Child Health Flashcards
Foreign bodies are more likely to be aspirated into which bronchus
Right main bronchus as it is wider, shorter and more vertical in comparison to the left
Likely Dx:
3 year old
Large, firm mass can be palpated on the left side of the midline in the upper abdomen
Hypertension
Haematuria
Wilm’s tumour (nephroblastoma)
Inferior MI:
A) Leads with ST elevation?
B) Coronary artery affected?
Leads: II, III, aVF
Right coronary artery
Anteroseptal MI:
A) Leads with ST elevation?
B) Coronary artery affected?
Leads: V1-V4
Left anterior descending artery
Lateral MI:
A) Leads with ST elevation?
B) Coronary artery affected?
Leads: I, aVL, V5, V6
Left circumflex artery
What is the most common side effect of salbutamol
Tachycardia
Likely Dx:
A 3-year-old girl is brought to general practice by her father, who is worried about a rash around her mouth. The rash started as small itchy red blisters, which have now burst and formed a golden crust.
Impetigo
Likely Dx:
Child with painful red blisters which affect the hands, feet and nappy area and can occur in the mouth and throat
Hand, foot, and mouth disease
Green or bilious vomit is a red flag symptom and is a feature of which kind of intestinal issue?
Intestinal obstruction, specifically obstruction distal to the second part of the duodenum which is where bile is secreted into the small intestine
Name 3 causes of bilious vomit?
Malrotation
Duodenal atresia
Meconium ileus
Projectile vomiting around 6-8 weeks of age is pathognomonic of what condition?
Pyloric stenosis
Paroxysmal coughing to the point of vomiting in a baby is pathognomonic of what condition?
Whooping cough
Seizures/bulging fontanelle with vomiting in a baby is pathognomonic of what?
Raised intracranial pressure
Bilious (green) vomiting, abdominal distention and a delay in passing stool after birth (>48 hours) is pathognomonic of what condition?
Hirschsprung disease
Meconium ileus is generally associated with what condition?
Cystic fibrosis
Abdominal distension and bilious vomiting in first 24-48 hours of life is pathognomonic of what condition?
Meconium ileus
What investigation is used to confirm the diagnosis of cystic fibrosis
Sweat test
A baby with soft swelling of the scalp that crosses suture lines after ventouse delivery is pathognomonic of?
Caput succedaneum
This is not concerning and usually resolves within a few days.
Crosses Sutures (CS) - Caput Succedaneum (CS)
A baby with swelling of the scalp that DOES NOT cross the suture lines that develops several hours after delivery is what?
Cephalohaematoma
Due to bleeding between the periosteum and skull
Children with cystic fibrosis are vulnerable to deficiency of which vitamins?
Fat soluble vitamins (A, D, E and K)
This is due to poor fat absorption secondary to reduced pancreatic lipase enzyme secretion
What kind of inheritance of cystic fibrosis
Autosomal recessive disorder
An infant with very salty sweat is pathognomonic of which condition?
Cystic fibrosis
An obese 12-year-old boy is referred with pain in the left knee and hip… pathognomonic of?
Slipped upper femoral epiphysis
Commonest in obese adolescent males.
XR feature of slipped upper femoral epiphysis
Displacement of the femoral epiphysis inferolaterally
Treatment of slipped upper femoral epiphysis
Rest and non weight bearing crutches.
Unilateral hip pain (may be referred to the knee) usually occurring between 5 and 12 years of age - pathognomonic of?
Perthes Disease
Management of Perthes Disease
Remove pressure from joint to allow normal development.
Physiotherapy.
Usually self-limiting if diagnosed and treated promptly.
Best imaging modality for developmental dysplasia of the hip
Ultrasound scan
Male children aged 3-11 with limp preceded by a viral infection is pathognomonic of?
Transient synovitis
First line investigations for transient synovitis
Bloods to exclude septic arthritis (WCC and inflammatory markers will be raised in septic arthritis whilst they are normal in transient synovitis)
Ultrasound - effusion
XR - normal
What is the definitive investigation to distinguish between transient synovitis and septic arthritis
Microscopy, culture and sensitivity of the joint aspirate will distinguish between the two, as bacteria within the joint space confirms septic arthritis.
Management of transient synovitis
Supportive treatment.
Generally resolves in around 7 days with minimal risk of long-term damage to the joint.
