Child Health Flashcards
1
Q
What is a normal baby weight?
A
5 Pounds 8 Oz - 8 Pounds 13Oz
2.5kg - 4kg
2
Q
What weeks are most babies born?
A
37 - 40
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
4
Q
What is neonatal period?
A
Time of transition from uterine environment to external world
Birth to 1 Month
5
Q
When is the perinatal period?
A
22 weeks - Day 7 birth
6
Q
Actions for children in respiratory distress
A
High flow O2 - 15L/Min O2 Mask + reservoir bag
7
Q
Choking Baby - What do you do?
A
5 Back Blows
5 Chest Thrusts (Baby) / Abdo Thrusts (Child)
8
Q
Hypoglycaemic emergency - ACTION?
A
IV/IO Glucose 10% 2ml/kg
9
Q
At what age would the average child have the ability to walk unsupported?
A
13-15 Months
10
Q
Which pathogen class causes the most childhood respiratory infections?
A
Viruses (80%)
11
Q
Name some respiratory viruses
A
respiratory syncytial virus(RSV),
rhinoviruses, parainfluenza,
influenza A & B
metapneumovirus and adenoviruses
12
Q
Name some respiratory infections caused by bacterial pathogens?
A
Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae, Moraxella catarrhalis, Bordetella pertussis, Mycoplasma pneumoniae.
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
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.
15
Q
Which method of nutrition is optimal for newborns
A
Breastfeeding
16
Q
Define Malnutrition
A
Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
Undernutrition or Obesity
17
Q
What can outcomes can result from poor nutrition?
A
Reduced height & weight - Failure to thrive
Diseases in later life
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
19
Q
What are the normal respiratory rates for
<1 y.
2-5y
5-12y
>12y
A
- 30-40bpm
- 25-30bpm
- 20-25bpm
- 12-20bpm
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
21
Q
What is meconium?
A
First faeces of a newborn infant.
Dark green colour
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
23
Q
How many nerve plexus inner are the intestines.
Name them
A
3
Submucosal (Meissner) - Parasympathetic
Myenteric (Auerbach) - Parasympathetic
Smaller mucosal plexus
24
Q
Where do enteric ganglion cells derive from in embryonic development
A
Neural crest
25
What is Apgar Score
Measurement criteria for APGAR
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
26
What Apgar score would require immediate resusciation
How often should APGAR be assessed
0-3
1,5 & 10 mins
27
When would you use a rectal thermometer on a baby?
Small babies who are very unwell or a child with a tympanic temperature below 33 degrees.
28
What age is a child considered a toddler?
1-3
29
What organisms is common for causing meningitis
Neissseria Meningitidis
30
Management plan for Meningitis?
IV Antibiotics
Steroids - >3M only
Fluids
Public health notification & prophylaxis of contacts
31
IV Antibiotics for meningitis?
> 3M - IV amoxicillin + IV cefotaxime
| < 3M - IV cefotaxime
32
Investigations for meningitis?
Lumbar puncture
33
Contraindications for Lumbar puncture?
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
34
Major Presentations for Meningitis?
```
Fever
Photophobia
Stiff neck
Bulging fontanelle
Pin-prick rash
Cold extremities - hands/feet
Extreme fatigue, irritability, crying, seizures
```
35
Kawasaki disease Management?
High dose aspirin
IV Immunoglobulin
ECG
36
Major complication of Kawasaki disease?
Coronary artery aneurysm
37
Major Presentations for Meningitis?
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
38
What is Kawasaki disease?
Type of vasculitis which mainly affects children <5 y.o
Peak <2
39
Most common cause of gastroenteritis?
Rotavirus
40
When should you consider doing stool culture on children
```
Blood or mucus in stool
Recent abroad travel
Diahorrea not improving by day 7
Suspected septicaemia
Suspected gastroenteritis
Immunocompromised
```
41
What are risk factors for dehydration in young children?
```
<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
```
42
Name some recessive conditions - (X-Linked)
```
Haemophilia A,B
Colour blindness
DMD
G6PD deficiency
Ocular albinism
```
Usually Only males are affected and females end up being carriers
43
What is Wilms Tumour?
