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Phase 3A Quiz > Child Health > Flashcards

Child Health Flashcards

1
Q

What is a normal baby weight?

A

5 Pounds 8 Oz - 8 Pounds 13Oz

2.5kg - 4kg

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2
Q

What weeks are most babies born?

A

37 - 40

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3
Q

Factors affecting birth weight?

A 
Mothers weight -Overweight women = Heavier BW
Lifestyle- Smoking and Alcohol
Diabetes
Baby Gender- M>F 
Firstborn - Tend to be smaller 
Multiplets- Tend to be smaller
Race- Caucasian sometimes larger 
Age- Teenage mums can have smaller babies
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4
Q

What is neonatal period?

A

Time of transition from uterine environment to external world

Birth to 1 Month

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5
Q

When is the perinatal period?

A

22 weeks - Day 7 birth

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6
Q

Actions for children in respiratory distress

A

High flow O2 - 15L/Min O2 Mask + reservoir bag

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7
Q

Choking Baby - What do you do?

A

5 Back Blows

5 Chest Thrusts (Baby) / Abdo Thrusts (Child)

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8
Q

Hypoglycaemic emergency - ACTION?

A

IV/IO Glucose 10% 2ml/kg

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9
Q

At what age would the average child have the ability to walk unsupported?

A

13-15 Months

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10
Q

Which pathogen class causes the most childhood respiratory infections?

A

Viruses (80%)

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11
Q

Name some respiratory viruses

A

respiratory syncytial virus(RSV),
rhinoviruses, parainfluenza,
influenza A & B
metapneumovirus and adenoviruses

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12
Q

Name some respiratory infections caused by bacterial pathogens?

A 
Streptococcus pneumoniae (pneumococ­cus)
Haemophilus influenzae,  
Moraxella catarrhalis, 
Bordetella pertussis, 
Mycoplasma pneumoniae.
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13
Q

Risk factors for respiratory infections in children ?

A 
Parental smoking
Poor nutrition
Underlying lung disease 
Immunodeficiency - 1* /2* (HIV)
Haemodynamically significant - CHD
Male gender
Poor socioeconomic status – large family size, overcrowded, damp housing
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14
Q

What antibiotic should you avoid in tonsillitis and why?

A

Amoxicillin it may cause a widespread maculo­ papular rash if the tonsillitis is due to infectious mononucleosis.

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15
Q

Which method of nutrition is optimal for newborns

A

Breastfeeding

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16
Q

Define Malnutrition

A

Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

Undernutrition or Obesity

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17
Q

What can outcomes can result from poor nutrition?

A

Reduced height & weight - Failure to thrive

Diseases in later life

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18
Q

When might you suspect a genetic condition/syndrome

A

Multiple anomalies
>3 Minor anomalies
>1 Major anomaly
One major anomaly and a few minor anomalies

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19
Q

What are the normal respiratory rates for

<1 y.
2-5y
5-12y
>12y

A
  1. 30-40bpm
  2. 25-30bpm
  3. 20-25bpm
  4. 12-20bpm
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20
Q

Why might a diaphragmatic hernia cause right apex beat deviation?

A

Liver partially enters the chest

Small intest. In left chest pushes heart and lungs to the right ->Possible left lung compression

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21
Q

What is meconium?

A

First faeces of a newborn infant.

Dark green colour

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22
Q

Explain Hirschsprung Disease?

A

Congenital disorder characterised by the Aganglinosis (absent ganglia) in the distal colon resulting in Functional Obstruction.

Presents first 48H
No Meconium passing / Passing gas
Abdominal distension

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23
Q

How many nerve plexus inner are the intestines.

Name them

A

3

Submucosal (Meissner) - Parasympathetic
Myenteric (Auerbach) - Parasympathetic
Smaller mucosal plexus

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24
Q

Where do enteric ganglion cells derive from in embryonic development

A

Neural crest

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25
Q

What is Apgar Score

Measurement criteria for APGAR

A

Score of the condition of a baby after birth.

Appearance, Pulse, Grimace (reflex irritability), Activity (muscle tone), Respiratory

Max score of 10 each sub-criteria is scored from 0-2

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26
Q

What Apgar score would require immediate resusciation

How often should APGAR be assessed

A

0-3

1,5 & 10 mins

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27
Q

When would you use a rectal thermometer on a baby?

A

Small babies who are very unwell or a child with a tympanic temperature below 33 degrees.

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28
Q

What age is a child considered a toddler?

A

1-3

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29
Q

What organisms is common for causing meningitis

A

Neissseria Meningitidis

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30
Q

Management plan for Meningitis?

A

IV Antibiotics
Steroids - >3M only
Fluids
Public health notification & prophylaxis of contacts

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31
Q

IV Antibiotics for meningitis?

A

> 3M - IV amoxicillin + IV cefotaxime

< 3M - IV cefotaxime

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32
Q

Investigations for meningitis?

A

Lumbar puncture

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33
Q

Contraindications for Lumbar puncture?

A

MENINGOCOCCAL SEPTICAEMIA

ANY SIGN OF RAISED ICP

  • Papillodedema
  • Buldging of fontanelle
  • DIC (Disseminated intravascular coag)
  • Focal neurological signs
  • Signs of cerebral herniation

PX with suspected MENINGOCOCCAL SEPTICAEMIA

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34
Q

Major Presentations for Meningitis?

A 
Fever
Photophobia 
Stiff neck 
Bulging fontanelle
Pin-prick rash
Cold extremities - hands/feet
Extreme fatigue, irritability, crying, seizures
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35
Q

Kawasaki disease Management?

A

High dose aspirin
IV Immunoglobulin
ECG

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36
Q

Major complication of Kawasaki disease?

A

Coronary artery aneurysm

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37
Q

Major Presentations for Meningitis?

A

High fever >5 days
Red eyes (conjunctival infection - non exudative)
Bright red, cracked lips, strawberry tongue
Cervical lymphadenopathy
Red palms and soles - which later peel
Maculopapular rash

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38
Q

What is Kawasaki disease?

A

Type of vasculitis which mainly affects children <5 y.o

Peak <2

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39
Q

Most common cause of gastroenteritis?

A

Rotavirus

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40
Q

When should you consider doing stool culture on children

A 
Blood or mucus in stool 
Recent abroad travel 
Diahorrea not improving by day 7 
Suspected septicaemia
Suspected gastroenteritis
Immunocompromised
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41
Q

What are risk factors for dehydration in young children?

A 
<1Y 
Low birth weight
6+ diarrhoeal  stools passed in 24 hours
Vomited 3+ times within 24H 
Children who aren't tolerated fluids 
Infants stopped feeding
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42
Q

Name some recessive conditions - (X-Linked)

A 
Haemophilia A,B 
Colour blindness
DMD
G6PD deficiency
Ocular albinism

Usually Only males are affected and females end up being carriers

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43
Q

What is Wilms Tumour?

A 
Kidney cancer in children.[Nephroblastoma]
Affects children <5y.o
Mainly Unilateral
Doesn't cross the midline
C11 defect loss WT1/WT2
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44
Q

Characteristics of Wilms Tumour?

A 
Abdominal mass 
Flank pain 
Painless haematuria
Fever
Anorexia
HTN

Any children with unexplained abdominal mass - arrange for a paediatric review 48H

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45
Q

Management of Wilms Tumour?

