build in a tower?

A 
2 = 6-7
3 = 9-10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When can a child climb stairs?

A

Age 2 = 2 feet per tread

Age 3 = alternate feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What primitive reflexes should all babies have?

A

Sucking and grasping
Moro - abduction and extension of arms with opening of hands on rapid neck movement (should be present up to 3-4 months old)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When would you expect a child to be toilet trained>

A

Around 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the 3 types of abnormal development?

A

1) Delay - global or specific
2) Deviation e.g. ASD
3) Regression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

List some important red flags for abnormal development

A

1) No social smile by 6 weeks
2) Not reaching for objects by 6 months
3) No sitting unsupported by 12 months
4) Not walking/ talking by 18 months
5) Any asymmetry in movement
6) Any regression
7) Any concern RE hearing or vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the features of ASD?

A

1) Impaired communication
2) Impaired social interaction e.g. don’t understand that conversation is reciprocal
3) Reduced flexibility of though/ imagination
4) Restricted interests
5) Sensory difficulties
6) Obsession with routine

The CHAT screening tool can be used to identify children with autism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Normal respiratory rate in a baby <1

A

30-40 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Normal resp rate in a child aged 5-12

A

20-25 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Normal resp rate in a child aged 1-2

A

25 -35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Name some live vaccines

A

These are attenuated organisms which replicate in host

E.g. polio, MMR, rotavirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Name some inactivated vaccine

A

These are either killed or its only a sub-unit e.g. pertussis, diphtheria and tetanus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are CI to vaccination

A

1) Analphylaxis reaction to same antigen/ vaccine
2) Live vaccine = immunosupression or pregnancy
3) Egg allergy
4) Acute illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Average HR, RR and BP for an infant <1

A 
HR = 110-160
RR = 30-40
BP = 70-90 systolic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

When considering ABC in a child you must think about effort, effect and efficacy. Signs of increased work of breathing?

A 
Use of accessory muscles
Sternal recession
Grunting
Nasal flaring
Tachypnoea
Sounds - stridor
Sitting up - tripod pose etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Stridor is inspiratory noise (harsh, musical noise due to upper airway obstruction e.g. supraglottis)

A

Wheeze is expiration noise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How do you check the efficacy and effect of breathing in a child?

A

Chest expansion
Breath sounds
Sats

Heart rate
Colour
Mental State

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Assessment of circulation in a sick child

A

Pulse
Cap refill
T
BP (if going down that is pre-terminal- kids are adaptive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

You are asked to see a child with breathing difficulty. What are you going to comment on?

A

1) Colour and posture
2) Use of accessory muscles
3) Nasal flaring
4) Sternal recession
5) Resp rate
6) Grunting
7) Then you will percuss and Auscultate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is stertor?

A

Inspiratory noise that suggests pharyngeal obstruction e.g. tonsils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Essential questions in all paediatric history other than presenting complaint etc

A

1) Pregnacy and birth - term, mode, SCBU etc AND breast/ bottle
2) Immunisations
3) Development milestones
4) Social - family unit,smoking, pets etc is important in a respiratory history, also how school and nursery is going

Maybe ask to see red book as this cab give lots of useful info

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Differential diagnosis for a 2 year old with acute onset stridor

A

1) Croup - parainfluenza and barking cough
2) Epiglottis (drooling)
3) Inhaled foreign body
4) Anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Management of acute severe stridor

A

1) Keep everyone calm
2) O2 mask
3) Get help - ‘critical airway’
4) Call anaesthetist for intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Differential of persistent stridor in children

A

Laryngomalacia
Vocal cord palsy
Laryngeal cyst/ cleft
Sub-glottis problem e.g cyst or haemangioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Mum brings in child with concern about wheeze. What do you need to ask?

What is the differential?

A

Onset, duration, triggers
Ask specifically about weather, exercise, cold, other features, exposure to smoke

1) Asthma
2) Bronchiolits
3) Allergy
4) Chronic Lung disease/ CF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is a reflex anoxic seizure?

A

A form of syncope
Young children have a seizure precipitated by pain or fear
Full recovery will occur spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Young child with several month history of extreme coughing. After coughing attacks she is often sick?

A

Whooping cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Cough with monophonic wheeze

A

Inhaled foreign body - commonly in right lower lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Causative organism in bronchiolits?

