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child health Flashcards

1
Q

A 48 hour old term baby delivered by spontaneous vaginal delivery has not passed meconium - what underlying pathology could be the cause?

A

Cystic fibrosis - meconium can get stuck in the lumen if its too sticky

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2
Q

6month old baby brought in by parents - snotty, wheezy and coughing lots - seems to be having spells where he doesn’t seem to breathe at all

What is the most likely causative organism ?

A

Resp. Syncytial virus

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3
Q

how does malrotation volvulus present

A

With green vomit

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4
Q

Why is TTN (transient tachypnoea of the newborn) more common in C-section than vaginal delivery ?

A

Due to a delayed clearing of fluid - since babies don’t undergo the same stress as they would via vaginal delivery

For fluid to be cleared from the lungs, the sodium channels need to be activated by adrenaline and this doesn’t happen in C-section sometimes.

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5
Q

What causative organism most commonly causes bronchiolitis ?

A

Resp. Syncytial virus

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6
Q

what is patau syndrome

A

A trisomy of 13

Baby presents with microcephaly, small eyes, cleft lip/palate, polydactyly, scalp lesions

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7
Q

What is Pierre-robin syndrome

A

Micrognathia, posterior displacement of the tongue - which can result in upper airway obstruction

Cleft palate

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8
Q

What is noonan’s syndrome

A

Webbed neck babies
Pectins excavating
Short stature
Pulmonary stenosis

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9
Q

Features of Williams syndrome

A

Short stature
Learning difficulties
Friendly, extroverted
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

‘Short, stupit, silly is oor willy’

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10
Q

Features of prader - willi

A

Hypotonia
Hypogonadism
Obesity

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11
Q

How and why are newborns given vit. K

A

Intramuscularly usually
They are deficient - reduce risk of haemorrhage (especially at risk if breast fed)

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12
Q

what is the ‘traffic light system’

A

It is a feverish illness guideline for children under 5 - presenting with fever

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13
Q

Kleinfelter’s syndrome features

A

KS or 47, XXY

Where males are born with an extra X chromosome

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14
Q

Healthy observation in newborns

A

RR = 30-60
BPM = 100 - 160
Temp. = 37 degrees Celsius

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15
Q

Management of necrotising fasciitis

A

Nil by mouth feeding
Clindamycin + cefotaxime

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16
Q

slapped cheek syndrome/erythema infectiosum causative organism

A

Parvovirus b19

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17
Q

When in doubt - keep on breastfeeding

A

Lol tips from second years

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18
Q

What are the developmental delay red flags

A

6 months - not reaching for objects
10 months - no smile or speech
12 months - cannot sit unsupported and has preferential use of one hand
18 months - cannot walk

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19
Q

Red/pink maculopapular rash, present on face and body with lymphadenopathy

Caused by togavirus

What is the disease

A

Rubella

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20
Q

*kolpik spots (white spots on the buccal mucosa)
This rash starts behind the ears and common complications include: otitis media

What disease is this ?

A

Measles caused by paramyxovirus

If this diagnosed you MUST tell public health

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21
Q

This rash is very very itchy, and the timeline = macular > papules > vesicles > scabs and is caused by varicella zoster virus

A

Chicken pox

Management is with Calamine

(CALamine CALms the itch)

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22
Q

*strawberry tongue

A

= Scarlet fever , caused by Group A strep pyogenes

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23
Q

management of scarlet fever

A

Oral penicillin V (for 10 years)
Can return to school 24 hours after abx started
Need to notify public health

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24
Q

Features of mumps

A

Parotitis - earache/pain on eating
Fever, fatigue

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25
Q

What virus causes mumps

A

Paramyxovirus

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26
Q

What is a common complication of mumps

A

Orchiditis - inflammation of the testicles

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27
Q

What 2 types of anaemia are associated with slapped cheek syndrome

A

Sickle cell anaemia
Aplastic anaemia

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28
Q

Rash that appears as vesicles in the mouth and on palms and soles
May have an associated fever and sore throat and is caused by coxsackie virus A16