```
Kidney cancer in children.[Nephroblastoma]
Affects children <5y.o
Mainly Unilateral
Doesn't cross the midline
C11 defect loss WT1/WT2
```
44
Characteristics of Wilms Tumour?
```
Abdominal mass
Flank pain
Painless haematuria
Fever
Anorexia
HTN
```
Any children with unexplained abdominal mass - arrange for a paediatric review 48H
45
Management of Wilms Tumour?
Depends on staging
Nephrectomy
Chemotherapy
Radiotherapy (Advanced stages)
Good prognosis rate 80%
46
Diagnosis of Wilms Tumour
US (+-doppler) - check for bilateral involvement, hydronephrosis
CT Abdo contrast
CXR - Rule out lung mets
47
What causes Scarlet Fever?
reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Streptococcus pyogenes
48
How is Scarlett fever transmitted
inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges, (especially during sneezing and coughing)
49
Characteristic symptoms of Scarlet Fever?
```
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
```
50
Diagnosis and Treatment of Scarlett Fever
Throat Swab
Notifiable Disease
AB should be started ASAP before receiving confirmation.
Penicillin V / Azithromycin for 10 Days
51
Complications that can arise from Scarlett fever?
Otitis Media
Acute glomerulonephritis
Rheumatic fever
52
Examples of X-linked dominant conditions?
Vit D resistant rickets (Hypophosphatemic Rickets)
| Rett Syndrome
53
Define Apnoeic attack?
Period of non breathing lasting >20sec with cyanosis and bradycardia.
54
What organisms causes Whooping Cough
Bordatella Pertussis
55
What’s the diagnostic criteria for whooping cough?
Acute cough lasted for 14 days+ without obvious cause
Paroxysmal Cough
Inspiratory whoop
Post-tussive vomiting
Undiagnosed apnoeic attacks/episodes
56
Investigations for Whooping cough
Nasal Swab Culture - can take several days/weeks to come back
PCR/Serology
57
Management of Whooping cough?
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)
58
Name some autosomal dominant diseases?
Huntington's disease
Marfan's syndrome
Ehlers-Danlos syndrome
Osteogenesis imperfecta
59
Name some autosomal recessive diseases?
Sickle cell disease
Thalassaemias
Wilson's disease
CF
60
What are Fraser guidelines usually considered for ?
Contraception
61
What elements of the Fraser guidelines need to be met?
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.
62
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?
True
63
True or False
Under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved?
True
64
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?
True
65
What are the 4 domains of development ?
Gross Motor
Fine Motor and Vision
Hearing and Language
Personal & Social
66
Causes of congenital cataracts?
Infection contracted by the mother during pregnancy - Rubella. HSV, Toxoplasmosis
Genetic defect - Downs syndrome
Post birth injury
67
What is Glue ear and how is it treated?
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.
68
Glue Ear CAUSES?
Narrowing of eustachian tube - > disruption in air and fluid balance in middle ear
Post infections - common cold, ear infection.
69
Acute Otitis Media TREATMENT
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.
70
Signs of respiratory distress
```
Cyanosis (central or peripheral)
Tachycardia
Tracheal Tug
Subcostal/Intercostal recessions
Wheeze on auscultation
Tachypnoea
Hypoxia
Head bobbing
Stridor
```
71
Name the components of the Upper Respirator Tract (3) and Lower Respiratory Tract (3) ?
URT
Nasal Cavity
Pharynx
Larynx
LRT
Trachea
Primary Bronchi
Lungs
72
Conditions associated with wheeze?
Asthma
Bronchitis
Pneumonia
Viral Induce Wheeze
73
Conditions associated with stridor?
```
Croup
Epiglottitis
Bacterial Tracheitis
Anaphylaxis
Angiodema
Inhaled foreign body
Diptheria
Laryngomalacia
```
74
What are the 3 types of Febrile Convulsions (Seizures)?
Seizures associated with fever with no definable intracranial cause.
Simple - <15 Minutes not recurring within 24hrs
Complex - 15-30 Minutes
Static Epileptcus ->30 Minutes
75
Define Seizure
Transient episode of abnormal and excessive neuronal activity in the brain.
76
Define Epilepsy?
Tendency to have recurrent seizures.