A

RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Young baby with FTT, poor feeding and ‘blowing bubbles’ when he coughs

A

Tracheo-Oesophageal fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Commonest cause of an ulcer on the ileum?

A

Meckel’s Diverticulum
Persistence of Vitelline duct
Ectopic gastric mucosa can ulcerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the triad of symptoms associated with HUS?

A

Haemolytic anaemia
Thrombocytopenia
Acute renal failure

Follows profuse diarrhoea and E.coli 0157

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Managment of enuresis

A

1) If primary and young child = reassure
2) Reduce fluid intake after 4pm
3) Bed-wetting alarm
4) Desmopressin - good for short term control e.g. camping trip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Blue discolouration on the back of a newborn

A

Mongolian blue spot = harmless, congenital condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Child with purpura, arthralgial GI signs and glomerulonephritis

A

HSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Where is McBurney’s point? What does tenderness show?

A

1/3 of the way between ASIS and umbilicus

Tenderness shows appendicits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Kid with bleeding tendency. Normal Bleeding time, PT time and prolonged APTT

A

Haemophila A

Most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Kid with bleeding tendency. Prolonged bleeding time and APTT. Normal PT.

A

Von-Willebrand’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Based on blood tests, how would you differentiate between haemophila and VWD

A 
Haemophilia = normal bleeding time
VWD = prolonged bleeding time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Overweight male child with hip pain?

A

SUFE
Slipped femoral epiphysis
Internal rotation is very limited and painful
Femoral head is displaced posterior-inferiorly
Treatment is surgical

Remember it is movement at the growth plate
If unstable, the patient can not walk and there is increased risk of AVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the big risk with extremely high/ untreated neonatal jaundice?

A

Kernicterus = a form of irreversible brain damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Visible jaundice at birth is always abnormal

A

Jaundice which occurs 24 hr after birth is common and usually physiological e.g. due to liver immaturity, lack of gut flora and short RBC life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Presence of reducing agents in urine

A

Galactosaemia (Lack of enzyme which means they struggle to break down galactose. Presents with lethargy, diarrhoea and jaundice in neonates or picked up by the heel prick test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Auer rods

A

Acute myeloid leukaemia

Associated with trisomy 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Idiopathic pulmonary haemosiderosis

A

Alveolar capillary bleeding + acculturation of haemosiderin in lungs —> triad of dyspnoea, IDA and haemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Abdo pain, vomiting and mild fever in child…

A

Appendicits until proven otherwise

Admit, NBM, IVI and monitor regularly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Presentation of croup

A

Stridor, barking cough, hoarseness (parainfluenza)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Management of croup

A

Mild/ Moderate = steroids e.g. dexamethsone 0.15mg/kg PO

Severe = admit, nebulised adrenaline (5ml of 1 in 1000) , consider ventilation

86
Q

Signs of severe croup

A 
Sternal recession
Cyanosis
Rising RR/ HR
Reduced conscious level
Exhaustion
87
Q

How do you investigate and manage diphtheria

A

Swab the material on the pseudo membrane for PCR

Diptheria anti-toxin and erythromycin

88
Q

Remember babies <6 months are most likely to have bronchiolotis

A

Children 6 months to 6 years are most likely to have croup

89
Q

A baby has bronchiolitis. What are the indications for admission

A 
Poor feeding
Dehydration
Apnoea
RR >50 (normal is 30-40bpm for a <1 year old) 
Parental/ child exhaustion
90
Q

Which 2 bugs are very much associated with CF?

A

Pseudomonas aeruginosa

Burkholderia cepacia

91
Q

Talk about some managment issues with CF

A

1) Respiratory - physio, treat infections aggressively
2) Steatorrhoea - enzymes to overcome pancreatic dysfunction
3) Increased energy requirement - due to chronic lung inflammation and poor absorption
4) Other complications —> DM, cirrhosis and infertility
5) Life expectancy may be into 50’s

92
Q

Asthma = reversible airway obstruction +/- dyspnoea, wheeze or cough

A

Don’t forget to ask:

  • Family/ personal history of atrophy
  • Smoking
  • exercise
  • diurnal variation
  • pets
  • does it affect sleep
93
Q

Features of severe asthma in a child

A

1) Tachypnoea - >40 if under 5, >30 if 5-12 and > 25 if over 12
2) Tachycardia - >140 if under 5, > 125 if 5-12 and > 110 if over 12
3) Unable to talk/ feed
4) Peak flow - <50% if 5-12, <33% if >12

