Child Health Flashcards
1
Q
Live attenuated vaccines:
A
MMR
Rotavirus
BCG
Smallpox
2
Q
Inactivated vaccines: Polysachharides
A
Hib
Meningococcal
Pneumococcal
3
Q
Vaccines at 2 months
A
6 in 1
ORAL rotavirus
Men B
4
Q
What comprises the 6 in 1 vaccine:
A
Diptheria, tetanus, pertussis, polio , Haemophilus B, hepatitis B
5
Q
Vaccines at 3 months:
A
6 in 1
Oral rotavirus
PCV
6
Q
Vaccines at 4 months:
A
6 in 1
Men B
7
Q
Vaccines at 12-13 months:
A
Hib/Men C
MMR
PCV (pneumococcal conjugate)
Men B
8
Q
Vaccines at 2-8 years
A
Flu vaccine (annual)
9
Q
Vaccines at 3-4 years:
A
4 in 1 preschool booster (DTaP w/ MMR)
10
Q
Vaccines at 12-13 years:
A
HPV vaccination
11
Q
Vaccines at 13-18 years:
A
3 in 1 teenage booster (Diptheria Tetanus and POLIO)
Men ACWY
12
Q
Stimulants for growth:
Infant
Child
Pubertal
A
Nutrient and insulin led (0-3)
GH and Thyroxine led (3-12)
Sex steroid led (12-18)
13
Q
What weight loss is considered normal in new borns:
A
5-10% of body weight
14
Q
What deviation from line is considered normal regarding child’s height on graph:
A
+/- 2 standard deviations
15
Q
Puberty in girls: 3 stages
A
Thelarche - budding of breasts
Adrenarche - Development of body hair and odour
Menarche - menstruation
16
Q
How long after thelarche does menarche occur on average
A
2 years
17
Q
Benefits of breast feeding to baby:
A
Reduces lifetime risk of obesity, diabetes and atopy
18
Q
Breast feeding benefits to mother:
A
Improves bonding
Reduces risk of breast cancer
19
Q
Thrush of breast tx. mum and baby:
A
Maternal: topical meconazole or oral fluconazole
Baby if < 4 months: oral nystatin
Baby if > 4 months: Miconazole gel
20
Q
Developmental red flags:
what should occur by 10 weeks
A
smile
21
Q
Developmental red flags:
What should baby be able to do by 12 months
A
Sit unsupported
22
Q
Developmental red flags:
What should baby be doing by 18 months:
A
Walking
23
Q
When should baby be able to speak:
A
10 months
24
Q
Other red flags for developmental issues:
A
Asymmetry of movement
Concerns over vision and hearing
Loss of skills
25
Microcephaly
Micrognathia
Overlapping of fingers
Rocker bottom feet
Edward's syndrome (trisomy 18)
26
Cleft lip
Extra fingers
Microcephaly
Cyclopia
Patau syndrome (trisomy 13)
27
```
Long protruding ears
Long face
High arched palate
Flat feet
Hypermobility
```
Fragile X
Also MARCOorchidism
28
Abormal face
Cleft lip
HYPOCALCAEMIA
increased risk of schizophrenia
DiGeorge syndrome (22)
29
Duchenne muscular dystrophy inheritance
X-linked recessive (anomaly as most structural diseases are autosomal dominant)
30
Very high ___ (blood test) in DMD
CK
31
Croup causative organism
Parainfluenza virus
32
Time of year croup typically occurs:
Autumn
33
Croup: breathing in earlier stages
Intermittent loud, harsh stridor
worse when upset
34
Croup: cough
BARKING cough which is typically worse at night
35
Croup indicators of severe disease:
Agitation and restlessness
Sternal retractions
Constant stridor
Cyanosis
36
Croup Ix.
Dx. clinical
| AP neck x-ray may show 'steeple' sign on epiglottis
37
Croup mx.
ORAL dexamethasone single dose (0.15 mg/kg) for ALL children regardless of severity
38
Croup emergency treatment (severe)
Nebulised adrenaline
| High-flow oxygen
39
Epiglottitis: causative organism:
Haemophilus influenzae type B
40
Epiglottitis presentation:
```
SUDDEN on-set -> no prodrome
Drooling
Unable to swallow
Muffled voice
Adopts TRIPOD position
```
41
Epiglottitis Dx.
Direct visualisation from trained staff
| X-rays may be done if concern about foreign body
42
Epiglottitis - neck x-ray:
THUMB sign
43
Epiglottitis mx.