A

Depends on staging

Nephrectomy
Chemotherapy
Radiotherapy (Advanced stages)

Good prognosis rate 80%

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46
Q

Diagnosis of Wilms Tumour

A

US (+-doppler) - check for bilateral involvement, hydronephrosis
CT Abdo contrast
CXR - Rule out lung mets

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47
Q

What causes Scarlet Fever?

A

reaction to erythrogenic toxins produced by Group A haemolytic streptococci

Streptococcus pyogenes

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48
Q

How is Scarlett fever transmitted

A

inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges, (especially during sneezing and coughing)

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49
Q

Characteristic symptoms of Scarlet Fever?

A 
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
'strawberry' tongue
rash
-Fine punctate (Pin-head) redness, usually torso
- Sandpaper in texture
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50
Q

Diagnosis and Treatment of Scarlett Fever

A

Throat Swab
Notifiable Disease

AB should be started ASAP before receiving confirmation.

Penicillin V / Azithromycin for 10 Days

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51
Q

Complications that can arise from Scarlett fever?

A

Otitis Media
Acute glomerulonephritis
Rheumatic fever

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52
Q

Examples of X-linked dominant conditions?

A

Vit D resistant rickets (Hypophosphatemic Rickets)

Rett Syndrome

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53
Q

Define Apnoeic attack?

A

Period of non breathing lasting >20sec with cyanosis and bradycardia.

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54
Q

What organisms causes Whooping Cough

A

Bordatella Pertussis

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55
Q

What’s the diagnostic criteria for whooping cough?

A

Acute cough lasted for 14 days+ without obvious cause

Paroxysmal Cough
Inspiratory whoop
Post-tussive vomiting
Undiagnosed apnoeic attacks/episodes

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56
Q

Investigations for Whooping cough

A

Nasal Swab Culture - can take several days/weeks to come back
PCR/Serology

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57
Q

Management of Whooping cough?

A

Notifiable Disease - REPORT
Macrolide- Azithromycin 3 Day course
Household contact prophylaxis (In contact past 3/52)

Kids should exclude themselves from school for 2 days (AB) / 3 wks (No AB)

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58
Q

Name some autosomal dominant diseases?

A

Huntington’s disease
Marfan’s syndrome
Ehlers-Danlos syndrome
Osteogenesis imperfecta

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59
Q

Name some autosomal recessive diseases?

A

Sickle cell disease
Thalassaemias
Wilson’s disease
CF

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60
Q

What are Fraser guidelines usually considered for ?

A

Contraception

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61
Q

What elements of the Fraser guidelines need to be met?

A
  1. Young person understands the professional’s advice.
  2. Young person cannot be persuaded to inform their parents.
  3. Young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment.
  4. Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer.
  5. Young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.
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62
Q

True or False

16 years or older a young person can be treated as an adult and can be presumed to have capacity to decide?

A

True

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63
Q

True or False

Under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved?

A

True

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64
Q

True or False

Where a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests?

A

True

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65
Q

What are the 4 domains of development ?

A

Gross Motor
Fine Motor and Vision
Hearing and Language
Personal & Social

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66
Q

Causes of congenital cataracts?

A

Infection contracted by the mother during pregnancy - Rubella. HSV, Toxoplasmosis
Genetic defect - Downs syndrome
Post birth injury

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67
Q

What is Glue ear and how is it treated?

A

Otitis media with effusion - Middle ear fills with glue-like fluid instead of air.

Grommet - Small plastic/metal tube placed in the middle of eardrum to allow air to pass through the middle ear preventing fluid build up.

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68
Q

Glue Ear CAUSES?

A

Narrowing of eustachian tube - > disruption in air and fluid balance in middle ear

Post infections - common cold, ear infection.

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69
Q

Acute Otitis Media TREATMENT

A

Oral Analgesia - Paracetamol / Ibuprofen
[Without complications/perforation]

Delayed antibiotic therapy (7) - Amoxicillin / Clarithromyin

Last resort - Tympanocentesis

Most are self-limiting are resolve within 3 days.

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70
Q

Signs of respiratory distress

A 
Cyanosis (central or peripheral)
Tachycardia 
Tracheal Tug 
Subcostal/Intercostal recessions 
Wheeze on auscultation 
Tachypnoea
Hypoxia
Head bobbing
Stridor
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71
Q

Name the components of the Upper Respirator Tract (3) and Lower Respiratory Tract (3) ?

A

URT
Nasal Cavity
Pharynx
Larynx

LRT
Trachea
Primary Bronchi
Lungs

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72
Q

Conditions associated with wheeze?

A

Asthma
Bronchitis
Pneumonia
Viral Induce Wheeze

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73
Q

Conditions associated with stridor?

A 
Croup 
Epiglottitis 
Bacterial Tracheitis 
Anaphylaxis 
Angiodema 
Inhaled foreign body 
Diptheria
Laryngomalacia
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74
Q

What are the 3 types of Febrile Convulsions (Seizures)?

A

Seizures associated with fever with no definable intracranial cause.

Simple - <15 Minutes not recurring within 24hrs

Complex - 15-30 Minutes

Static Epileptcus ->30 Minutes

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75
Q

Define Seizure

A

Transient episode of abnormal and excessive neuronal activity in the brain.

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76
Q

Define Epilepsy?

A

Tendency to have recurrent seizures.

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77
Q

5 Headings that causes of coma?

A 
Infection-Meningitis, Encephalitis
Trauma - Head injury
Metabolic- Hypoglycaemia 
Drugs- Opiates, Lead
CNS Disorder - Seizures
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78
Q

List focal neurological signs?

A

Focal Impairments of CNS - Brain or SC

Affect specific brain function that affects specific part of the body. Left arm weakness, R Arm Weakness, Paresis, Plegia

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79
Q

Signs of Raises ICP

A 
Focal Neurological Signs
Tense/ bulging fontanelle
Systemic hypertension/Bradycardia
Abnormal body posture/ flaccidity
Unequal/unreactive pupils
Abnormal Resp Pattern
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80
Q

Define Syndrome

A

A syndrome is a group of signs or symptoms that happen together and help to identify a unique medical condition.

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81
Q

What 3 elements make up a childhood seizure?

A
  1. Type of seizures
  2. First onset of seizures
  3. Specific EEG pattern
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82
Q

What are 5 common childhood epileptic syndromes?

A
  1. Infantile spasms - 1st Year of life, spasms/jerks of the body (clusters) + possible developmental, cognition and learning issues
  2. Benign Rolandic - 3 to 10, grow out by 16, focal aware seizures,often at night, which begin with a tingling feeling in the mouth, gurgling or grunting noises and dribbling
  3. Lennox-Gaustaut -3 to 5, Multiple seizures types, Difficult to treat with AEDs, During sleep - Prolonged seizures
  4. Childhood Abscence - 4 to 10 , Many grow out by 16
    Juvenile Abscence - Do not outgrow their seizures prolonged medication
  5. Juvenile Myoclonic - 12 to 18, Usually occurs first thing in the morning, Many have triggers (lights, tiredness, stress and alcohol), Long-standing into adulthood.
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83
Q

What is a lifestyle modification for treatment of epilepsy

A

Ketogenic diet

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84
Q

Important questions things do you need to find out following a seizure?

A

Events Before, During and After the seizure

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85
Q

Questions before a seizure?

HINT: 6

A

Did anything trigger the seizure – for example, did you feel tired, hungry, or unwell?

Any warning that the seizure was going to happen?

Change in mood –excited, anxious or quiet?

Any sounds - Crying out or mumbling?