The barking cough and absence of stridor or systemic symptoms points to a diagnosis of
Mild croup
First line treatment for croup
Immediate single dose of oral dexamethasone (0.15 mg/kg) regardless of disease severity
Barking cough is pathognomonic of what condition
Croup
Management of emergency treatment of croup
High-flow oxygen
Nebulised adrenaline
What investigations are conducted in infants younger than 3 months with fever
Full blood count
Blood culture
C-reactive protein
Urine testing for UTI
Chest radiograph (only if respiratory signs are present)
Stool culture (if diarrhoea is present)
Jaundice in the first 24 hours after birth is always pathological.
What is the most common cause
Rhesus haemolytic disease
Biliary atresia is a cause of physiological jaundice.
What time after birth does it usually present
Presents after 14 days
What is the more common cause of jaundice (presenting after 14 days of birth) in breastfed babies
breast milk jaundice
Likely Dx:
Prolonged jaundice (i.e., jaundice that persists beyond 14 days of life)
Signs of biliary obstruction (e.g, dark urine and chalky white stool)
Biliary atresia
Occurs when the bile ducts of an infant are progressively fibrosed and destroyed, leading to conjugated hyperbilirubinaemia, liver failure and death if not treated.
What is the definitive diagnosis of biliary atresia
Confirmed with cholangiography, which will fail to show normal architecture of the biliary tree
Management of biliary atresia
Hepatoportoenterostomy (Kasai procedure) - surgery in which a new pathway from the liver to the gut to bypass fibrosed ducts is formed
Parents of child with febrile convulsions should be advised to phone for an ambulance if the seizure lasts how long
> 5 minutes
Management of any child less than 3 months old with a temperature > 38ºC
Urgent referral to a paediatrician
Repeated flexion of head/arms/trunk (contracting of his neck and drawing up of his legs) followed by extension of arms is pathognomonic of what
Infantile spasms (West syndrome)
Type of epilepsy presenting at 4-8 months
Typically has repeated flexion and extension movements (Salaam attacks) repeated up to 50 times
Examination of a sausage-shaped mass in the right hypochondrium and emptiness in the right lower quadrant (Dance’s sign)
Hallmark features of?
Intussusception
Nectroising enterocolitis is staged using what classification
Bells’ classification
Uses a mix of clinical signs and radiological findings
Likely Dx:
Infant (first three weeks of life)
Suddenly starts having feeding intolerance
Abdominal distension
Bloody stools
Necrotising enterocolitis
How is necrotising enterocolitis diagnosed
Abdominal X-ray which may show:
Dilated bowel loops
Pneumatosis intestinalis (gas within the bowel wall)
Portal venous gas
Pneumoperitoneum
Bells’ criteria is used to diagnosis based on clinical and radiological signs
Management of necrotising enterocolitis
Nil-by-mouth
Nasogastric tube
IV fluids/total parenteral nutrition to rest the bowel
Broad-spectrum IV antibiotics
Likely Dx:
From Bangladesh
Coughs in bouts that are so severe turns red.
Vomiting
No fevers
Whooping cough
Likely Dx:
Severe testicular pain
Absent cremaster reflex on the affected side.
Elevation of the testicle results in worsening of the pain.
Testicular torsion
Occurs when the testis turns on the remnant of the processus vaginalis thereby restricting blood flow
In epididymitis elevation of the testes does what to the pain?
Often relieves the pain (Prehn’s sign positive)
first-line investigation for slipped upper femoral epiphysis (SUFE)
Plain X-ray of both hips (AP and frog-leg views)
Which patient groups should be referred for ultrasound of the hips to assess for developmental dysplasia of the hip (DDH)
All babies that were breech at any point from 36 weeks (even if not breech by time of delivery)
Babies born before 36 weeks who had breech presentation,
All babies with a first degree relative with a hip problem in early life
Gold standard investigation for diagnosis of Hirschsprung’s disease
Rectal biopsy
Microscopic examination shows a lack of ganglionic nerve cells in the affected segment.
Hirschsprung’s disease is strongly associated with what condition
Down’s syndrome
What is the definitive management of Hirschsprung’s disease
Surgery to affected segment of the colon
Foetal alcohol syndrome is associated with ___cephaly:
A) Macrocephaly
B) Microcephaly
B) Microcephaly ie. small head
How to distinguish between Mesenteric adenitis and appendicitis
Mesenteric adenitis: follows a recent viral infection and no rebound tenderness or guarding
What is Mesenteric adenitis
Inflamed lymph nodes within the mesentery so will cause pain in the iliac fossas however will not have rebound tenderness or guarding
Often follows a recent viral infection
Conservative treatment
Likely Dx:
Bilious vomiting in neonates, a few hours after birth
Distended abdomen
Duodenal atresia
Congenital malformation in which the duodenum does has a blind end, and so is not patent
What condition is strongly associated with duodenal atresia
Downs Syndrome
Gold standard diagnosis of duodenal atresia
Abdominal X-rays
Characteristic ‘double bubble’
one gas bubble visible in the stomach, and one gas bubble visible in the most proximal (patent) part of the duodenum prior to the atresia
Management of duodenal atresia
Duodenoduodenostomy - surgical repair reconnecting the closed proximal and distal segments of the duodenum in order to relieve the obstruction.