A

Hand foot and mouth disease

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29
Q

What is the most common causative organism for UTIs and why

A

E.coli

Because of vesicoureteral reflux

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30
Q

Management of croup

A

Oral dexamethasone

Severe = nebulised adrenaline

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31
Q

Management of epiglottitis

A

Immediate ENT senior help
IV ceftriaxone + oxygen
Do not examine the throat - could make it even worse

Children often adopt the tripod position

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32
Q

Radiological differences of croup and epiglottitis

A
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33
Q

High chloride concentration on sweat test indicates what disease

A

CF
CF is an autosomal recessive CFTR gene mutation on chromosome 7

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34
Q

How would a newborn with CF present

A

Not passing meconium within 1st 24 hours of life
Recurrent Resp. Infection
Malabsorption > due to lack of digestive enzymes
Pancreatitis

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35
Q

what is the causative organism for epiglottitis

A

H. Influenzae

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36
Q

What is the causative organism for croup

A

Parainfluenza virus

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37
Q

What causes whooping cough

A

Bordetella pertussis

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38
Q

Management of whooping cough

A

Nasal swab is diagnostic

> > oral macrolide ie erythromycin

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39
Q

What can happen if DDH is left untreated

A

Very shallow or false acetabulum > severe arthritis + shortened limb

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40
Q

What are the investigation for DDH

A

Initial = Barlow + Ortolani
Diagnostic = US

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41
Q

How long would a baby with DDH be in a pavlik harness for ?

A

6 weeks

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42
Q

at what point do you consider surgery for DDH

A

When it is persistent > 18 months

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43
Q

What is Perthes

A

Avascular necrosis of the femoral head

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44
Q

How does Perthes present

A

Usually in a very active boy with short stature
Unilateral pain or limp > developed over a few weeks
Loss of rotation + loss of abduction
+ve trendelenburg

Hanging rope sign on x-ray, widening of joint space and smaller femoral head w/ patchy density

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45
Q

*hanging rope sign

A

= Perthes disease

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46
Q

What is the most common cause of hip pain in children

A

Transient synovitis of the hip

Follows a URTI and is self-limiting , mxm = NSAIDs + rest

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47
Q

*klein lines on x-ray

A

SUFE - slipped upper femoral epiphyses

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48
Q

Management of SUFE

A

Urgent pin femoral head surgery as there is risk of avascular necrosis

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49
Q

What is the Kocher criteria used for

A

Septic arthritis

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50
Q

Mxm of septic arthritis

A

Urgent irrigation + debridement
IV antibiotics and flucloxacillin

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51
Q

*olive shaped mass in RUQ + projectile vomiting

A

Pyloric stenosis

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52
Q

management of pyloric stenosis

A

Ramstedt pyloromyotomy

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53
Q

Child is unwell and floppy, producing red currant jelly stool and there is a palpable sausage mass

On US there is a target/bullseye sign

What disease matches this profile ?

A

Intussesception - telescoping of small bowel leading to obstruction

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54
Q

*green, bilous vomit

A

Malrotation w volvulus

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55
Q

Abdo x-ray of necrotising fasciitis

A

Dilated bowel loops
Bowel wall oedema
Gas in peritoneum
Gas in bowel wall

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56
Q

Which hormone secreted from the hypothalamus triggers the onset of puberty

A

GnRH

*hypothalamus secretes GnRH which stimulates the production of FSH/LH from anterior pituitary
> circulating FSH/LH act upon the gonads which release the sex hormones (oestrogen + testosterone)

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57
Q

When do children start to engage in symbolic play

A

18-24 months

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58
Q

When do children use spoons to feed themselves

A

18 months

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59
Q

When do children engage in parallel play

A

2.5years - 3 years

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60
Q

When do children become continent of urine

A

2 years

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61
Q

How many hours a day is a 3 year old recommended to be physically active ?