Notice any unusual sensations- odd smell or taste, or a rising feeling in your stomach?
Events prior to seizure - Where, What were you doing before the seizure?

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86
Q

Questions during a seizure?

HINT: 11

A

Did you appear to be ‘blank’ or stare into space?
Did you lose consciousness or become confused?
Did you do anything unusual - mumble, wander about or fiddle with your clothing? (Automatism)
Colour change? - (become pale or flushed) and if so, where (face or lips)?
Change in breathing? - Become noisy or look difficult
Any body movement? - Any part of your body move, jerk or twitch?
Falls?, Stiffness or floppiness?
Loss of incontinence? -Wet yourself
Did you bite your tongue or cheek?

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87
Q

Questions after a seizure?

HINT: 3

A

Post-seizure feelings – did you feel tired, worn out or need to sleep?

How long was it before you were able to carry on as normal?

Did you notice anything else?

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88
Q

Define Intussusception?

A

Invagination of one part of the bowel into another.

Usually distal part of small bowel (Ileum) into the proximal part of the Large bowel (Caecum).
Peyer Patches enlargement acts the lead point that invaginates into the distal bowel

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89
Q

What are the clinical features of Intussusception?

A 
Paroxysmal colicky abdominal pain
Vomiting 
Abdominal mass (Sausage shaped in RUQ)
Legs drawn up when crying/screaming
Redcurrent jelly stool - Blood, Mucus,

Infants 6-9 months

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90
Q

What are the consequences of Intussusception?

A

Bowel obstruction and ischaemia of the of infolded section of bowel.

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91
Q

IX and Tx for Intussusception?

A

IX - Ultrasound [Target Sign] ,Barium enema

Tx - Fluid Resus [Large volumes of fluid to restore circulation]
Broad Spec AB - Clindamycin
Surgical reduction / Air enema

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92
Q

Clinical signs of pyloric stenosis?

A

Non-bilious projectile vomiting
Constipation (Reduced fluid intake)
Late signs - Jaundice, Dehydration, malnutrition.

Palpable mass - Upper abdomen

Hypochloraemic, hypokalaemia alkalosis

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93
Q

Treatment for Pyloric stenosis?

A

Ramdert’s Pyloromyotomy

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94
Q

What is the cause of intussusception in older children?

A

POLYP / MECKEL’S DIVERTICULIM

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95
Q

Investigations for pyloric stenosis?

A

Test feed - Bottle/breastfeeding whilst palpation of baby’s abdomen - Waves of peristalsis across upper abdomen
Bloods - hyperchloraemic metabolic alkolosis [High HCO3- levels, Hypokalemia]

Diagnosis most common using US

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96
Q

What is Meckel’s Diverticulum?

IX, Clinical characterstics and Tx?

What is the rule of 2s? (4)

A

Abnormal pouch of tissue on the small intestine. Vitello-intestinal duct remnant

Nuclear medicine scan
Painless rectal bleeding due o peptic ulcertation.
Surgical removal

Rule of 2s - 2Yr old, 2ft from ileocaecal valve, 2in long, 2% of population

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97
Q

What are the signs and symptoms of IBD?

A 
Cramping lower abdo pain [CD>UC]
Bloody diarrhoea [UC>CD] 
weight loss / Faltering growth
Perianal disease [CD] 
Change/loss to menstraul cycle 
Mouth Ulcers 
Anaemia
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98
Q

Differences between UC and CD

A 
CD 
-Skip Lesions/Irregular progression pattern
-Affect all of GI Tract [Mouth to anus]
-Transmural thickness inflammation
- String sign Bar [X-ray] 
-Terminal Ileum [Origin site]
Complications - Strictures, fistulas, abscess, granulomas, lymphoid aggregates
-RLQ Mass  
-Mouth Ulcers

UC

  • Continuous proximal progression pattern
  • Anus [Origin site]
  • Smoking protective
  • Submucosa/mucosa thickness inflammation
  • Lead pipe sign [Bar X-ray]
  • Complications - Toxic megacolon, Hamorrhage
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99
Q

Treatment for CD?

A

Steroids, Immunosuppresants - Prednisolone & Mesalazine
Surgery

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100
Q

Treatment for UC?

A

Steroids & Immunosuppresants - Prednisolone, Inflixamab,
Surgery - Colectomy

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101
Q

Define Constipation?

A

Delay or difficulty in defecation of greater than 2 weeks.

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102
Q

Red flags of constipation?

A

Faltering growth
Meconium passed >24H
Abdominal distention or vomiting
Delyaed walking/lower limb neurology

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103
Q

What is a characteristic sign of spina bifida

A

Hairy Patch

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104
Q

Clinical Features of JIA?

A 
joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows
limp
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
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105
Q

What investigations can you do for JIA?

A

ANA - May be positive (especially in oligoarticular JIA)
Rheumatoid factor - Usually negative
[Non-specific]

Infection Screen - Throat swab, Urinalysis, Viral serology

Inflammatory markers - ESR, CRP

FBC- Anaemia/Thrombocytosis/Neutrophillia

Imaging - XRay/ US

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106
Q

What is JIA?

A

Arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks

Autoimmune disorder
Synovium is attacked causing inflammation.
Most Common type - 4 or Fewer joints affected (Oligoarthritis)

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107
Q

Differential Diagnoses for arthritis in children?

A

Infective- Septic arthiritis, Osteomylitis, Rubella
Maliganancy - Leukeamia
Orthopaedic - Perthes disease / Hip Dysplaisa
Hypermobility - Marfans/EDL
Connective tissue disease - SLE
Haematological - SCD/ Haemophilla
Vasculitic - HSP, Kawasaki

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108
Q

Management of JIA?

A 
Analgesia -Naproxen/Diclofenac/Ibuprofen
Regular Eye screen 
Daily Exercise 
Steroid injections - triamcinolone
DMARDS - Methotrexate (+Folic Acid)
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109
Q

Differentials for a limping child?

A 
Septic arthritis/osteomyelitis
JIA
Trauma
Development dysplasia of the hip
Perthes disease
Slipped upper femoral epiphysis
Transient synovitis
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110
Q

What is Perthes Disease?

A

Degenerative condition affecting the hip joints due due to avascular necrosis of the femoral head

M>F - X5 more common
4-8 Yrs

Clinical Features
Hip pain: develops progressively over a few weeks
Limp
Stiffness and reduced range of hip movement
X-ray: Early Signs - Widening of joint space,
Late Changes - Decreased femoral head size/flattening

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111
Q

Define Septic Arthritis?

A

Infectious Arthritis of the synovial joint.

Paeds - Knee>Hip>Ankle [Commonly affected joints]
Neonates - Can develop from osteomyelitis

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112
Q

Whats the most common pathogenic cause and spread of Septic Arthritis?

A

Staphyloccocus Aureus
Haematogenous spread

Teenagers - Sexually active N. Gonorrhoeae

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113
Q

What is the Kocher Criteria for Septic Arthritis?

A

Fever >38.5 degrees C
non-weight bearing (Unable to bear any weight on the joint)
raised ESR
raised WCC

Unilateral or bilateral involvement (Mainly unilateral)

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114
Q

Tx for Septic Arthritis?

A 
IV Vancomycin
IV Clindamycin (Pen allergy) 
IV -Ceftriaxone (Gonorrhoea)
6-12 Weeks 
Splintage in acute setting 
Physiotherapy - Avoid stiffness
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115
Q

Investigations for Septic Arthritis?