94
Q

Features of life threatening asthma

A

1) Silent chest
2) PEFR <33% of predicted
3) Reduced GCS
4) Cyanosis

95
Q

Inhaler of choice in a 6 year old child

A

All children <8 should use a:

Pressurised metered dose inhaler with spacer

96
Q

What are the stages of treatment of asthma in children?`

A

1) SABA - inhaled metered dose + spacer —> increase if using >3 times per week
2) + an ICS e.g. beclometasone (Clenil Modulite)
3) if still not well controlled :
- <5 = oral montelukast before bed
- > 5 = inhaled salmeterol (if ineffective then consider increasing ICS, or adding montelukast
4) Refer to specialist
5) Don’t forget that a course of oral prednisolone can be prescribed at any stage

97
Q

In a child with diarrhoea what is your differential?

A

1) Gastroenteritis - viral or bacterial

2) Malaborption - CF, coeliac etc

98
Q

Management of GORD in an infant

A

1) Reassure - once you have excluded anything serious
2) Try Gaviscon
3) + ranitidine if gaviscon ineffective
4) Consider milk protein intolerance

99
Q

What is the genetic mutation in coeliac disease?

A

HLA DQ2 or

HLA DQ8

100
Q

Histology of coeliac disease

A

Lymphocytic infiltration
Crypt hyperplasia
Villous atrophy

101
Q

Which 2 antibodies are associated with coeliac disease?

A

TTG

Anti-endometrial

102
Q

List some complications of coeliac disease

A

Osteoporosis
T-cell lymphoma
Anaemia

103
Q

Which non-invasive test can be used to distinguish between IBD and Crohn’s disease?

A

Stool calprotectin

It is a substance released by the bowel during inflammation e.g. it will not be present in IBS

104
Q

List some components of the criteria for functional constipation?

A

1) <3 bowel movement/ week
2) at least 1 episode per week of soiling
3) Large diameter e.g. block toilet
4) History of stool retention/ hard stools
5) Large mass in rectum

105
Q

What is recurrent rectal prolapse a sign of?

A

CF

106
Q

Baby with explosive passing of stools after PR exam?

A

Hirschprung disease

107
Q

How do you treat constipation in children?

A

Reassure
Increase fluid and fibre intake
Softener = movicol or lactulose

108
Q

What must be excluded in a child presenting at 6-8 weeks with projectile vomiting?

A

Pyloric stenosis - examination and US

109
Q

12 month old baby with colicky pain and red currant stools?

A

Intussuception until proven otherwise
US is best imaging
Most can be treated with rectal air, otherwise surgery is required

110
Q

New baby with bilious vomit

A

Must exclude gut malrotation

Treatment is surgical

111
Q

How do you make oral rehydration solutions?

A

6 spoons of sugar and 6 of salt in 1L of water

112
Q

Where are iron, folate and B12 absorbed?

A 
Iron = duodenum
Folate = jejunum
B12 = terminal ileum
113
Q

What must be considered in a baby who has not passed meconium in the first 24 hours?

A

Hirschsprung disease

114
Q

Red flags for injury e.g. ?NAI

A

1) Not in-keeping with child development
2) Soft tissue e.g. not bony prominence
3) Genitals, ears, mouth etc
4) Specific pattern or markings
5) Delayed presentation
6) Insufficient/ changing history
7) Fractures of different ages and location

115
Q

If any concern for NAI it is vitally important to document EVERYTHING in the notes - clearly and precisely

A

Remember to distinguish between fact and opinion

The fact is that he has extensive bruising on his torso, my opinion is that these are not accidental injuries

116
Q

Which medical conditions COULD present as NAI?

A

Osteogenesis imperfecta - frequent fractures and blue sclera
Rickets
Bleeding disorders

Osteoporosis of prematurity

Menke’s disease - copper disorder

117
Q

Process if concerned about NAI

A

1) Consult with patient and document everything
2) Speak to senior
3) There is a child protection page on Staffnet - use that to work out who to contact
4) Explain what you are going to do
5) Arrange investigations - CT, bloods etc

118
Q

In a neonate where should the tip of an ET tube be

A

2cm above the carina at about D2/3

119
Q

Define febrile convulsion

A

Seizure in a child > 1 month of age associated with a febrile illness (not CNS) without previous unprovoked seizure

Peak incidence at 18 months

120
Q

What makes a febrile convulsion complex?