Immediate senior involvement
DO NOT examine the throat
Oxygen/IV antibiotics
44
Antibiotics of choice for epiglottitis:
IV CEFTRIAXONE
45
Bronchiolitis: typically seen in
Children < 1 years
46
Bronchiolitis causative organism:
Respiratory syncytial virus (RSV)
47
Bronchiolitis fx.:
Coryzal symptoms w/ mild fever: precede
Dry cough
Increasing breathlessness
wheezing and fine inspiratory crackles
48
Bronchiolitis consider referral if
RR >
difficulty w/
60
| Breastfeeding or inadequate oral intake
49
Bronchiolitis mx.
Supportive
| Humidified oxygen may be used if saturations are persistently < 92%
50
CAP non severe and < 1 yrs antibiotic
Co-amoxiclav
51
CAP non severe and > 1 yrs antibiotic
Amoxicillin
52
Whooping cough: causative organism
Bordatella Pertussis
53
Pertussis (whooping cough) px.
1-2 weeks of cold symptoms plus cough at night
Followed by 2-3 weeks of:
Paroxysms of COUGH -> fits
Inspiratory whoop
54
Pertussis other assoc. symptoms:
vomiting, cyanosis
55
Diagnosis of pertussis dx.
Nasal swab
| PCR and serology
56
Tx. Bordatella pertussis:
ORAL MACROLIDE (Clarithromycin, azithromycin)
57
Is whooping cough a notifiable disease:
YES Pertussis is a notifiable disease
58
Household contacts of pt. w/ whooping cough should receive:
Antibiotic prophylaxis
59
School exclusion: whooping cough
48 hours from commencing antibiotics
| or 21 days of no antibiotics
60
Pregnant women should be offered which two vaccines:
| When are they offered
Influenza
Pertussis (2012)
16-32 weeks gesation
61
What should all children w/ an exacerbation of asthma receive:
Bronchodilator therapy: b2 agonist
Steroid therapy for 3-5 days
(<2 yrs 10 mg, >2: 20 mg)
62
Secondary management of asthma (if no response to inhaled therapy)
IV salbutamol
Aminophyline (only if unresponsive to inhaled therapy)
IV MgSO4
63
When should antibiotics be considered in AOM:
<2 yrs
Bilateral
Marked otorrhoea
Bulging tympanic membrane
64
Which antibiotic is used (if indicated) in AOM
Amoxicillin
| Clarithromycin
65
Scarlet fever: develops following infection from which organism
GABHS and tonsilitis
66
Scarlet fever: Following onset of sore throat ->
Fever
Strawberry tongue
Lymphadenopathy
SANDPAPER RASH
67
Scarlet fever tx.
Oral Penicillin V for 10 days
68
Scarlet fever school exclusion:
24 hours after starting antibiotics
69
Is scarlet fever a notifiable disease?
YES
70
Most common complication of scarlet fever:
Otitis media
71
Features of innocent cardiac murmur in childhood:
Patient asymptomatic
No radiation or thrill
Change w/ respiration and position
72
Innocent murmurs will
___ when sitting up
___ when lying down
Decrease
Increase
73
Continuous murmur heard best below the clavicles:
Disappears when child lies down
Due to turbulent flow in the head and neck veins
Venous hum
74
Cyanosis plus murmur (1-2 months):
Tetralogy of Fallot
75
Cyanosis plus murmur (1-2 days):
Transposition of the great vessels or tricuspid atresia.
76
VSD murmur
PANsystolic - assoc. with thrills and symptoms of heart failure.
77
Coarctation of aorta murmur:
Ejection systolic
78
Atrial septal defect murmur:
Soft ejection systolic murmur
79
Patent ductus arteriosus murmur:
Continuous machine-like murmur best heard below left clavicle
80
Rotavirus ix.
Stool PCR
81
Mesenteric adenitis px.
mimics?
mx.
occurs secondary to a viral URTI
Appendicitis
Self-limiting
82
Diagnosis of Henoch Schonlein Purpura:
Skin or RENAL biopsy
83
Pyloric stenosis electrolyte disturbance:
Hypochloraemic, hypokalaemic metabolic alkalosis due to persistent vomiting
84
Pyloric stenosis diagnostic investigation:
Abdominal ultrasound
85
Green bilious vomit is what until proven otherwise:
Malrotation w/ volvulus
86
Paediatric assessment of chronic diarrhoea initial investigations:
Bloods: incl. anti-TTG
Sweat test
Stool culture
GROWTH CHARTS
87
If all ix. in chronic diarrhoea are normal w/ no visible allergy trial ->
Cows milk-free diet
88
Constipation red flags:
Failure to pass meconium w/in 48 hours
Abnormal appearance of anus
Constipation from birth
Faltering growth
89
Failure to pass first meconium in 48 hours w/
| explosive passage of stool following PR exam:
Hirschprung's
90
Hirschprung's diagnostic ix.