77
5 Headings that causes of coma?
```
Infection-Meningitis, Encephalitis
Trauma - Head injury
Metabolic- Hypoglycaemia
Drugs- Opiates, Lead
CNS Disorder - Seizures
```
78
List focal neurological signs?
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
79
Signs of Raises ICP
```
Focal Neurological Signs
Tense/ bulging fontanelle
Systemic hypertension/Bradycardia
Abnormal body posture/ flaccidity
Unequal/unreactive pupils
Abnormal Resp Pattern
```
80
Define Syndrome
A syndrome is a group of signs or symptoms that happen together and help to identify a unique medical condition.
81
What 3 elements make up a childhood seizure?
1. Type of seizures
2. First onset of seizures
3. Specific EEG pattern
82
What are 5 common childhood epileptic syndromes?
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.
83
What is a lifestyle modification for treatment of epilepsy
Ketogenic diet
84
Important questions things do you need to find out following a seizure?
Events Before, During and After the seizure
85
Questions before a seizure?
HINT: 6
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?
86
Questions during a seizure?
HINT: 11
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?
87
Questions after a seizure?
HINT: 3
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?
88
Define Intussusception?
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
89
What are the clinical features of Intussusception?
```
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
90
What are the consequences of Intussusception?
Bowel obstruction and ischaemia of the of infolded section of bowel.
91
IX and Tx for Intussusception?
IX - Ultrasound [Target Sign] ,Barium enema
Tx - Fluid Resus [Large volumes of fluid to restore circulation]
Broad Spec AB - Clindamycin
Surgical reduction / Air enema
92
Clinical signs of pyloric stenosis?
Non-bilious projectile vomiting
Constipation (Reduced fluid intake)
Late signs - Jaundice, Dehydration, malnutrition.
Palpable mass - Upper abdomen
Hypochloraemic, hypokalaemia alkalosis
93
Treatment for Pyloric stenosis?
Ramdert's Pyloromyotomy
94
What is the cause of intussusception in older children?
POLYP / MECKEL'S DIVERTICULIM
95
Investigations for pyloric stenosis?
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
96
What is Meckel's Diverticulum?
IX, Clinical characterstics and Tx?
What is the rule of 2s? (4)
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
97
What are the signs and symptoms of IBD?
```
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
```
98
Differences between UC and CD
```
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
99
Treatment for CD?
Steroids, Immunosuppresants - Prednisolone & Mesalazine
Surgery
100
Treatment for UC?
Steroids & Immunosuppresants - Prednisolone, Inflixamab,
Surgery - Colectomy
101
Define Constipation?
Delay or difficulty in defecation of greater than 2 weeks.
102
Red flags of constipation?
Faltering growth
Meconium passed >24H
Abdominal distention or vomiting
Delyaed walking/lower limb neurology
103
What is a characteristic sign of spina bifida
Hairy Patch
104
Clinical Features of JIA?
```
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
```
105
What investigations can you do for JIA?
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
106
What is JIA?
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)
107
Differential Diagnoses for arthritis in children?
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
108
Management of JIA?
```
Analgesia -Naproxen/Diclofenac/Ibuprofen
Regular Eye screen
Daily Exercise
Steroid injections - triamcinolone
DMARDS - Methotrexate (+Folic Acid)
```
109
Differentials for a limping child?
```
Septic arthritis/osteomyelitis
JIA
Trauma
Development dysplasia of the hip
Perthes disease
Slipped upper femoral epiphysis
Transient synovitis
```
110
What is Perthes Disease?
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
111
Define Septic Arthritis?
Infectious Arthritis of the synovial joint.
Paeds - Knee>Hip>Ankle [Commonly affected joints]
Neonates - Can develop from osteomyelitis
112
Whats the most common pathogenic cause and spread of Septic Arthritis?
Staphyloccocus Aureus
Haematogenous spread
Teenagers - Sexually active N. Gonorrhoeae
113
What is the Kocher Criteria for Septic Arthritis?
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)
114
Tx for Septic Arthritis?
```
IV Vancomycin
IV Clindamycin (Pen allergy)
IV -Ceftriaxone (Gonorrhoea)
6-12 Weeks
Splintage in acute setting
Physiotherapy - Avoid stiffness
```
115
Investigations for Septic Arthritis?
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
116
What is osteomyelits?