A

Joint Aspiration - decompress the joint and obtain synovial fluid

Bloods - Culture, FBC, ESR, CRP

US of the joint - Effusion detection
X-ray - Widened joint space =effusion

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116
Q

What is osteomyelits?

A

Infection of the bone

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117
Q

Causative organisms in osteomyelitis?

A

Staph. aureus is the most common

Patients with sickle-cell anaemia - Salmonella

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118
Q

Tx for Osteomyelitis

A

IV emperical antibiotic therapy

Flucoxacillin
Teicoplanin
Tazocin

119
Q

IX for Osteomyelitis?

A 
Inflammatory markers -CRP/ESR
WBC -Elevated
MRI  
Ultrasound 
Blood cultures
120
Q

Risk Factors for Osteomyelitis?

A 
Sickle cell disease
Diabetes 
IV drug user
Immunosuppression
Alcohol excess
121
Q

Clinical Signs for Osteomylitis

A

non speciific pain
Fatigue & Malaise
Low grade fever

122
Q

What are the pubertal developmental signs in boys?

A

first sign is testicular growth at around 12 years of age (range = 10-15 years)
testicular volume > 4 ml indicates onset of puberty
maximum height spurt at 14

123
Q

What are the pubertal developmental signs in girls?

A

first sign is breast development at around 11.5 years of age (range = 9-13 years)
height spurt reaches its maximum early in puberty (at 12) , before menarche
menarche at 13 (11-15)
there is an increase of only about 4% of height following menarche

124
Q

Who starts puberty first?

A

Girls

125
Q

What is Necrotizing enterocolitis (NEC)?

Clinical Features?

Treatment?

A

Condition in which a portion of the bowel dies. Usually in premature newborns. Due to an exaggerated immune response within the bowel.

Features - poor feeding, abdominal distension and bloody stools, vomiting

X-Ray: gas cysts in the bowel wall, Football sign (Gas outlining falciform ligament)

Tx: IV feeding (TPN) + Antibiotics, IVFluids

Surgical :- Only if obstruction, GI perforation

  • SURGICAL EMERGENCY*
  • Premature babies MAJOR RISK FACTOR
126
Q

Croup Treatment

A

Oral Dexamethason 0.15mg/kg

Emergency - High flow O2 + Nebulised Adrenaline

127
Q

What does Indometacin do?

A

NSAID blocks prostaglandin synthesis and helps initiate duct closure.

128
Q

How does the Ductus arteriosus close?

A

First breaths due to increased pulmonary flow which enhances prostaglandins clearance

129
Q

Classic triad of meningitis symptoms

A

Neck stiffness, photophobia, headace

130
Q

Signs of respiratory distress

A

Grunting
Nasal flaring
Use of accessory respiratory muscles - Subcostal/Intercostal recession/ Tracheal tug (WOB++)
Tachypnoea

131
Q

What is Cepacia syndrome?

A

Necrotising pneumonia that occurs in patients with CF
Liquefaction and cavitation on CT
Bulkholderia infection.
Very high mortality rate in CF patients

132
Q

Common infective organisms in patients with CF?

A 
Staph Aureus
Pseudomonas aeruginosa
MRSA
H. Influenza
Bulkholderia
133
Q

Management for CF

A

regular (at least twice daily) chest physiotherapy and postural drainage.
Deep breathing exercises
High calorie diet, including high fat intake
Minimise contact with each other to prevent cross infection with Burkholderia cepacia complex and Pseudomonas aeruginosa
vitamin supplementation
pancreatic enzyme supplements taken with meals
heart and lung transplant (In serious cases)

134
Q

Paediatric BLS Steps?

A 
unresponsive? - shout for help
open airway
look, listen, feel for breathing
give 5 rescue breaths
check for signs of circulation
15 chest compressions:2 rescue breaths (2+ ppl) / 30:2
135
Q

What does a presence of raised Immunoreactive trypsinogen (IRT) in blood indicate?

A

Possible CF.

Needs to be followed up by a SWEAT TEST

136
Q

What day of birth are newborns tested for congenital diseases?

Which diseases?

A

Day 5 - Heel Prick (Guthrie Heel Prick)

SCD
Congenital hypothyroidism
CF - Cystic Fibrosis
PKU - Phenylketonuria

137
Q

What is a sweat test?

A

Test to measure the amount of chloride excreted in sweat.

Patient’s with CF have abnormally high sweat chloride.
Normal value < 40 mEq/l
CF indicated by > 60 mEq/l

138
Q

Causes of false positive sweat test

A 
Skin Oedema
malnutrition
adrenal insufficiency
glycogen storage diseases
nephrogenic diabetes insipidus
hypothyroidism, hypoparathyroidism
G6PD
ectodermal dysplasia
139
Q

What does a Hydrogen breath test do and how does it work?

A

Exclude fructose and lactose malabsorption.

Anaerobic bacteria produce hydrogen when exposed to unabsorbed sugars and carbohydrates so in malabsorption there are more unabsorbed foods which so more hydrogen is produced

140
Q

What is the Rome IV criteria and what is it used for?

A

To classify IBS

Recurrent abdo pain,
on avg at least 1 day per week in the last 3 months. Onset >6m before diagnosis

Associated with at least 2
Change in appearance (form) of stool
Change in frequency of stool
Pain related to defecation.

141
Q

what genes are associated with Coeliac disease?

A

HLA-DQ8 & HLA- DQ2

142
Q

Symptoms of coeliac disease?

A

Failure to thrive
Diarrhoea
Abdominal distension
Anaemia - older children may present

143
Q

What is Coeliac disease?

A

Coeliac disease is caused by sensitivity to the protein gluten. Repeated exposure leads to villous atrophy which in turn causes malabsorption.

144
Q

Diagnosis for Coeliac disease?

A

jejunal biopsy showing subtotal villous atrophy

anti-endomysial and anti-gliadin antibodies are useful screening tests

145
Q

What is Kocher’s Criteria?

A

Tool used to differentiate between Septic Arthritis & Transient Synovitis (Irritable Hip)

Temp >38.5
Refusal to weight bear on affected limb
Raised inflammatory markers -ESR >40mm/hour + CRP >20mg/l
Raised WCC >12 x 10^9

146
Q

What are the risk factors for Developmental dysplasia of the hip (DDH)?

A

female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios (Lack of amniotic fluid in placenta)
birth weight > 5 kg
congenital calcaneovalgus foot deformity (foot and ankle excessively bent up)

147
Q
  1. Screening for DDH?

2. Examination for DDH?

A
  1. FH of hip problems early in life
    Breech presentation after 36wks
    Multiple pregnancy (Twins +)
    Newborn & 6week check of hips
  2. Barlow (Attempt to dislocate femoral) & Ortalani (Relocate a dislocated femoral head)

Symmetry of leg length
US if needed / X-Ray (Older children 5M+)

148
Q

Tx for DDH

A

Most hips spontaneously stabilise by themselves
Pavlik Harness
Surgery

149
Q

What things may indicate a harmless murmur?

HINT: 4S?

A

Soft
aSymptomatic
left STERNAL edge
Systolic Hx

150
Q

What is Croup?

A

Laryngeotracheobronchitis

Infection of the upper airway which obstructs breathing and causes inflammation around the voice box (larynx), windpipe (trachea) and bronchial tubes (bronchi)

151
Q

Croup Clinical Features

A 
Barking cough
Stridor
Hoarse Cry/Voice 
Poor Feeding 
Worse at night
Mild Fever
152
Q

What should you ensure when examining a child with URTI/Obstruction?