Rectal biopsy
91
Lower UTI tx.
< 3 months
> 3 months
IV amoxicillin, gentamicin
Trimpethoprim/nitrofurantoin (3 days)
92
Upper UTI tx.
IV Amoxicillin and Gentamicin
93
Investigation of UTI in children:
USS of renal tract
94
Which children get ix. in UTI
All children < 3 months
During infection if atypical
Up to six weeks otherwise
All children > 6 months who suffer recurrent infections
95
Measles virus: organism
RNA Paramyxovirus
96
Measles Px.
4 days prodromal cough, fever nasal discharge
Koplick spots - white spots on red background that develop on the buccal mucosa
Maculopapular rash - starts on face, neck, behind ears
97
Measles: notifiable disease?
Yes
98
Pink discrete maculopapular rash that starts on face and spreads to whole body
Sub-occipital and post auricular lymphadenopathy
RUBELLA
99
Eczema distribution in infants:
Face and trunk often affected
100
Eczema distribution in younger children:
Eczema on extensor surfaces
101
Roseola infantum causative organism:
Human herpes 6 (HHV-6)
102
Roseola infantum px.
High fever: lasting a few days
followed by maculopapular rash
Nagayama spots: uvula and soft palate papules
103
Roseola infantum school exclusion:
NONE required
104
Erythema infectiosum: also known as:
Slapped cheek, Fifths disease
105
Measles school exclusion:
4 days from onset of rash
106
Mumps school exclusion:
5 days from onset of swollen glands
107
Rubella school exclusion:
5 days from onset of rash
108
Impetigo school exclusion:
until lesions have crusted over or 48 hours after commencing antibiotic therapy
109
Scabies school exclusion:
Until treated
110
Influenza school exclusion:
Till recovered
111
Chicken pox school exclusion:
Till all lesions have crusted over
112
Diarrhoea and vomiting school exclusions
Until symptoms have settled for 48 hours
113
Hand foot and mouth causative organism:
Coxsackie
114
Purpura - how does ITP present:
Post-infective w/ mild mucosal bleeding in an otherwise well child
115
Skin lesions as DDx. for NAI
Mongolian blue spot - birth mark
116
Mx. Bacterial Meningitis:
< 3 months:
> 3 months:
IV Cefotaxime + Amoxicillin
IV cefotaxime
117
Infective encephalitis prominent presenting symptom in children:
Odd behaviour
118
Febrile convulsions: Simple
Generalized tonic clonic seizure that lasts < 5 minutes
| Complete recovery of consciousness w/in one hour
119
Febrile convulsions: complex
Focal onset
Lasts longer than 10 minutes
recurrent seizures in one febrile illness
120
Below what age is red flag for febrile convulsions and why?
< 2 years
| as children this age often show the classic signs and symptoms of meningitis
121
Febrile convulsions tx.
Rectal or buccal midazolam - parents are trained in this
122
Febrile convulsions risk of epilepsy?
Risk low but slightly higher than population average
Overall risk of epilepsy will increase if:
Complex febrile seizures
Family history of epilepsy
pre-existing neurodevelopmental condition
123
Hepatic metabolism in children ->
Greater than in adults due to comparative size of liver thus require higher doses of anti-epileptics and theophylline. - doses should not exceed adult dose.
124
Means of measuring temperature in child:
< 4 weeks
4 weeks - 5 years
Electronic thermometer in axilla
Electronic thermometer in axilla or infrared thermometer in axilla
125
Traffic light system for feverish child:
Respiratory ->
Amber risk:
```
AMBER:
Nasal flaring,
> 50 RR in 6-12 month
> 40 RR for >12 months
Oxygen saturation < 95%
Crackles in chest
```
126
Traffic light system for feverish child:
Respiratory ->
Red risk:
Grunting
Tachypnoea: RR > 60 breaths/minute
Moderate or severe chest in-drawing
127
Traffic light system for feverish child:
Circulation and hydration:
Amber risk:
```
Tachycardia
>160 beats/minute < 12 months
>150 beats/minute 12-24 months
>140 beats/minute if 2-5 years
Cap refill > 3 secs
Dry, poor feeding, reduced urine output
```
128
Traffic light system for feverish child:
| Red: age and temperature
<3 months with temperature over 38*
129
Mx. Amber pathway:
Safety netting or refer to paediatric specialist for advice
130
Suspected meningococcal meningitis presenting to primary care: what to give before transfer to hospital
IM Benzyl penicillin
131
Suspected NAI: Protocol
```
Admit to hospital for:
Senior escalation
Blood tests
Foresnic examination
Skeletal survery always done if < 2
```
132
Autism spectrum disorder: what are the 4 domains of impairment
Social interactions
Thoughts and behaviours
Communication
Sensory hypersensitivity
133
Describe Kawasaki disease:
Large to medium cell vasculitis
134
Kawasaki px.
```
Resistant fever > 5 days
Red palms of hands
Dry, cracked lips and strawberry tongue
Bacterial conjunctivitis
Widespread polymorphous rash
```
135
Kawasaki disease tx.
High dose aspirin
136
Investigation for Kawasaki disease:
Echocardiograph - due to complication of Coronary artery aneurysm
137
Cow's milk allergy tx.
1st line is extensively-hydrolysed formula feed.
138
Hypospadias tx.
Corrective surgery before the age of 12 MONTHS - 1 year
139
Undescended testes
Referred before:
seen by surgeon before:
3 months
6 months
Orchidopexy to treat
140
Shaken baby triad of signs:
Retinal haemorrhages
Subdural haemorrhage
Encephalopathy
141
First line investigation for DDH if pt. > 4.5 months
X-ray
US can be used also
142
Measles complication occurring soon after infection:
Pneumonia
143
Perthe's tx. if < 6 years old
Observation as good prognosis
144
Causes of obesity in children:
```
Growth hormone deficiency
Hypothyroidism
Down's syndrome
Cushing's syndrome
Prader-Willi syndrome
```
145
Wilm's nephroblastoma tumour: presenting fx.
Abdominal mass (most common presenting fx.)
Painless haematuria
Flank pain
One of the most most common childhood malignancies
146
Tx. for Children w/ immune thrombocytopenia: (ITP)
None required for children w/ petichiae only and no significant bleeding
147
Age where most children achieve day and night urinary continence:
3-4 years-old
148
Second hearing test for newborns/infants if otoacoustic test is abnormal
Auditory brainstem response test
149
Airway manoeuvre which may be required in acute epiglottitis
Endotracheal intubation
150
Features of growing pains:
```
NEVER present at the start of the day
worse after a day of activity
No limp, limitations of physical activity
systemically well
Normal physical examination
```
151
What is used to make a diagnosis of muscular dystrophy:
Genetic testing
| used to be muscle biopsy
152
Which other trinucleotide repeat disorders also exhibit genetic anticipation:
Fragile X
Huntington's
Myotonic dystrophy
Spinocerebellar ataxia
153
Most common finding related to neonatal sepsis:
Respiratory distress
154
Noonan syndrome features:
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
155
Pierre robin syndrome features:
Posterior displacement of tongue (may result in airway obstruction)
Cleft palate
Micrognathia
156
Friendly extroverted personality with learning difficulties and elf like face
Supravalvular aortic stenosis
Williams syndrome
157
Meningitis organisms in <3 months
GBS
E.coli
Listeria
158
Meningitis organisms in 3 months - 6 years
Strep pneumoniae
N. meningitidis
H.influenzae
159
Meningitis organisms in > 6 years
Strep pneumoniae
| N. meningitidis
160
Croup: which inspiratory sound and when is an indication for admission:
Audible stridor at rest
161
Mode of inheritance for Prader-Willi
Imprinting
162
Neonatal hypoglycaemia if symptomatic:
Admit to neonatal unit
| IV 10% dextrose
163
CXR features in TTN
Hyperinflation and fluid in the horizontal fissure
164
Age to consent
| Age to refuse treatment
16
| 18
165
Paediatric laxative ladder:
1) Movicol
2) Stimulant laxative - Bisacodyl, Senna, glycerol
3) Osmotic laxative - Polyethylene glycol, lactulose
166
Hand, foot and mouth school exclusion:
No need to stay off school if child feels well.
167
Rate of chest compressions all children:
100-120 compressions/minute
168
Infant < 3 months w/ UTI action:
Refer immediately to paediatrics
169
Most common cause of primary headache in children
Migraines
170
Adverse effects of CICLOSPORIN
```
Nephrotoxicity
Hepatotoxicity
Fluid retention
Hypertension
Hyperkalaemia
```
Everything UP: fluid, BP, K+, Hair, Gums, Glucose)