A

3 hours - spread throughout the day

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62
Q

How many hours of RIGOROUS/MODERATE intensity exercise should a 12 year old boy have a day ?

A

1 hour

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63
Q

how many days is a 7 yr old girl recommended to do vigorous activity in a week ?

A

3 days

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64
Q

what is oral rehydration solution ?

A

Oral rehydration - treatment of dehydration , replacing sugars and electrolytes and shit

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65
Q

Features of oral rehydration solution

A

-relies on the sodium-glucose co-transport system (active transport of sodium = osmotic pull for water)
-water absorption is mostly in the jejunum
-UK solution contains less sodium than developing countries
-can easily be made using a combination of salt, sugar and water

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66
Q

is effective contraceptive use a factor in reducing child mortality

A

Nope

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67
Q

What are the WHO 6 solutions for preventing deaths in under-5s

A
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68
Q

Red flag for constipation

A

leg weakness

69
Q

is passing a stool once a week a red flag for constipation

70
Q

When should infants be weaned onto family foods

71
Q

Semi-skimmed milk should not be given before x years

72
Q

Full fat I modified cows’ milk can be introduced as a drink from x months

73
Q

When is the earliest an infant can be introduced to solid foods

74
Q

Skimmed milk should not be given before x years

75
Q

Common complications of Down syndrome

A

Congenital heart abnormalities (AVSD)
Acute lymphoblastic leukaemia
Duodenal atresia
Otitis media

76
Q

When do boys experience their pubertal growth spurt

77
Q

What is the first sign of puberty in girls

A

Breast bud development

78
Q

What is the first sign of puberty in boys

A

Testes growth

79
Q

when is puberty considered precocious

A

8 in girls
9 in boys

80
Q

*massive painless GI bleeding in a child between 1-2 ?

A

Meckels diverticulum is the most common cause

81
Q

Features of rickets

A

Kyphoscoliosis
Joint Widening
Aching bones and joints
Lower limb abnormalities - bow legs + knock knees
Rickety rosary
Harrisons

82
Q

What is the most common cause of ambiguous genitalia

A

Congenital adrenal hyperplasia

83
Q

A neonate is found to have a left subclavicular thrill, a heaving apex beat and a continuous machinery like murmur

What is the correct management

A

This baby has patent Ductus arteriosus

Therefore give indomethacine to the Neonate postnatally

84
Q

When should circumcision NOT be performed in children ?

A

Hypospadias

85
Q

Risk factors for neonatal sepsis

A

Low birth weight
Maternal chorioamnionitis
Premature
Mother who has had a previous baby with GBS infection

86
Q

What is first line treatment for febrile seizures

A

Buccal Midazolam

87
Q

What is Rhesus disease

A

Antibodies in a pregnant woman’s blood destroy her baby’s blood cells

Aka haemolytic disease of the foetus and newborn

88
Q

How to treat Rh incompatibility

A

Phototherapy using bilirubin lights

Also IV immunoglobulins

(This would be an obstructive jaundice)

89
Q

A test for RhD antibodies

A

Coombs test

90
Q

What is ABO incompatibility

A

This happens when a mothers blood type is O
And her baby’s is A or B

The mothers immune system may react and make antibodies against the baby’s blood cells

91
Q

Treatment of ABO incompatibility

A

Phototherapy

92
Q

Example of active immunity

93
Q

Example of passive immunity

A

Transplacental transfer from mother to unborn baby

94
Q

What diseases can immunity be granted passively

A

Hep B
Rabies
Varicella zoster
Diphtheria
Botulin

95
Q

What are the 2 mechanisms of active immunity

A

Natural infection
Vaccines

96
Q

What are the two mechanisms of passive immunity

A

Transplacental transfer
Artificial human IgG

97
Q

Rotavirus, shingles, MMR, polio are types of what vaccine

A

Live attenuated (whole pathogen)