A

Not to distress child and don’t examine throat.

153
Q

Main pathogens causing croup?

A

PAIR

Parainfluenza
Adenovirus
Influenza A & B
RSV

154
Q

Define Epiglottis?

A

Rapidly progressive infection causing inflammation of the epiglottis and surrounding tissues leading to upper airway obstruction.

Life threatening emergency.

155
Q

What is the causative pathogen for Acute Epiglottis?

A

Haemophillus influenza B (HiB)

Vaccination available - From 2M

156
Q

Clinical features of epiglottis?

A

Sore throat
Child Drooling - Unable to speak or swallow
High fever
Difficulty swallowing / Pain during swelling (Odynophagia)
Tripod Position - Abnormal positioning, Sitting up leaning forward extending the neck.
Inspiratory stridor - Soft
Respiratory distress - Retractions

157
Q

Epiglottitis Management?

A

IV Cefuroxime, Airway management (O2), Steroids (Dexamethasone)

158
Q

How do you estimate children’s weight in an emergency setting?

A

(Age+4)x2

159
Q

What are some possible side effects of salbutamol?

A

Tachycardia
Hypokalaemia - Intracellular movement of potassium from extracellular space
Hyperglycaemia - Stimulation of gluconeogenesis

ECG monitoring
BG Monitoring.

160
Q

What Vaccines are in the 6-in-1 ?

A

D - Diptheria (Corynbacterium diphtheria)
T - Tetanus (Clostridium tetani?)
aP - Pertussis (B. Pertussis)
IPV - Polio (?Poliovirus)
HiB - Haemophilus influenza B (?Meningitis)
Hep B

2/3/4 months

161
Q

Whats signs indicate life-threatening asthma attack?

A 
Sats <92
PEF <33% best/predicted 
Silent chest 
Poor respiratory effort 
Cyanosis 
Altered consciousness 
Agitation
162
Q

Whats signs indicate life-threatening asthma attack?

A

Sats <92&
PEF 33-50 best/predicted
Too breathless to talk or eat

HR = >125bpm (>5+ yrs)
HR=  >140bpm (1-5 yrs)
RR = >30bpm (>5+ yrs)
RR = >40bpm (1-5 yrs)

Use of accessory neck muscles

163
Q

Management Steps for asthma?
(5-16yrs)

Hint: 7 Steps

A

Children aged 5-16 managed like adults

  1. SABA
  2. SABA + low dose ICS
  3. SABA + low dose ICS + Leukotriene receptor antagonist (LRTA)
  4. SABA + low dose ICS +LABA
  5. SABA + low dose ICS+ MART (Maintenance & reliever)
  6. SABA + Moderate ICS MART
  7. SABA + High ICS + MART / Theophylline

REFERRAL

164
Q

Management steps for asthma?
(<5yrs)

Hint: 4 Steps

A
  1. SABA
  2. SABA + Moderate ICS (8wk trial of symptoms)

Review point >4wks reoccurrence give / <4wks restart trial

  1. SABA + Low ICS + LTRA
  2. Stop LTRA + REFERRAL
165
Q

What signs indicate poorly controlled asthma?

A 
asthma with symptoms >= 3 / week use of reliever
night-time waking
Not eacheive acceptable peak flow 
Increase SOB, wheeze, coughing
Poor tolerance to physical activity 
Treatment response slowing down 
Non adherence
Increase use of quick-relief medication (>12 puffs per day)
166
Q

What is a low, moderate and high dose of ICS?

A

Low - <200 mug budesonide
Moderate- 200-400 mcg budesonide
High- >400 mcg budesonide

167
Q

Define Asthma?

A

Chronic inflammatory disorder due to airway inflammation, bronchial hyperactivity and reversible airway obstruction.

168
Q

What things cause airway obstruction in asthma?

A

Bronchospasms
Increased mucous production - Mucous plug
Mucosal swelling and inflammation

169
Q

Clinical features for asthma?

A 
SOB
Increase WOB
Chest tightness
Coughing (after exercise/nocturnal) 
Expiratory wheeze + Prolonged expiration
Chest wall deformity (Hyperinflation, Barrel-shaped chest) 
Diurnal Variation - (Symptoms worse at night, occur throughout the day)
Sptum production 
Decrease exercise tolerance
170
Q

What factors may trigger episodes of wheeze in asthmatics?

A 
Weather change - Cold
Environmental - Tabocca smoke 
Exercise 
Emotions
Infection
171
Q

What type of wheeze is usually heard in asthmatics?

A

Widespread Polyphonic wheeze.

Localised wheeze suggests alternative diagnoses e.g. Inhaled FB

172
Q

Key investigations for Asthma?

A

Spirometry - Obstructive pattern FEV1/FVC <70%
FEV1 <80%

Bronchodilator reversibility - Reversibility shown 12% improvement in FEV1/FVC significant/suggestive of asthma.

CXR - Hyperinflation, Atelectasis (collapse/closure of a lung),

173
Q

Key steps for acute managment of asthma?

A 
ABCDE 
High flow O2
Salbutamol nebs 
Ipratropium bromide nebs 
IV salbutamol (Cardiac monitoring/Blood glucose monitoring) 
Magnesium sulphate IV (bronchodilator)

Nebs only in severe acute asthma. Use inhalers for mild to moderate severity.

174
Q

What is montelukast?

A

LTRA - preventer tablets

effective in exercise-induced asthma and in asthma associated with allergic rhinitis

175
Q

Give examples of reliever inhaler?

Give example of preventer inhaler?

Explain the 3 different types of device inhalers?

A

Ventolin, Salamol

Beclomethasone, Budesonide, Fluticasone

Metered dose inhalers (MDIs) - give the medicine in a aerosol for - e.g. Ventolin

Breath actuated inhalers (BAIs) - automatically release a spray of medicine when you begin to inhale. e.g. Easi-breathe

Dry powder inhalers (DPIs) - Give the medicine in a dry powder instead of a spray. e.g. Accuhaler

176
Q

Name some LABAs?

A

Folmetrol, Salmetrol

Theophylline (Tablet form)

177
Q

Side effects of steroid treatments?

A

Impaired growth
Altered bone metabolism
Adrenal suppression
Oral candidiasis

178
Q

Usual dose for salbutamol?

A

2 puffs 5 mins before exercise/ every 4-6 hrs

100mcg/dose mdi

179
Q

What is meconium illeus?

A

Bowel obstruction caused by meconium of the distal ileum due to abnormally thick and impacted meconium.

Meconium: earliest stool of a newborn. Thick, dark green poop is made up of cells, protein, fats, and intestinal secretions (bile).

180
Q

Define Cystic Fibrosis?

A

Autosomal recessive genetic disorder leading to a defect in the CF Transmembrane receptor protein (CTFR) which results in defective ion transport in exocrine glands.

Increased viscosity of secretions and blockage of narrow passageways.

Pancreatic ducts blocked by thick secretions - maldigestion/absorption/steathorrea

Reduction in air surface liquid layer / impaired cillary function to clear mucus.

181
Q

What are exocrine glands?

A

Glands that excrete products onto body surfaces or into body cavities directly or via ducts

i.e. Mucous, sweat, oil & salivary, tear glands

182
Q

What are the clinical features of cystic fibrosis?

A 
DMT
Short stature
Delayed Puberty 
Nasal Polyps 
Male infertility/Female subfertility
Recurrent chest infections
Steathorrea/Malabsorption  
Meconium iléus - Neonate
Failure to thrive, poor weight gain, weight loss
Cough
Wheeze 
SOB
Sputum production 
Haemoptysis
GORD
Hepatosplenomegaly 
Clubbing
183
Q

Investigations for CF?