A

1) Focal onset
2) Recurrent seizure in same febrile illness
3) Status epilepticus (30 min)
4) >10 minutes of seizure

121
Q

FH is very important when taking a history about suspected febrile convulsion

A

Risk is 1 in 5 if sibling affected and 1 in 3 if parent and sibling affected

122
Q

Features making CNS infection more likely than febrile convulsion

A

1) Incomplete immunisation
2) Physical signs of meningitis e.g. photophobia
3) Hx of irritability, lethargy etc
4) drowsiness/ prolonged post-octal state

123
Q

Risk of repeat febrile seizure?

A 
About 1 in 30 children will have febrile convulsion 
Risk is increased by:
- young age of onset
- low fever
- multiple seizure 
- family history
124
Q

Will my child develop epilepsy after febrile convulsion?

A

Most will not - only 2% with simple seizure and 8% with complex seizure

Increased risk (>50%) if FH of epilepsy, complex seizures and neurodevelopmental difficulties

125
Q

Seizure first aid

A

1) Protect them e.g. move away from a danger
2) nothing in mouth
3) check breathing after stop
4) put in recovery position
5) >5 min = rescue drugs (buccal midazolam)
6) Attend training/ get advice from nurse specialists at seizure clinica

126
Q

Fluid bolus in paediatrics

A

20 ml/ kg

127
Q

What is the classic triad of Guillain- Barre?

A

Progressive ascending paralysis
Reduced/ absent deep tendon reflex
No sensory loss

128
Q

Miller fisher syndrome

A

Like Guillain-Barre but with cranial nerve signs e.g. opthalmoplegia

129
Q

Differential diagnosis of acute flaccid paralysis in a child

A

Guillain Barre

Spinal cord lesion e.g. SOL, demyelinating lesion, transfer myelitis

130
Q

How will you diagnose Guillain Barre?

A

1) Clinical suspicion - progressive motor weakness + absent deep tendon reflexes + no sensory loss

131
Q

What do you do if GCS <9?

A

Clear airway and incubate immediately

132
Q

CI to LP?

A 
Signs of raised ICP
GCS<8 or deteriorating
Focal neurological signs
Imaging suggests SOL
Septic shock/ overlying infection
133
Q

What is the 4:2: 1 rule for fluid maintenance?

A

4 ml/kg/ hr for 1st 10 kg
2ml/kg/hr for next 10 kg
1ml/kg / hr for rest of weright

134
Q

Talk through the grading of APGAR?

A

Measured at 1, 5 and 10 minutes

A = appearance (blue/pale > blue extremity > pink)
P = pulse (none > <100, >100
G = grimace (none >some flexion > cries/withdraws)
A = activity (none >limited flexion > spontaneous
R = respiration (none > weak cry > good cry
135
Q

What is persistent pulmonary hypertension of the newborn?

A
  • failure of adaptation —> pulmonary hypertension due to failure of normal blood vessel dilatation
  • presents with hypoxia due to left-right shunt
  • Treatment is supportive with O2 and nitric oxide which helps the vessels dilate
136
Q

What secretes surfactant?

A

Type 2 pneumocystis

137
Q

Baby CXR with ‘ground glass appearance and air bronchogram…

A

RDS

138
Q

PDA is a non-cyanotic murmur. Why?

A

Oxygenated blood from the lungs is shunted back to the lungs via the PDA rather than to the rest of the body

If the pressure changes (eisenmunger’s phenomenon) and the shunt reverses then they can become blue as deoxygenated blood is now being pumped around

139
Q

How do we close a PDA?

A

Detect if continuous murmur and FTT

Close with indamethicin (prostaglandin inhibitor)

140
Q

Differential for baby jaundice at 12 hours

A
  • haemolytic disease of newborn (Rh and ABO incompatibility)
  • G6PD
  • hereditary spherocytosis
  • infection

(remember between 2 days and 2 weeks the commonest cause is physiological jaundice)

141
Q

What causes physiological jaundice of the newborn?

A

1) Fetal RBC are being broken down —> increased unconjugated bilirubin
2) Not enough enzyme in liver cells to conjugate the bilirubin —> excess leaks into blood
3) phototherapy changes the shape of the unconjugated bilirubin to make it more water soluble —> peed out

142
Q

Why is Crigler-Najjar syndrome usually fatal?