Infection of the bone
117
Causative organisms in osteomyelitis?
Staph. aureus is the most common
Patients with sickle-cell anaemia - Salmonella
118
Tx for Osteomyelitis
IV emperical antibiotic therapy
Flucoxacillin
Teicoplanin
Tazocin
119
IX for Osteomyelitis?
```
Inflammatory markers -CRP/ESR
WBC -Elevated
MRI
Ultrasound
Blood cultures
```
120
Risk Factors for Osteomyelitis?
```
Sickle cell disease
Diabetes
IV drug user
Immunosuppression
Alcohol excess
```
121
Clinical Signs for Osteomylitis
non speciific pain
Fatigue & Malaise
Low grade fever
122
What are the pubertal developmental signs in boys?
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
What are the pubertal developmental signs in girls?
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
Who starts puberty first?
Girls
125
What is Necrotizing enterocolitis (NEC)?
Clinical Features?
Treatment?
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
Croup Treatment
Oral Dexamethason 0.15mg/kg
Emergency - High flow O2 + Nebulised Adrenaline
127
What does Indometacin do?
NSAID blocks prostaglandin synthesis and helps initiate duct closure.
128
How does the Ductus arteriosus close?
First breaths due to increased pulmonary flow which enhances prostaglandins clearance
129
Classic triad of meningitis symptoms
Neck stiffness, photophobia, headace
130
Signs of respiratory distress
Grunting
Nasal flaring
Use of accessory respiratory muscles - Subcostal/Intercostal recession/ Tracheal tug (WOB++)
Tachypnoea
131
What is Cepacia syndrome?
Necrotising pneumonia that occurs in patients with CF
Liquefaction and cavitation on CT
Bulkholderia infection.
Very high mortality rate in CF patients
132
Common infective organisms in patients with CF?
```
Staph Aureus
Pseudomonas aeruginosa
MRSA
H. Influenza
Bulkholderia
```
133
Management for CF
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
Paediatric BLS Steps?
```
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
What does a presence of raised Immunoreactive trypsinogen (IRT) in blood indicate?
Possible CF.
Needs to be followed up by a SWEAT TEST
136
What day of birth are newborns tested for congenital diseases?
Which diseases?
Day 5 - Heel Prick (Guthrie Heel Prick)
SCD
Congenital hypothyroidism
CF - Cystic Fibrosis
PKU - Phenylketonuria
137
What is a sweat test?
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
Causes of false positive sweat test
```
Skin Oedema
malnutrition
adrenal insufficiency
glycogen storage diseases
nephrogenic diabetes insipidus
hypothyroidism, hypoparathyroidism
G6PD
ectodermal dysplasia
```
139
What does a Hydrogen breath test do and how does it work?
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
What is the Rome IV criteria and what is it used for?
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
what genes are associated with Coeliac disease?
HLA-DQ8 & HLA- DQ2
142
Symptoms of coeliac disease?
Failure to thrive
Diarrhoea
Abdominal distension
Anaemia - older children may present
143
What is Coeliac disease?
Coeliac disease is caused by sensitivity to the protein gluten. Repeated exposure leads to villous atrophy which in turn causes malabsorption.
144
Diagnosis for Coeliac disease?
jejunal biopsy showing subtotal villous atrophy
| anti-endomysial and anti-gliadin antibodies are useful screening tests
145
What is Kocher's Criteria?
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
What are the risk factors for Developmental dysplasia of the hip (DDH)?
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
1. Screening for DDH?
| 2. Examination for DDH?
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
Tx for DDH
Most hips spontaneously stabilise by themselves
Pavlik Harness
Surgery
149
What things may indicate a harmless murmur?
HINT: 4S?
Soft
aSymptomatic
left STERNAL edge
Systolic Hx
150
What is Croup?
Laryngeotracheobronchitis
Infection of the upper airway which obstructs breathing and causes inflammation around the voice box (larynx), windpipe (trachea) and bronchial tubes (bronchi)
151
Croup Clinical Features
```
Barking cough
Stridor
Hoarse Cry/Voice
Poor Feeding
Worse at night
Mild Fever
```
152
What should you ensure when examining a child with URTI/Obstruction?
Not to distress child and don't examine throat.
153
Main pathogens causing croup?