A

Heel prick screening test - Raised IRT (immunoreactive trypsinogen)
Sweat test - Increase in CL ions / >60mmol/L , (neg <30)
Faecal elastase (low levels)
Genetic screening - abnormal CFTR protein.
Pancreatic enzyme levels - Protease, lipase, amylase (decreased)

184
Q

Complications of CF?

A

COPD
Pancreatic insufficiency -
Liver disease - Cirrhosis & Portal HTN
GORD
Male infertility
DMT
Delayed puberty
Arthropathy
Intussuception / Bowel obstruction - Distal intestines
Respiratory conditions - Pneumothorax, Bronchietasis, Recurrent chest infections

185
Q

Differentials of CF?

A

Coeliac disease
Asthma - no clubbing/purlent bronchitis
GORD - no malabsorption
Primary immunodeficiency

186
Q

What may failure to pass meconium mean?

A

Possible CF / Bowel obstruction

Ideally want it to be passed within first 24 hours.

187
Q

What genetic abnormality occurs in CF?

A

Males - Absence of vas deferens

188
Q

Possible examination findings with CF patients

A 
Clubbing 
Nasal polyps 
Bilateral absence of vas deferens 
Low BMI/ Below normal vmi
Increased AP diameter of the chest
Stool mass - RLQ 
Hepatosplenomegaly
189
Q

Treatment for meconium ileum?

A

Water soluble contrast enema + Lactulose (Oral osmotic agent)

Surgery (If failure of med management) + NG decompression + supportive therapy

190
Q

Management for CF

A

Chest physiotherapy - Breathing exercises, chest percussion
Postural draining + mucolytics (hypertonic saline inh)
Prophylactic ABx
High caloric diet + Vit Sups (AEDK)
Pancreatic enzyme replacement - CREON
Regular review - Every 3M
Bronchodilators (Inhaled salbutamol)

Teams involved: Docs, nurses, dietician, physios, psychologists.

191
Q

Which organisms are common CF Patients for recurrent chest infections?

A

Staph Aureus, Psedudomonas, Haemophilus

192
Q

Main objectives of CF treatment?

A

Prevention of colonisation and infection of lungs
Nutritional support
Effective mucocillary clearance

193
Q

Coryzal symptoms

A

Acute Inflammation of nasal mucous membranes

Runny noses
Sore throat,
Sneezing,
Fever

194
Q

Acute Cough Differentials?

A 
Allergic rhinitis 
URTI
Asthma
Common cold 
CHF -LVHF
Sinusitis
COPD
Foreign body aspiration
GORD
Pneumonia
Viral syndrome
Post Nasal drip (Excess mucus production that felt in back of nose and throat)
195
Q

Explain diurnal variation in asthma?

A

Asthma is worse at night. Gets worse as the day goes along.

Causes for variability in peak flow. i.e gets higher as midday aproaches and very low at nighttime (Increase resistance)

Highest in the morning. Cortisol is lowest midday/evening. Exaggerated peak occurs at the same time as the greatest airway inflammation in asthmatics.

196
Q

Bile stained vomit in 1st week of life. Primary differential until proven otherwise?

A

Intestinal Malrotation

Mainly affecting male infants.

197
Q

What is Succussion?

A

Gastric Solash - Audible Sloshing sound during auscultation.

198
Q

Define Achalasia?

A

Where oesophagus loses the ability to move food and liquid to stomach.

LES fails to open (Smooth muscles unable to relax) and peristalsis is lost.

Back passage of food

199
Q

When are Atrovent Inhalers given?

A

Useful in children with Atopy with Wheeze when Salbutamol fails

200
Q

What is Motelukast

A

Leukotriene Receptor Antagonist

  • Preventer/Maintenance Asthma treatment
  • Given in children w/ no history of Atopy
201
Q

What is Ipratropium bromide?

A

Antimuscarinic (Anticholinergic) Bronchodilator

Short Acting
B2 Agonist

202
Q

What can be used to bring down hyperbilirubinaemia?

A

Ursodeoxycholic Acid - Brings down serum bilirubin levels.

203
Q

Why is caffeine given to neonates?

A

Improve cardiac drive.

204
Q

Name the conditions to the defect?

  1. Defect in phenylalanine hydroxylase
  2. Decreased Alpha-ketoacid dehydrogenase
  3. Defect in Cysteine transporter
  4. Deficiency in homogentisic acid oxidase
  5. Defect in tyrosinase
A
  1. Phenylketonuria - Excess of phenylketones in the urine which an accumulation leads to a musty odour of skin & hair
  2. Maple-syrup urine disease (Brain damage + Fatal)
  3. Cystinuria - Persistant kidney stones
  4. Brown/Black urine discolouration when exposed to air
  5. Albinism - Complete absence of pigment in skin, hair & eyes.
205
Q

What is the emergency resuscitations steps for a neonate?

A

Dry Baby Throught -> Remove wet towel
[Colour, tone, breathing,HR]

Total of 10 inflation breaths [5 Inflation breaths + Repeat 5]
[123 off, 223, 323, 423, ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀]

Breaths + Ventilation + Compressions
Ventiation for 30 seconds [1on,1off]

[30 second given before ventilation as HR improves with effective aeration]

Assess

HR <60 following ventilation -> MOVE TO CHEST COMPRESSIONS

3: 1 RATIO (COMPRESSION:VENTILATION) . HR should be checked every 30 seconds.
- Thumbs internipple line, central sternum (Just belwo nipples) / Downwards 2 fingers action

[Appropriate mask]

206
Q

What is the ratio of chest compression: ventilations in a child?

A

15: 2

207
Q

What techniques can be used to help infants with GORD?

A

Thickening of feeds

Position infant 30 degrees head up -prone position post feeding

208
Q

What injury can can shoulder dystocia during labour delivery cause?

A

Erbs Palsy - Trauma of upper trunk of branchial plexus (C5/6)

-Injury of Radial, Axillary, Musculocutaneous nerve

Complications - Arm remaining adducted (deltoid paralysis) and Medial rotation (trees minor paralysis) , Wrist drop (paralysis of wrist extensors).

Sensory loss- Posterolateral aspect of limb

209
Q

What is the Treatment of choice for Haemophilia B ?

A

Recombinant factor 9 (IX)

Prophylactic use in severe cases/hx of significant bleeds

210
Q

What is the treatment choice for Haemophilia A?

A

Recombinant factor 8 (VIII)

Prophylatic use in severe cases/hx of significant bleeds

211
Q

What will a Persistent VSD (Untreated) lead to?

A

Pulmonary HTN (Compensatory pulmonary vascular hypertrophy) + CHF

Cyanosis

212
Q

Eisemenger Syndrome?

A

Shunt reversal of blood. Right to Left

213
Q

Phenylketonuria (PKU)

A. Inheritance Pattern
B. Error
C. Characteristic features
D. How is it screened

A

A - Autosomal recessive condition which affects amino acid metabolism.
B. Phenylalanine hydroxylate (deficiency)
C. Eczema (non-responsive), Musty smell of child’s urine /breath, behavioural problems, seizures/learning disability.
D. Heel-prick-test

214
Q

G6PD Deficiency (Glucose-6-Phosphate Dehydrogenase)

A. Inheritance Pattern
B. Complications

A

A. X-linked recessive

B. Individual develop haemolysis (haemolytic crisis) which can be triggered by an infection or various medications.

215
Q

What is HSP (Henoch-Schonlein purpura)?

A. What is it
B. Distribution of Rash
C. Other symptoms
D. Who it usually affects.

A

Anaphylactoid purpura, Small vessel vasculitis characterised by palpable purpura.

Buttocks, lower extremities
Polyarthalgia, GI symptoms (N&V, Colicky abode pain, Diarrhoea/Constipation/ Blood and mucus per rectum) + glomerulonephritis

4-7 year olds

216
Q

Investigations for HSP?

A

Urinalysis - Proteinuria + Microscopic Haematuria, RBC Casts

217
Q

INTUSSUSCEPTION [PAEDIATRIC EMERGENCY]

Key Clinical Findings
Hint: 3’S + Triad Symptoms

A

Screaming and pallor
Stool - Redcurrant jelly
Sausage shaped mass, palpable RHS of abdomen

Triad of symptoms

  • Vomiting (Bilous vomiting)
  • Abdo Pain
  • Blood and mucus PR

Indrawing of legs to chest

218
Q

What is Intussusception?

A

Bowel segment invaginate into a neighbouring part of the bowel (Bowel telescoping) causing obstruction.

<1 years old, BOYS

219
Q

What site does Intussusception usually occur?

A

Ileocaecal junction.

220
Q

What is mesenteric adenitis and clinical features?

A

Swollen (inflamed) lymph glands in the abdomen causing abdominal pain.

RIF Pain, Fever, Lymphandenopathy, Sore throat/ symptoms of a cold

AKA Mesenteric lymphadenitis

221
Q

Management of Mesenteric adenitis?

A

Supportive Care - Analgesia (Paracetamol and Ibuprofen)

Antibiotics may be given to treat underlying bacterial infection if suspected.

222
Q

Drug treatment choice for procedural sedation?

A

Midazolam (Oral/Intranasal)
Nitrous Oxide
Ketamine

223
Q

Why are child protection plans put in place?

A

Children are thought to be at risk of significant harm.

224
Q

Aims of child protection plans?

A

Ensure child is safe from harm and prevent them suffering further harm
Promote child’s health and development
Support family and wider family members to safeguard and promote welfare of their child.

225
Q

What is Merkel’s Diverticulum?

Hint Rule of 2s (6s)

A

Congenital abnormality of small intestine caused by persistence of vitalise duct.

PAINLESS RECTAL BLEEDING

2 % of population prevalence
2 :1 ratio (M/F)
2 - 2 Inches long
2 - 2 Feet from ileocaecal valve
2- 1/2 contain ectopic tissue -gastric/pancreatic
2 - Rectal bleeding under 2s (Important cause)

226
Q

Treatment for Merkel’s Diverticulum?

A

Excision of diverticulum and its adjacent ideal segment

227
Q

Characteristic Ultrasound for pyloric stenosis?

A

Target lesion

>3mm muscle thickness

228
Q

Characteristic findings in pyloric stenosis

A

Non-billious Projectile vomiting
RUQ Pain, Palpable mass (size of a grape/olive shaped)
Visible peristalsis

229
Q

What condition is duodenal atresia associated with?

A

Downs Syndrome (Trisomy 21)

230
Q

Define gastroschisis?

A

Abdominal contents have herniated throughout he abdominal wall.

No covering of contents.

231
Q

Immediate treatment for gastroschisis?

A

Incubate, fluid resus, ng tube, surgery

232
Q

What should you do if a non-vaccinated child gets exposed to someone infected with measles?

A

Offer MMR Vaccine - WITHIN 72 HRS

Produces antibodies quicker than natural infection.

233
Q

Triad of Shaken Baby Syndrome?

A

Retinal haemorrhages,

Subdural haematoma, and encephalopathy.

234
Q

Pink Salmon Rash. Characteristic for what condition?

A

JIA - Juvenile Idiopathic Arthritis

235
Q

If testes are undescended at what point do you take action?

A

Review at 3 months then referral for orchidopexy
(Surgery to move undescended testicles - Around 1yrs)

Bilateral - REVIEW WITHIN 24HRS

236
Q

Complications of undescended testes?

A

Infertility
Torsion
Testicular cancer

237
Q

What type of vaccine is Rotavirus.

When is it given?

A

Oral, live attenuated vaccine

2 doses (8 Weeks, 12 Weeks)

Doses shouldn’t be given at (14 weeks, 23weeks - Intussusception risk)

238
Q

Example of inactivated toxin vaccine (toxoid)

A

DTP (tetanus, diphtheria and pertussis)

Should be deferred in children with an evolving or unstable neurological condition

239
Q

When is the 6-in-1 Vaccine given?

What does it protect against?

A

8, 12 and 16 weeks old.

Diphtheria
Hepatitis B
Hib (Haemophilus influenzae type b)
Polio   
Tetanus
Whooping cough (pertussis)
240
Q

Name Some Live attenuated vaccines?

A 
BCG
MMR
Influenza (intranasal)
Oral Rotavirus
Oral Polio
Yellow fever
Oral Typhoid
241
Q

Name some inactivated vaccines?

A

Rabies
Hepatitis A
Influenza (intramuscular)

242
Q

Who is the MMR Vaccine contraindicated in?

A

Pregnant women

243
Q

Some of the features that may present from hypothermia in newborn baby

A

Poor feeding
Grunting
Low saturations
Low blood sugars

244
Q

TORCH INFECTIONS?

A

Toxoplasmosis - Cerebral palsy, Hydrocephalus/Microcephaly

Rubella - Sensorineural deafness, Glaucoma, cataracts

Cytomegalovirus - Growth retardation, Sensorineural deafness

Herpes simplex - Limb hypoplasia
-Give VCZ Immunoglobulins

-Congenital abnormalities (Intracerbral calcifications, Periventricular haemorrhage)

245
Q

What is Vit K important in production of?

A

Clotting factors

10,9, 7, 2 (1972) + Protein C + S

246
Q

When is the latest a child should be babbling or imitating sounds?

A

9 MONTHS

REFERRAL FOR FULL DEVELOPMENTAL ASSESSMENT IF NOT.

247
Q

Define Acute Otitis Media (AOM)?

Most common causing pathogens?

A

Acute inflammation of the middle ear. Symptoms for ear infection lasting <3w

Strep. pneumonia, Haemophilus influenzae, Moraxella catarrhalis

248
Q

Complication of Otitis Media?

A

Perforation of tympanic membrane (Severe pain + Pop and discharge)
Temporary hearing loss
Meningitis
Mastoiditis

249
Q

Treatment for perforated tympanic membrane?

A

5-day course of amoxicillin

Primary care review

250
Q

Symptoms of AOM?

Findings on examination

A 
Fever 
Ear tugging (reflecting pain) 
Irritable child
Poor sleeping
URTI Symptoms (Recent URTI -> AOM complications) -ENT EXAM essential

Otoscopy
- Red, bulging, inflamed tympanic membrane

251
Q

Why AOM more common in children?

A

Eustachian tube is more horizontal which imparts clearance of bacteria and viruses.

252
Q

Criteria for Atypical UTI?

A 
Infection with non-e.coli organism
Seriously ill child
Poor urine flow 
abdo/bladder mass 
raised creatinine 
septicaemia 
failure to respond to abx treatment within 48H
253
Q

Management for an Atypical UTI in UNDER 6M

A

Urgent US - Urinary tract structural abnormalities?
Routine DMSA post infection 4-6M - Kidney scarring/renal agenesis (growth failure)
MCUG (Micturating cystourogram) - Looking for Vesico-uteric reflux/posterior urethral valve

Over 6M - Routine US + DMSA Only

254
Q

When is a MCUG indicated for UTIs?