Koplik spots (small white lesions on buccal mucosa) are pathognomonic for what condition
Measles
What is the most useful investigation to screen for the complications of Kawasaki disease?
Echocardiogram as coronary artery aneurysms are a potential complication of Kawasaki disease
Management of Kawasaki disease
High-dose aspirin
IV immunoglobulin
What syndrome are children at risk for when given aspirin
Reye’s syndrome
Hence aspirin is normally contraindicated in children
What is the most likely causative agent of a bacterial pneumonia in children
Streptococcal pneumoniae
What is the first-line treatment for all children with pneumonia
Amoxicillin
First line treatment option in pneumonia associated with influenza in children
Co-amoxiclav
Most common causative agent in acute epiglottitis
Haemophilus influenzae type B
Pathogonomonic in unvaccinated kid
Unvaccinated drooling child with inspiratory stridor is likely
Acute epiglottis
Child with recurring UTIs.
micturating cystourethrogram done
Diagnosis
Vesicoureteric reflux i.e. abnormal backflow of urine from the bladder into the ureter and kidney
Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity
What kind of scan may be performed to look for renal scarring in Vesicoureteric reflux
DMSA scan
Gold standard diagnosis for Vesicoureteric reflux
Micturating cystourethrogram
Initial treatment for patent ductus arteriosus to promote duct closure
Indomethacin
OR
Ibuprofen
Patent ductus arteriosus results in the abnormal flow of blood from where to where
Flow of some oxygenated blood from the descending aorta to the pulmonary artery
Continuous ‘machinery’ murmur is pathognomonic of what?
Patent ductus arteriosus
What murmur is associated with Turner’s syndrome is
Ejection systolic murmur due to bicuspid aortic valve
sandpaper rash and strawberry tongue are pathogonomic of what infection
Scarlet fever (group A Strep cause)
Name some of the later complications of Downs Syndrome
Subfertility
Learning difficulties
Short stature
Repeated respiratory infections
Hearing impairment from glue ear
Acute lymphoblastic leukaemia (ALL)
Hypothyroidism
Alzheimer’s disease
What test is used to screen newborns for hearing problems
Otoacoustic emission test
Fail - referred to have impedance audiometry testing
Osgood-Schlatter disease occurs as a result of inflammation at which bony prominence?
Tibial tuberosity
Likely Dx:
Mild systemic upset, oral ulcers followed by vesicles on the palms and soles
Hand, foot and mouth disease
What is the most common causative agent for hand, food and mouth disease
Coxsackie A16 virus
Likely Infective Dx:
Several days of high fever, followed by a distinctive rash just as the fever breaks.
Roseola
Fever -> Rash
Slapped cheek syndrome is commonly caused by what causative agent
Parvovirus B19
What is the chest compressions to breathes in CPR Paeds
Ratio 15:2
What is the chest compressions to breathes in CPR Neonates
Ratio 3:1
As part of the child health surveillance neonates get heel-prick test on day 5-9.
What conditions is this checking for
“My Child, My Poor Husband”
Metabolic diseases
Cystic fibrosis
Medium-chain acyl Co-A dehydrogenase deficiency (MCADD)
Phenylketonuria
Hypothyroidism
Presenting features of cystic fibrosis
Meconium ileus (failure to pass meconium)
Recurrent chest infections
Steatorrhoea (foul smelling stools)
Failure to thrive
Projectile vomiting after every feed in a young baby
Pathognomonic of?
Pyloric stenosis
What is the electrolyte abnormality associated with pyloric stenosis
Hypochloraemic, hypokalaemic metabolic alkalosis
This is due to persistent vomiting
Hypochloraemic, hypokalaemic metabolic alkalosis is an electrolyte abnormality pathognomonic of
Pyloric stenosis
Gold standard diagnosis of pyloric stenosis
Abdominal ultrasound scan
Will show hypertrophy of the circular pylorus muscles
Management of pyloric stenosis
Surgical with a pyloromyotomy to cut the pyloric sphincter to widen the outlet
Likely Dx:
Teen that is keen on spots with painful swelling over the tibial tubercle
Osgood-Schlatter disease
Most common causative agent for Scarlet fever
Group A streptococci (usually Streptococcus pyogenes).