PAIR
Parainfluenza
Adenovirus
Influenza A & B
RSV
154
Define Epiglottis?
Rapidly progressive infection causing inflammation of the epiglottis and surrounding tissues leading to upper airway obstruction.
Life threatening emergency.
155
What is the causative pathogen for Acute Epiglottis?
Haemophillus influenza B (HiB)
Vaccination available - From 2M
156
Clinical features of epiglottis?
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
Epiglottitis Management?
IV Cefuroxime, Airway management (O2), Steroids (Dexamethasone)
158
How do you estimate children's weight in an emergency setting?
(Age+4)x2
159
What are some possible side effects of salbutamol?
Tachycardia
Hypokalaemia - Intracellular movement of potassium from extracellular space
Hyperglycaemia - Stimulation of gluconeogenesis
ECG monitoring
BG Monitoring.
160
What Vaccines are in the 6-in-1 ?
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
Whats signs indicate life-threatening asthma attack?
```
Sats <92
PEF <33% best/predicted
Silent chest
Poor respiratory effort
Cyanosis
Altered consciousness
Agitation
```
162
Whats signs indicate life-threatening asthma attack?
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
Management Steps for asthma?
(5-16yrs)
Hint: 7 Steps
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
Management steps for asthma?
(<5yrs)
Hint: 4 Steps
1. SABA
2. SABA + Moderate ICS (8wk trial of symptoms)
Review point >4wks reoccurrence give / <4wks restart trial
3. SABA + Low ICS + LTRA
4. Stop LTRA + REFERRAL
165
What signs indicate poorly controlled asthma?
```
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
What is a low, moderate and high dose of ICS?
Low - <200 mug budesonide
Moderate- 200-400 mcg budesonide
High- >400 mcg budesonide
167
Define Asthma?
Chronic inflammatory disorder due to airway inflammation, bronchial hyperactivity and reversible airway obstruction.
168
What things cause airway obstruction in asthma?
Bronchospasms
Increased mucous production - Mucous plug
Mucosal swelling and inflammation
169
Clinical features for asthma?
```
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
What factors may trigger episodes of wheeze in asthmatics?
```
Weather change - Cold
Environmental - Tabocca smoke
Exercise
Emotions
Infection
```
171
What type of wheeze is usually heard in asthmatics?
Widespread Polyphonic wheeze.
Localised wheeze suggests alternative diagnoses e.g. Inhaled FB
172
Key investigations for Asthma?
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
Key steps for acute managment of asthma?
```
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
What is montelukast?
LTRA - preventer tablets
effective in exercise-induced asthma and in asthma associated with allergic rhinitis
175
Give examples of reliever inhaler?
Give example of preventer inhaler?
Explain the 3 different types of device inhalers?
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
Name some LABAs?
Folmetrol, Salmetrol
Theophylline (Tablet form)
177
Side effects of steroid treatments?
Impaired growth
Altered bone metabolism
Adrenal suppression
Oral candidiasis
178
Usual dose for salbutamol?
2 puffs 5 mins before exercise/ every 4-6 hrs
| 100mcg/dose mdi
179
What is meconium illeus?
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
Define Cystic Fibrosis?
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
What are exocrine glands?
Glands that excrete products onto body surfaces or into body cavities directly or via ducts
i.e. Mucous, sweat, oil & salivary, tear glands
182
What are the clinical features of cystic fibrosis?
```
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
Investigations for CF?
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
Complications of CF?
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
Differentials of CF?
Coeliac disease
Asthma - no clubbing/purlent bronchitis
GORD - no malabsorption
Primary immunodeficiency
186
What may failure to pass meconium mean?
Possible CF / Bowel obstruction
Ideally want it to be passed within first 24 hours.
187
What genetic abnormality occurs in CF?
Males - Absence of vas deferens
188
Possible examination findings with CF patients
```
Clubbing
Nasal polyps
Bilateral absence of vas deferens
Low BMI/ Below normal vmi
Increased AP diameter of the chest
Stool mass - RLQ
Hepatosplenomegaly
```
189
Treatment for meconium ileum?
Water soluble contrast enema + Lactulose (Oral osmotic agent)
Surgery (If failure of med management) + NG decompression + supportive therapy
190
Management for CF
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
Which organisms are common CF Patients for recurrent chest infections?
Staph Aureus, Psedudomonas, Haemophilus
192
Main objectives of CF treatment?
Prevention of colonisation and infection of lungs
Nutritional support
Effective mucocillary clearance
193
Coryzal symptoms
Acute Inflammation of nasal mucous membranes
Runny noses
Sore throat,
Sneezing,
Fever
194
Acute Cough Differentials?
```
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
Explain diurnal variation in asthma?
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
Bile stained vomit in 1st week of life. Primary differential until proven otherwise?
Intestinal Malrotation
Mainly affecting male infants.
197
What is Succussion?
Gastric Solash - Audible Sloshing sound during auscultation.
198
Define Achalasia?
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
When are Atrovent Inhalers given?
Useful in children with Atopy with Wheeze when Salbutamol fails
200
What is Motelukast
Leukotriene Receptor Antagonist
- Preventer/Maintenance Asthma treatment
- Given in children w/ no history of Atopy
201
What is Ipratropium bromide?
Antimuscarinic (Anticholinergic) Bronchodilator
Short Acting
B2 Agonist
202
What can be used to bring down hyperbilirubinaemia?
Ursodeoxycholic Acid - Brings down serum bilirubin levels.
203
Why is caffeine given to neonates?
Improve cardiac drive.
204
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
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
What is the emergency resuscitations steps for a neonate?
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
What is the ratio of chest compression: ventilations in a child?
15: 2
207
What techniques can be used to help infants with GORD?
Thickening of feeds
Position infant 30 degrees head up -prone position post feeding
208
What injury can can shoulder dystocia during labour delivery cause?
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
What is the Treatment of choice for Haemophilia B ?
Recombinant factor 9 (IX)
Prophylactic use in severe cases/hx of significant bleeds
210
What is the treatment choice for Haemophilia A?
Recombinant factor 8 (VIII)
Prophylatic use in severe cases/hx of significant bleeds
211
What will a Persistent VSD (Untreated) lead to?
Pulmonary HTN (Compensatory pulmonary vascular hypertrophy) + CHF
Cyanosis
212
Eisemenger Syndrome?
Shunt reversal of blood. Right to Left
213
Phenylketonuria (PKU)
A. Inheritance Pattern
B. Error
C. Characteristic features
D. How is it screened
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
G6PD Deficiency (Glucose-6-Phosphate Dehydrogenase)
A. Inheritance Pattern
B. Complications
A. X-linked recessive
| B. Individual develop haemolysis (haemolytic crisis) which can be triggered by an infection or various medications.
215
What is HSP (Henoch-Schonlein purpura)?
A. What is it
B. Distribution of Rash
C. Other symptoms
D. Who it usually affects.
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
Investigations for HSP?
Urinalysis - Proteinuria + Microscopic Haematuria, RBC Casts
217
INTUSSUSCEPTION [PAEDIATRIC EMERGENCY]
Key Clinical Findings
Hint: 3'S + Triad Symptoms
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
What is Intussusception?
Bowel segment invaginate into a neighbouring part of the bowel (Bowel telescoping) causing obstruction.
<1 years old, BOYS
219
What site does Intussusception usually occur?
Ileocaecal junction.
220
What is mesenteric adenitis and clinical features?
Swollen (inflamed) lymph glands in the abdomen causing abdominal pain.
RIF Pain, Fever, Lymphandenopathy, Sore throat/ symptoms of a cold
AKA Mesenteric lymphadenitis
221
Management of Mesenteric adenitis?
Supportive Care - Analgesia (Paracetamol and Ibuprofen)
Antibiotics may be given to treat underlying bacterial infection if suspected.
222
Drug treatment choice for procedural sedation?
Midazolam (Oral/Intranasal)
Nitrous Oxide
Ketamine
223
Why are child protection plans put in place?
Children are thought to be at risk of significant harm.
224
Aims of child protection plans?
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
What is Merkel's Diverticulum?
Hint Rule of 2s (6s)
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
Treatment for Merkel's Diverticulum?
Excision of diverticulum and its adjacent ideal segment
227
Characteristic Ultrasound for pyloric stenosis?
Target lesion
| >3mm muscle thickness
228
Characteristic findings in pyloric stenosis
Non-billious Projectile vomiting
RUQ Pain, Palpable mass (size of a grape/olive shaped)
Visible peristalsis
229
What condition is duodenal atresia associated with?
Downs Syndrome (Trisomy 21)
230
Define gastroschisis?
Abdominal contents have herniated throughout he abdominal wall.
No covering of contents.
231
Immediate treatment for gastroschisis?
Incubate, fluid resus, ng tube, surgery
232
What should you do if a non-vaccinated child gets exposed to someone infected with measles?
Offer MMR Vaccine - WITHIN 72 HRS
| Produces antibodies quicker than natural infection.
233
Triad of Shaken Baby Syndrome?
Retinal haemorrhages,
| Subdural haematoma, and encephalopathy.
234
Pink Salmon Rash. Characteristic for what condition?
JIA - Juvenile Idiopathic Arthritis
235
If testes are undescended at what point do you take action?
Review at 3 months then referral for orchidopexy
(Surgery to move undescended testicles - Around 1yrs)
Bilateral - REVIEW WITHIN 24HRS
236
Complications of undescended testes?
Infertility
Torsion
Testicular cancer
237
What type of vaccine is Rotavirus.
When is it given?
Oral, live attenuated vaccine
2 doses (8 Weeks, 12 Weeks)
Doses shouldn't be given at (14 weeks, 23weeks - Intussusception risk)
238
Example of inactivated toxin vaccine (toxoid)
DTP (tetanus, diphtheria and pertussis)
Should be deferred in children with an evolving or unstable neurological condition
239
When is the 6-in-1 Vaccine given?
What does it protect against?
8, 12 and 16 weeks old.
```
Diphtheria
Hepatitis B
Hib (Haemophilus influenzae type b)
Polio
Tetanus
Whooping cough (pertussis)
```
240
Name Some Live attenuated vaccines?
```
BCG
MMR
Influenza (intranasal)
Oral Rotavirus
Oral Polio
Yellow fever
Oral Typhoid
```
241
Name some inactivated vaccines?
Rabies
Hepatitis A
Influenza (intramuscular)
242
Who is the MMR Vaccine contraindicated in?
Pregnant women
243
Some of the features that may present from hypothermia in newborn baby
Poor feeding
Grunting
Low saturations
Low blood sugars
244
TORCH INFECTIONS?
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
What is Vit K important in production of?
Clotting factors
10,9, 7, 2 (1972) + Protein C + S
246
When is the latest a child should be babbling or imitating sounds?
9 MONTHS
REFERRAL FOR FULL DEVELOPMENTAL ASSESSMENT IF NOT.
247
# Define Acute Otitis Media (AOM)?
Most common causing pathogens?
Acute inflammation of the middle ear. Symptoms for ear infection lasting <3w
Strep. pneumonia, Haemophilus influenzae, Moraxella catarrhalis
248
Complication of Otitis Media?
Perforation of tympanic membrane (Severe pain + Pop and discharge)
Temporary hearing loss
Meningitis
Mastoiditis
249
Treatment for perforated tympanic membrane?
5-day course of amoxicillin
| Primary care review
250
Symptoms of AOM?
Findings on examination
```
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
Why AOM more common in children?
Eustachian tube is more horizontal which imparts clearance of bacteria and viruses.
252
Criteria for Atypical UTI?
```
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
Management for an Atypical UTI in UNDER 6M
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
When is a MCUG indicated for UTIs?
Any Dilation present on US
Poor urine flow
FH of VUR
Non-ecoli infection (atypical)
255
Causes of Cervical Lymphadenopathy?
L - Leukemia/Lymphoma
I - Infection
S - Sarcoidosis
T - Tumours/TB
256
What conditions does Epstein-Barr-Virus tend to cause?
Glandular fever
| Infectious mononucleosis
257
Haemorragic disease of newborn (HDN)
CAUSE?
Signs?
Vitamin K deficiency
Largely asymptomatic, Intracranial haemorrhages, bleeding internal organs, Intramuscular haemorrhage
258
Inhaled corticosteroids can cause Oral Candidiasis. How can you prevent this?
Rinsing the mouth with water after inhalation of a dose.
| Using a Spacer device
259
Side effects of SABA/LABAs
Tachyarrhythmias
Tremors
Dizziness
260
What is classed as a recurrent UTI?
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
DiGeorge Syndrome Main features?
HINT:CATCH22
```
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
Tay-Sachs Disease
Characteristic features?
Deficiency defect?
Macula cherry red spot, Progressive neurodegeneration, NO HEPATOMEGALY
Hexosamindase A
263
Follow up action on Abnormal hip NIPE examination?
Scan within 2 Weeks
Ultrasound of both hips at 4-6 weeks for any RF patients + d
264
When does the ductus arteriosus usually close by?
By day 11.
265
What is oesophageal atresia?
Primary features?
Risk factors?
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
Newborn Respiratory Distress Syndrome (NRDS).
What are the signs? '
What maternal pre-existing condition is a risk factor?
```
Grunting
Tachypnoea
Intercostal recession
Increased respiratory efforts
Bilateral pulmonary oedema
```
Diabetes - Infants from diabetic mothers have delayed lung maturation.
267
Explain why Total Thyroxine concentration increases during pregnancy?
Increased hepatic synthesis of thyroid-binding globulin.
268
What does a positive coombs test indicate
Fetus is RH +VE (At risk of Rh isoimmunisation)
269
Fetal Complications of Rh Isoimmunisation
Jaundice and hepatosplenomegaly
Kernicterus
Hydrops fettles (gross oedema)
Haemolytic anaemia (erythroblasts on peripheral blood smear)
270
Embroyological reason why TOF occurs?
Anterosuperior displacement of the infundibular septum
S -VSD
H - RVH
O - OVERRIDING AORTA
P - PULMONARY STENOSIS
271
Embroyological reason why Truncus arteriosus occurs?
Failure of the aorticopulmonary septum to divide
272
Embroyological reason why TGA occurs?
Failure of the aorticopulmonary septum to spiral
273
When does SPONTANEOUS CLOSURE of VSD commonly happen?
Under 1.
| Less likely after 2 years.
274
What condition are VSD at high risk of?
Infective endocarditis.
No longer high risk once surgical repair has taken place.
275
Differentials DDX for a limp?
Mneumonic?
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
Define Osteomyelitis
Inflammatory bone condition caused by infection - S. Aureus.
Involves single bone (Rarely infects multiple sites)
277
At what point is chicken pox non-infective?
Once ALL lesions have crusted over. (Usually at day 5 after onset.)
Children should be self-isolate until crusting has been complete.
278
What heart defects are associated with Turner's Syndrome?
Bicuspid aortic valve
Aortic root dilatation
Coarctation of the aorta
279
Treatment for Biliary Atresia
Kasai Portoenterostomy - [Hepatoportoenterostomy]
Removal of bile ducts and replaced with sequent of small bowel
280
Precocious Puberty?
[Early Development of secondary sexual characteristics]
What is consider early puberty for boys and girls?
Boys - 9
Girls - 8
Normally
281
Which requires urgent surgical correction?
Exomphalos or Gastroschisis ?
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
Gastroschisis vs Exomphalos (Omphalocele)
Position to umbilicus.
G - Lateral to umbilicus. (NO PERITONEAL COVERING)
E - At umbilical site (PERITONEAL COVERING)
283
What organisms causes Roseola?
Human herpes virus 6
284
What's Ebstein Anomaly?
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
What Sign would indicate a Meconium Aspiration?
Reflex bradycardia
286
When giving Paediatric BLS what pulses should you palpate
Infant - Femoral/ Brachial
| Child - Femoral
287
Why should you avoid giving ibuprofen in chicken pox?
RISK FOR NECROTISING FASCITIS
288
Most common headache type in children?
Migraine
289
47 XXY
WHAT IS THE CONDITION?
Klinefelter syndrome
290
Trisomy 13
NAME THE SYNDROME?
PATAU
291
Trisomy 18
NAME THE SYNDROME?
EDWARDS
292
What is the criteria for microcephaly?
Common causes?
Head circumference <2nd Centil (Occipital-frontal)
Congenital infection, fetal alchohol syndrome, patau, familial / normal variation.
293
Risk factors for Sudden Infant Death Syndrome?
```
Prone sleeping (On front)
parental smoking
bed sharing
hyperthermia and head covering
prematurity
```