A

Any Dilation present on US
Poor urine flow
FH of VUR
Non-ecoli infection (atypical)

255
Q

Causes of Cervical Lymphadenopathy?

A

L - Leukemia/Lymphoma
I - Infection
S - Sarcoidosis
T - Tumours/TB

256
Q

What conditions does Epstein-Barr-Virus tend to cause?

A

Glandular fever

Infectious mononucleosis

257
Q

Haemorragic disease of newborn (HDN)

CAUSE?
Signs?

A

Vitamin K deficiency

Largely asymptomatic, Intracranial haemorrhages, bleeding internal organs, Intramuscular haemorrhage

258
Q

Inhaled corticosteroids can cause Oral Candidiasis. How can you prevent this?

A

Rinsing the mouth with water after inhalation of a dose.

Using a Spacer device

259
Q

Side effects of SABA/LABAs

A

Tachyarrhythmias
Tremors
Dizziness

260
Q

What is classed as a recurrent UTI?

A

2 or more episodes of UTI with acute pyelonephritis/upper urinary tract infection

1 episode of UTI with acute pyelonephritis/UUTI + 1/more episodes of UTI with cystitis/lower urinary tract infection, or

3 or more episodes of UTI with cystitis/LUTI

261
Q

DiGeorge Syndrome Main features?

HINT:CATCH22

A 
C-Cardiac abnormalities (TOF, Trunc Art, Interrupted arch)
A-Abnormal facies 
T- Thymic aplasia/hypoplasia
C-Cleft palate
H-Hypocalcaemia
22- Deletion of chromosome 22 (22q11)
262
Q

Tay-Sachs Disease

Characteristic features?
Deficiency defect?

A

Macula cherry red spot, Progressive neurodegeneration, NO HEPATOMEGALY

Hexosamindase A

263
Q

Follow up action on Abnormal hip NIPE examination?

A

Scan within 2 Weeks

Ultrasound of both hips at 4-6 weeks for any RF patients + d

264
Q

When does the ductus arteriosus usually close by?

A

By day 11.

265
Q

What is oesophageal atresia?
Primary features?
Risk factors?

A

Oesophageal tube is interrupted becoming a closed off from the rest of the tube.

Fistula develop with nearby trachea leading to complications

Primary Features
Increased drooling secretions
Regurgitation of feeds / Aspiration
Choking - Cyanosis/Respiratory distress

Treatment - Surgical
-Tracheo-oesophageal fistuala repaired & blind ends of oesophagus reconnected

RF
Polyhydramnious

266
Q

Newborn Respiratory Distress Syndrome (NRDS).
What are the signs? ‘

What maternal pre-existing condition is a risk factor?

A 
Grunting 
Tachypnoea 
Intercostal recession
Increased respiratory efforts 
Bilateral pulmonary oedema

Diabetes - Infants from diabetic mothers have delayed lung maturation.

267
Q

Explain why Total Thyroxine concentration increases during pregnancy?

A

Increased hepatic synthesis of thyroid-binding globulin.

268
Q

What does a positive coombs test indicate

A

Fetus is RH +VE (At risk of Rh isoimmunisation)

269
Q

Fetal Complications of Rh Isoimmunisation

A

Jaundice and hepatosplenomegaly
Kernicterus
Hydrops fettles (gross oedema)
Haemolytic anaemia (erythroblasts on peripheral blood smear)

270
Q

Embroyological reason why TOF occurs?

A

Anterosuperior displacement of the infundibular septum

S -VSD
H - RVH
O - OVERRIDING AORTA
P - PULMONARY STENOSIS

271
Q

Embroyological reason why Truncus arteriosus occurs?

A

Failure of the aorticopulmonary septum to divide

272
Q

Embroyological reason why TGA occurs?

A

Failure of the aorticopulmonary septum to spiral

273
Q

When does SPONTANEOUS CLOSURE of VSD commonly happen?

A

Under 1.

Less likely after 2 years.

274
Q

What condition are VSD at high risk of?

A

Infective endocarditis.

No longer high risk once surgical repair has taken place.

275
Q

Differentials DDX for a limp?

Mneumonic?

A

STARTS HOT

S - Septic Joint
T - Trauma
A - Avascular Necorsis (Perthe's)
R - RA/ JIA
T - TB
S - Slipped upper femoral epiphysis/ SCD

H - HSP
O - Osteomyelitis
T -Tumour

276
Q

Define Osteomyelitis

A

Inflammatory bone condition caused by infection - S. Aureus.

Involves single bone (Rarely infects multiple sites)

277
Q

At what point is chicken pox non-infective?

A

Once ALL lesions have crusted over. (Usually at day 5 after onset.)

Children should be self-isolate until crusting has been complete.

278
Q

What heart defects are associated with Turner’s Syndrome?

A

Bicuspid aortic valve
Aortic root dilatation
Coarctation of the aorta

279
Q

Treatment for Biliary Atresia

A

Kasai Portoenterostomy - [Hepatoportoenterostomy]

Removal of bile ducts and replaced with sequent of small bowel

280
Q

Precocious Puberty?
[Early Development of secondary sexual characteristics]

What is consider early puberty for boys and girls?

A

Boys - 9
Girls - 8

Normally

281
Q

Which requires urgent surgical correction?

Exomphalos or Gastroschisis ?

A

Gastroschisis ASAP - COVER WITH CLING FILM AS NO PERITONEAL COVERING

Exomphalos (Omphalocele) - Staged closure 6-12 months. To prevent respiratory complications (allow lung adaptation). IF SMALL IMMEDIATE CLOSURE

282
Q

Gastroschisis vs Exomphalos (Omphalocele)

Position to umbilicus.

A

G - Lateral to umbilicus. (NO PERITONEAL COVERING)

E - At umbilical site (PERITONEAL COVERING)

283
Q

What organisms causes Roseola?

A

Human herpes virus 6

284
Q

What’s Ebstein Anomaly?

A

Low insertion of the tricuspid valve resulting in a large RA and small RV causing tricuspid incompetence.

Associated w/ Lithium use during pregnancy
Complications - WPW, ASD (Patent foramen ovale)

285
Q

What Sign would indicate a Meconium Aspiration?

A

Reflex bradycardia

286
Q

When giving Paediatric BLS what pulses should you palpate

A

Infant - Femoral/ Brachial

Child - Femoral

287
Q

Why should you avoid giving ibuprofen in chicken pox?

A

RISK FOR NECROTISING FASCITIS

288
Q

Most common headache type in children?

A

Migraine

289
Q

47 XXY

WHAT IS THE CONDITION?

A

Klinefelter syndrome

290
Q

Trisomy 13

NAME THE SYNDROME?

A

PATAU

291
Q

Trisomy 18

NAME THE SYNDROME?

A

EDWARDS

292
Q

What is the criteria for microcephaly?

Common causes?

A

Head circumference <2nd Centil (Occipital-frontal)

Congenital infection, fetal alchohol syndrome, patau, familial / normal variation.

293
Q

Risk factors for Sudden Infant Death Syndrome?

A 
Prone sleeping (On front) 
parental smoking
bed sharing
hyperthermia and head covering
prematurity

Phase 3A Quiz (7 decks)

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