A

The enzyme which conjugates bilirubin is absent —> really high levels of unconjugated bilirubin

This is deposited in the brain (kernicterus)

143
Q

Give a few causes of jaundice (2-14 days)

A

Unconjugated - physiological/ breast mil, UTI, hypothyroid

Conjugated = neonatal hepatitis, biliary atresia

144
Q

Kernicterus

A

Accumulation of excess unconjugated bilirubin in the basal ganglia —> cerebral palsy and sensorineural hearing loss

(remember treatment for neonatal jaundice includes phototherapy and exchange transfusion)

145
Q

What is the difference between an omphalocoele and gastroschisis/

A

Omphalocoele = herniation of abdo contents through umbilicus - covered by membranous sac (associated with trisomy 13,18 and 21)

Gastroschisis = herniation through abdo wall - not covered by membrane —> risk of heat and fluid loss

146
Q

Which congenital defect is most associated with polyhydramnios?

A

Oesophageal atresia - the fetus is unable to swallow amniotic fluid

147
Q

Erb = waiters palsy = C5/6

A

Klemperer = claw = C8/T1

148
Q

Which 1 investigation should be done in all children with a fever?

A

Urine dip

149
Q

HIGH risk if aged 0-3 months and temp >38

A

HIGH risk if aged 3-6 months and temp >39

150
Q

Diagnosis in an unwell child with conjunctivitis and limbus sparing?

A

Kawasaki disease

Medium vessel vasculitis which usually affects boys under 5

151
Q

What is the main complication of Kawasaki disease?

A

Vasculitis in the coronary arteries —> fibrosis and aneurysm

Also risk of thrombosis and Ischaemia

152
Q

Why do we not give aspirin to children?

A

Risk of reye syndrome —> encephalopathy and liver injury

Aspirin is given in Kawasaki’s disease

153
Q

What are the features of Kawasaki’s disease?

A

CRASH and burn

Conjunctivitis
Rash - all over body
A adenoathy (cervical lymph nodes)
S strawberry tongue
H hand and feet swelling

Burn = fever for 5 days

Treated with IVIG and aspirin, remember that serial Echos are required due to risk of heart complications

154
Q

Risk of epilepsy doubles for children who have had a febrile convulsion

A

From 1 in 100 to 1 in 200

155
Q

What is an encephalocoele?

A

A neural tube defect where the brain extrudes through the midline due to a skull defect

156
Q

What is the difference between a myelomeningocoele and a meningocoele?

A

Myelomeningocoele = abnormal spinal cord with visible defect

Meningocoele = normal spinal cord with defect covered in skin

157
Q

Give some causes of comminicating and non-communicating hydrocephalus?

A

Communicating = too much CSF or failure to resorb e.g. infection, bleed for CSF producing tumour

Non communicating = obstruction to flow e.g. tumour W

158
Q

What is setting sun sign?

A

The downward deviation of a child’s eyes due to increased ICP

159
Q

Child with railroad track calcification on CT brain

A

Tuberous sclerosis

The prognosis is very poor with most dying by age 25 from epilepsy

160
Q

What is ataxia telangiectasia?

A
  • autosomal recessive neurodegenerative disorder of DNA repair
    —> poor co-ordination and telangiectasia
  • thymus is affected —> immunodeficiency is a feature

Most die in 20s due to immunodeficiency

ALL is very common

161
Q

What is the mutation in Duchennes?

A

Mutation in Xp21 —> abnormal dystrophin

162
Q

Which child infection causes a synticia?

A

RSV - causes multiple bronchiole cells to joint together to form one large multi-uncleared cell W

163
Q

What is palivizumab used for?

A

Monoclonal antibodies administered to high risk children e.g. chronic lung disease to prevent RSV and bronchiolitis

164
Q

Rather than thinking ‘it’s croup’ think its viral laryngotracheal infection

A

Remember to ask if the stridor is worse on exertion and try not to upset the child

Dexamethasone +/- nebulised adrenaline

Dexamethasone is 150micrograms/ kg PO for 1st dose (GP) then subsequent doses can be given in hospital IF required

165
Q

Remember that a cough is NOT a feature of epiglotitis

A

MUST ask about vaccinations

166
Q

How can mucus plugs cause hyperinflation?