Management of scarlet fever
Oral penicillin V for 10 days
When can children return to school after commencing antibiotics for scarlet fever
24 hours
scarlet fever is a notifiable disease
What vitamin is given to neonates to prevent haemorrhagic disease of the newborn
IM vitamin K
One off injection shortly given after birth
Given as newborn babies are relatively deficient in vitamin K and thus may result in impaired production of clotting factors
First line treatment for Threadworms
Mebendazole for children > 6 months old
Treat all members of the household
What is the most likely organism to cause croup?
Parainfluenza virus
“crouP Parainfluenza”
What is the most likely organism to cause bronchilitis
Respiratory syncytial virus (RSV)
Likely Dx:
Fever > 5 days
Bilateral conjunctivitis
Cervical lymphadenopathy
Polymorphic rash
Cracked lips/strawberry tongue
Oedema/desquamation of the hands/feet
Kawasaki disease
Pattern of inheritance for haemophilia A
X-linked recessive
Ventricular septal defect present as what kind of murmur
Pansystolic murmur
Likely Dx:
Young infant
Coughing fit followed by periods in which the child stops breathing and turns blue. The child appears lethargic.
Whooping cough
notifiable disease
Most common causative agent in whooping cough
Bordetella pertussis
Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress
Pathognomonic of
Congenital diaphragmatic hernia
What is the first-line therapy following general advice for nocturnal enuresis ie bed wetting
Enuresis alarm
An alarm that will make a loud sound or vibrate when a sensor detects moisture from even a small amount of urine
What condition should be suspected in an otherwise well infant with noisy breathing
Laryngomalacia
Caused by a congenital softening of the cartilage of the larynx, causing collapse during inspiration.
Usually self-resolves before 2 years of age.
Characteristics of Kawasaki disease
‘CRASH and burn’.
C: conjunctivitis (bilateral).
R: rash (non-vesicular).
A: adenopathy (cervical).
S: swollen, strawberry tongue.
H: hand swelling (or feet).
Burn: fever lasts >5 days and is very high.
Triad of hallmark features of Intussusception
i) Intermittent abdominal pain
ii) Vomiting
iii) Right upper quadrant mass
Presents, usually after the first three months of life
‘red currant jelly’ stool is pathognomonic of what condition
Intussusception
What is the first line investigation for Intussusception
Abdominal ultrasound
Hallmark feature: ‘target sign’
Intramural gas (pneumatosis intestinalis) is a pathognomonic sign of what condition
Necrotising enterocolitis
Likely cancer:
Infant with palpable non-tender mass on flank
Painless haematuria
Reduction in appetite with a distended but non-tender abdomen
Wilms’ tumour (nephroblastoma) is an embryonic tumour from the developing kidney
Typically presents in children under 5 years of age
Definitive diagnosis of Wilm’s tumour (nephroblastoma)
Definitive diagnosis and staging can be confirmed via renal biopsy.
Small round blue cells may be seen on histology - though this is not exclusive to nephroblastomas.
Next step of management of nocturnal enuresis if enuresis alarm has been ineffective/is not acceptable to the family
desmopressin
particularly if short-term control is needed (e.g. for sleepovers)
Cradle cap is characterised by an erythematous rash with coarse yellow scales.
What is the medical name for cradle cap
Seborrhoeic dermatitis
Management of cradle cap i.e. seborrhoeic dermatitis
reassurance usually resolves within a few weeks
Topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.
if severe/persistent a topical imidazole cream may be tried
Describe the murmur associated with atrial septal defect
“ASD = A Split Double”
Fixed split S2 sound due to the increased venous return overloading the right ventricle during inspiration and delaying closure of the pulmonary valve
Describe the murmur associated with ventricular septal defect
“VSD = Very Systolic = Pansystolic”
They have a pansystolic murmur
Pathogenesis of Perthes Disease
due to avascular necrosis of the femoral head, specifically the femoral epiphysis.
What is the most common cardiac pathology associated with Duchenne muscular dystrophy?
Dilated cardiomyopathy
Pattern of inheritance for Duchenne muscular dystrophy
X-linked recessive
Characterised by progressive muscle-weakening and wasting
Definitive diagnosis of Duchenne muscular dystrophy
Genetic testing
Baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers
Diagnosis?
Edward’s syndrome (trisomy 18)
“overlapping of fingers = Edward Scissor Hands”
“Edward = Rocker”
Baby born with microcephalic, small eyes, cleft lip/palate, polydactyly, scalp lesions
Diagnosis
Patau syndrome (trisomy 13)
Baby born with webbed neck, pectus excavatum, short stature, pulmonary stenosis
Diagnosis?
Noonan syndrome
Baby born with learning difficulties, macrocephaly, long face, large ears, macro-orchidism
Fragile X
“X Large” - most of the features are large
Nephrotic syndrome is classically defined as a triad of
Proteinuria
Hypoalbuminaemia
Oedema
Most common cause of Nephrotic syndrome in children
Minimal change glomerulonephritis
“Mini = Children”
Likely Dx:
Down syndrome infant with episodic hypercyanotic ‘tet’ spells that can result in loss of consciousness
Tetralogy of Fallot
What are the four features of tetralogy of fallot
Ventricular septal defect (VSD)
Right ventricular hypertrophy
Right ventricular outflow tract obstruction
Overriding aorta
Management of tetralogy of fallot
Surgery
Five causes cyanotic congenital heart diseases (CHD)
5 Ts:
i) Tetralogy of fallot
ii) Transposition of great vessels (TGA)
iii) Tricuspid atresia
iv) Total anomalous pulmonary venous return
v) Truncus arteriosus
What is the initial management of suspected cyanotic congenital heart disease
Prostaglandin E1 (alprostadil)
Used to prevent the closure of the patent ductus arteriosus until a surgical correction can be carried out. This will allow mixing of deoxygenated and oxygenated blood so as to provide adequate systemic circulation.
“Prostaglandin Props the ductus open”
Methylphenidate (Ritalin) can be used in the management of attention-deficit hyperactivity disorder (ADHD).
What parameters must be monitored every 6 months when taking this medication
Height and weight
Methylphenidate, a stimulant, may suppress appetite and cause growth impairment in children
Diagnosis of Intestinal malrotation
Upper GI contrast study and ultrasound scan
Management for intestinal malrotation
Laparotomy
If volvulus is present (or at high risk of occurring then a Ladd’s procedure is performed (includes division of Ladd bands and widening of the base of the mesentery)
Management of Hirschsprung’s disease
Rectal washouts initially, after that an anorectal pull through procedure
Abdominal x ray features of Hirschsprung’s disease
Dilated loops of bowel with fluid levels
Not diagnostic - Full-thickness rectal biopsy is required for diagnosis
Distinguishing features of a cephalhaematoma from Caput succedaneum
Cephalhaematoma:
Usually develop after birth
Do not cross the suture lines of the skull
Blood is confined between the skull and periosteum
Caput succedaneum:
Extraperiosteal collection of blood
Can cross over the suture lines
Can be present at birth
Which one of these can cross the suture lines of the skull:
A) Cephalhaematoma
B) Caput succedaneum
B) Caput succedaneum
“Capput succedaneum ‘succedes’ in crossing over the suture lines”
What is the investigation of choice to diagnose vesicoureteric reflux?
Micturating cystourethrogram
Diagnosis of coeliac disease
Jejunal biopsy showing subtotal villous atrophy
Barlow and Ortolani test is used to examine for developmental dysplasia of the hip.
What is the Barlow test
Attempts to dislocate an articulated femoral head
Barlow and Ortolani test is used to examine for developmental dysplasia of the hip.
What is the Ortolani test
Attempts to relocate a dislocated femoral head
What is the first line investigation for developmental dysplasia of the hip in infants > 4.5. months
X-Ray
What is the first line management for developmental dysplasia of the hip
Pavlik harness (dynamic flexion-abduction orthosis)
Likely Dx:
Ultrasound shows a defect in the abdominal wall and the intestines are outside the foetal body but contained within a membrane.
Exomphalos (omphalocoele)
Foetus diagnosed with exomphalos (omphalocoele). Recommended birth plan?
Plan a caesarean section at 37 weeks
First-line replacement formula in mild-moderate cow’s milk protein intolerance in a formula-fed baby
Extensive hydrolysed formula should be tried
Replacement formula in infants with severe cow’s milk protein intolerance or if no response to extensive hydrolysed formula
Amino acid-based formula
What criteria is used to assess the probability of septic arthritis in children
Kocher’s criteria using 4 parameters:
Non-weight bearing
Fever >38.5ºC
Raised WCC
Raised ESR
Management of Slipped capital femoral epiphysis
Internal fixation across the growth plates
An emergency, as there is a risk of avascular necrosis of the femoral head.
What times should you assess the APGAR scores?
1, and 5 minutes of age. If the score is low then it is again repeated at 10 minutes.
Early-onset neonatal sepsis in the UK is most commonly caused by
group B streptococcus infection