98
Q

Flu and rabies are types of what vaccines

A

Inactivated whole organisms vaccine

99
Q

What are some examples of recombinant protein vaccines

A

Hep B
HPV
MenB

100
Q

Toxoid vaccines protect against what diseases

A

Diphtheria
Tetanus
Pertussis

101
Q

What is a conjugate vaccine

A

Polysaccharide + immunogenic protein ie Hib , MenC , MenACWY

102
Q

How is herd immunity calculated

A

Depends on transmissibility and infectiousness , and social mixing proportions

Eg herd immunity to be achieved for measles is 90% but for mumps is 75-85%

103
Q

What is generally the percentage needed to be achieved for herd immunity

104
Q

What is in the 6 in 1

A

Tetanus
Pertussis
Diphtheria
Hep B
Polio
Hib

105
Q

Clinical suspicion of what childhood infections should be reported to practitioners immediately due to public health ris

A

Diphtheria
Meningococcal
Smallpox
Hib
Pertussis
Typhoid
Measles
Polio
SARS

106
Q

@ 4 weeks what vaccines given to baby

A

MMR and DTaP (4in1 = diphtheria , tetanus , polio, pertussis )

107
Q

@ 8 weeks - what vaccines

A

Hib HepB , IPV , DTaP

108
Q

@ 12 weeks - what vaccines

A

DTaP , Hib Hep B , rotavirus , PCV13

109
Q

@ 16 weeks - what vaccines

A

DTaP , Hib , Hep B and Men B

110
Q

At about 1 year old - what vaccines to be given

A

Men C and B , Hib , PCV13 , MMR

111
Q

@ 3 -5 years old - what vaccines

A

MMR and DTaP

112
Q

@ 2 years and beyond - what vaccines

A

Flu (annually)

113
Q

What age do kids get HPV vaccine

A

12-13 years old

114
Q

At what age do kids get IPV, Men ACWY and Td (tetanus + diphtheria)

115
Q

What is APGAR scoring

A

A = appearance
P = Pulse
G = grimace
A = activity
R = respiration

116
Q

Antibiotic of choice for suspected bacterial infection in babies (sepsis)

A

Benzyl penicillin (is a gram + and - cover)

(Gentamicin is a further gram - cover)
(Cefotaxime as well is an option for gram + and - cover)

117
Q

What is covered in the TORCH screen

A

Toxoplasma
Others (hep b and syphilis)
Rubella
CMV
Herpes

118
Q

What is TTN

A

Transient tachypnoea of the newborn
- most common in C-section babies
- due to a delay in clearing lung fluid (dependant on active epithelial Na channels —> usually activated through stress by vaginal delivery)

119
Q

When should TTN resolve

A

Within the first 24 hours of life

120
Q

TTN x-ray ?

A

Fluid in the horizontal fissure

121
Q

*ground glass appearance and air bronchograms on CXR

A

Respiratory distress syndrome

122
Q

What babies are given vitamin K straight after delivery

A

TRICK QUESTION

All babies are

123
Q

Why does ABO incompatibility cause jaundice

A

The mothers blood produces antibodies to the babies red cells — some of which cross the placenta , entering babies circulation — these antibodies continue to attack and break down babies RBCs at an increased rate —> leading to increases bilirubin

124
Q

Most common type of brain tumour in children

A

Astrocytoma - Brain and spinal cord tumour

Most often found in cerebrum but also in cerebellum

125
Q

What is global delay

A

Significant delay in >2 developmental areas

126
Q

What are the developmental mile stone red flags

A

6 months —> not reaching for objects
10 months —> no smile or speech
12 months —> cannot sit unsupported and has preferential use of one hand
18 months —> cannot walk

127
Q

Cause of cerebral palsy

A

TORCH (80%)

(Toxoplasma, rubella, cmv, herpes simplex)

128
Q

Management of cerebral palsy

A

Oral diazepam & oral baclofenac for spasticity

129
Q
    • Gower’s sign
A

Muscular dystrophy

(When they used their hands to push on legs to stand)

130
Q

What is Duchenes muscular dystrophy ?

A

It is an x-linked condition - due to malformation of the dystrophin gene

131
Q

How does Duchene’s muscular dystrophy present ?

A

Boys aged 1-6 who are struggling to walk
Proximal muscle wasting
Hypertrophy of the calves
+Gower’s

132
Q

Investigation for muscular dystrophy

A

Increased serum creatinine kinase

133
Q

What is the management of muscular dystrophy

A

There is poor prognosis - usually die in 20s

Symptomatic control

134
Q

*bulging fontanelle

A

Describes the presentation of meningitis in neonates

135
Q

Management of a bulging Fontanelle

A

Mannitol 0.5g/kg over 10 minutes

136
Q

Most common organisms causing meningitis in babies <3 mo

A

MEN-IN-GEL-ITIS

GEL -
Group B strep.
E.coli
Listeria monocytogenes

137
Q

How to treat meningitis in babies at the GP

A

IM or IV benpen (before even calling 999)

138
Q

Management of meningitis in the hospital

A

<3 mo = Cefotaxime + Amox.
>3 mo = ceftriaxone + dexamethasone

139
Q

Post exposure prophylaxis for meningitis in babies

A

Rifampicin or ciprofloxacin

140
Q

Most common causative org. In uti

A

E.coli due to vesicoureteric reflux

141
Q

Diagnosis of uti in babies

A

Abdominal USS
Urine dipstick / or clean catch sample in babies

142
Q

Management of lower uti in babies over 3 months

A

PO antibiotics for THREE days

Either trimethoprim or nitrofurantoin

143
Q

Maannagemt of lower uti in babies under 3 months

A

IV amox. + gentamicin

144
Q

Management for upper UTI in babies of any age

A

Admit to hospital for IV amoxicillin + gentamicin

145
Q

How to investigate for vesicoureteric reflux

A

Mistrusting cystourethrogram

146
Q

Cause of measles

A

Paramyxovirus

147
Q

*kolpik spots

A

measles

(They are white spots on the buccal mucosa)

148
Q

What is the most common complication of measles

A

Otitis media

Think mEARsles

149
Q

Causative organism for rubella

150
Q

Causative organism for scarlet fever

A

Group A strep pyogenes

151
Q

Management of scarlet fever

A

Oral penicillin V (10 days) notify public health

152
Q

Cause of mumps

A

Paramyxovirus

153
Q

What is the main complication of mumps

A

Orchiditis

154
Q

Cause of erythema infectiosum

A

Aka slapped cheek syndrome , parvovirus b19

155
Q

Causative organism for hand foot n mouth

A

Coxsakie virus A16

156
Q

Management for hand foot n mouth

A

Is self limiting

157
Q

Suspicion of epiglottis ?

A

Send them straight to senior ENT specialists

158
Q

*steeple sign

159
Q

*thumb print sign

A

Epiglottis I

160
Q

Why is there male infertility in cystic fibrosis

A

Bilateral absence of vas deferens

161
Q

Management of whooping cough

A

Oral macrolide (erythromycin etc)

162
Q

Diagnostic test for whooping cough

A

Nasal swab

163
Q

Medication in CF

A

Lumacaftor

164
Q

What investigation is contraindicated in meningococcal septicaemia

A

Lumbar puncture

165
Q

Treatment of transposition of the great arteries

A

Prostaglandin E1

166
Q

Treatment for Patent ductus arteriosus

A

Indomethacin

167
Q

Gold standard investigation for pyloric stenosis

A

Abdominal ultrasound

168
Q

Forceps delivery can lead to what in a baby

A

Elevated bilirubin (haemolysis due to bruising)

169
Q

At what age should hearing be formally tested first

A

Newborn - in the otoacoustic emission test

everything (29 decks)

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