A

Mucus plugs can act as a valve —> allowing air in BUT not allowing air out

Alveoli fill with air and the chest becomes hyperinflated

167
Q

Most likely diagnosis in a ventilated patient with a right sided pneumonia?

A

Probably aspiration pneumonia

168
Q

What is the commonest cause of a mediastinal mass in children?

A

Lymphoma

169
Q

What is the most common mutation in CF?

A

A deletion in F508 gene on the long arm of chromosome 7

1 in 25 is carrier

Elevated Na in sweat test

170
Q

The aim of treatment of CF is to prevent and treat lung infections and maintain lung function. Other than physio, what medications are used?

A

Mucolytic e.g. dornase Alfa or hypertonic NaCl

Flucloxacillin is used for prophylaxis in children over 3

171
Q

Metabolic consequences of SEVERE pyloric stenosis?

A

Hypochloraemic hypokalaemic metabolic acidosis

172
Q

List the 3 grains which contain glutuen?

A

1) Wheat
2) Rye
3) Barley

Oats do not contain glutuen but are usually contaminated during processing

173
Q

Don’t forget abdominal migraine is an important cause of episodic abdominal pain in children

A

It presents often without a headache but other features such as cyclical vomiting may exist

Totally well with normal physical examination between episodes

174
Q

Meconium is the delayed passage of meconium (after 24 hours). What is the important cause?

A

Hirschprung’s disease

Need to do a biopsy

175
Q

Remember that intestinal malrotation itself probably will not cause any problems

A

It’s the complications of volvulus —> acute Bowen obstruction that is bad

176
Q

A radioisotope scan will show normal uptake by the liver but no excretion in BILIARY ATRESIA. What is the treatment?

A

Kasai procedure

(Hepatoportoenterostomy - done within 8 weeks of life)

A liver transplant may be required down the line

177
Q

A child in a developing country develops cataracts in infancy and shows arrested physical development. What is the most likely diagnosis?

A

Galactosemia - the GALT enzyme is absent/ faulty —> babies cannot convert galactose to glucose

It is inherited autosoomal recessive and is detected by the heal prick test in the UK

Normal at birth > jaundice, liver enlargement and growth failure

Treatment is simple - avoid all milk products

178
Q

All UTI in children <6 months requires investigation

A

Renal USS is used for structural abnormalities

Micuturating cysturogram = vesicles-ureteric reflux

Radionucleotide scan = renal scarring

179
Q

Foramen ovale connects RA and LA

A

Ductus arteriosus connects arch of aorta and pulmonary artery

180
Q

Child with hypertension in arms but not legs?

A

Probably co-arctation of the aorta

Associated with Turners syndrome and rib notching

181
Q

What is the tetralaogy of fallout?

A

Pulmonary stenosis (RV outflow obstruction)
Over-riding aorta
Septal defects (VSD)
Hypertrophy (RVH)

182
Q

What are the cyanotic heart defects?

A

1) Tetrology of Fallot
2) Transposition of the great arteries

(all the others e.g. VSD, ASD etc are non-cyanotic)

183
Q

Most likely diagnosis in a baby with cyanotic spells. There is RAD and RV hypertrophy on ECG

A

Most likely tetralogy of Fallot

Treat with O2, morphine and propranolol acutely. Surgery at 6 months

(Remember it is associated with DiGeorge syndrome)

184
Q

Why might prostaglandins be given to babies with transposition of the great arteries?

A

1) 2 separate circuits are created when the aorta comes out the RV and pulmonary artery comes out the LV
2) If the ductus arteriosus stays open then there is some mixing of the 2 circuits - the baby will not die immediately
3) Prostaglandins help keep the ductus arteriosus open

185
Q

The heart of a baby looks like an ‘egg on its side’ on a CXR. What is the diagnosis?

A

1) Transposition of the great arteries

2) due to RVH and LV atrophy

186
Q

Pathology shows Ashcoff bodies with characteristic Anitschkow cells…

A

Rheumatic fever

(anitschkow cells look like caterpillars)

Remember rheumatic fever causes Pancarditis, polyarthritis, subcutaneous nodules, erythema marginatum and syndenham chorea - these symptoms occur several weeks after a sore throat

187
Q

The Jones criteria is used for the diagnosis of …

A

Rheumatic fever

remember it is the mitral valve which is most commonly affected

188
Q

Neuroblastoma is cancer of the neural crest cells (sympathetic chain and adrenal medulla)

A

Neuroblastoma is commonest in children <5

The symptoms depend on chemokine release —> fever, weight loss, sweating and fatigue

Other features depend on location of tumour e.g. SOB, spinal cord compression, abdo mass, Horners

1/2 of neuroblastoma mets to bone?

189
Q

Child aged 3 presents with fatigue, weight loss and raccoon eyes. What is your main concern?

A

Neuroblastoma

Important cause of periorbital ecchymosis/ raccoon eyes

Often spread to bones and can cause base of skull # —> blood and fluid around eyes —> eccymosis

190
Q

How does retinoblastoma present?

A

Absent red reflex
Squint
Visual symptoms

Remember that 45% are hereditary

191
Q

Give an example of a condition caused by a trinucleotide repeat?F

A

Fragile X

Huntington chorea

192
Q

Give 2 examples of imprinting disorders?

A

Prayer Willia

Angelman

193
Q

List some complications of Down’s syndrome?

A
  • hypothyroid
  • Alzheimer’s
  • Leukaemia (AML)
  • duodenal atresia
  • heart defects e.g. AVSD
  • coeliac disease

Life expectancy around 50

194
Q

Which condition does a child with Brushfield spots probable have?

A

Brushfield spots are small white/ grey spots found in the iris. They are found in Down syndrome

195
Q

Remember that girls with klinefelters syndrome have NORMAL IQ

A

They are often diagnosed at birth due to swelling of their hands and feet (due to lymphoedema)

196
Q

In a child with duodenal atresia, what condition should be considered/

A

Downs

20-40% of children with duodenal atresia have DS

197
Q

Child with wrist x-ray showing cupping, fraying of metaphyses and widened epiphyseal plate?

A

Probably rickets, their ALP is raised, with normal/ low calcium and LOW VIT D

Treat with vit D supplements

198
Q

Newborn with lethargy, jaundice at 3 weeks and an enlarged tongue?

A

Probably congenital hypothyroidism. It is normally caused by maldescent of the thyroid gland

Should be detected by neonatal screening

Lifelong levothryoxine

199
Q

Zone glomerulsa makes aldosterone

A

Zona fasciculata and glomerulosa makes cortisol and and androgens

Don’t forget that the medulla makes adrenaline and noradrenaline

200
Q

Remember that girls with CAH usually present with ambiguous genitalia

A

Boys normally present with salt wasting or early puberty

The treatment is predominantly with glucocorticoids and mineralocorticoids

Surgery for ambiguous genitalia - can also help to prevent UTI which is important

201
Q

When is puberty delayed?

A

Onset of puberty not present by:
14 in girls
16 in boys

202
Q

When is precocious puberty?

A

<8 in girls

<9 in girls

203
Q

Remember in child BLS, perform CPR for 1 minute BEFORE getting help

A

5 resume breaths are given before starting CPT

204
Q

Depth of chest compression in a child?

A

4cm for infant
5cm for child

15:2 at a rate of 100-120

205
Q

What is the key question when assessing a choking child?

A

Is the cough effective?

Yes = encourage cough
No:
Conscious = 5 back blows ans 5 thrusts (chest for infant, abdo if >1)
Unconscious = 5 breaths and CPR

206
Q

When are children measured via height and not length?

A

From age 2

207
Q

How is the length/ weight of a baby born premature plotted on a growth chart?

A

From 32-42 weeks, plot their weight on the premature section of the growth chart

After 42 weeks move onto the normal chart i.e age 0

208
Q

How do you plot the gestational age on a growth chart?

A

For children born at <37 weeks, Dot at the child’s actual height/ weight and age

Do a line of dots and arrows back to the child’s gestational age:

209
Q

How long should gestational correction be continued?

A

For 1 year in children born at >32 weeks

For 2 years in children born <32 weeks

210
Q

It is very common for babies to lose a bit of birthweight in the first few days/ weeks. 80% will have regained this in 2 weeks

A

Weight loss of >10% at any stage is suspicious and warrants further investigation

211
Q

At age 2, why do the centile lines move down slightly?

A

Children start having their height measured —> spine is squished a bit so they are not as tall as their length

Paediatrics (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions