Corrections 2 Flashcards
Presentation of intestinal atresia vs pylroic stenosis?
Intestinal atresia –> bilious vomiting, typically presents first 24h of life
Pyloric stenosis –> non-bilious vomiting, typically begins 3-5w after birth
Features of rickets?
- aching bones and joints
- lower limb abnormalities:
in toddlers genu varum (bow legs)
in older children - genu valgum (knock knees) - ‘rickety rosary’ - swelling at the costochondral junction
- kyphoscoliosis
- craniotabes - soft skull bones in early life
- Harrison’s sulcus
What age group is roseola infantum most common?
6m to 2y
Cause of roseola infantum?
HHV-6
Features of roseola infantum?
- high fever: lasting a few days, followed later by a
maculopapular rash - Nagayama spots: papular enanthem on the uvula and soft palate
- febrile convulsions occur in around 10-15%
- diarrhoea and cough are also commonly seen
Where do dermoid cysts occur>
Typically at sites of embryonic fusion
Mx of Perthe’s disease <6 y/o?
Reassure & follow up
What is the correctd age of a premature baby?
The corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks
How long should you leave in between MMR doses?
<10 y/o –> 3 months
> 10 y/o –> 1 month
In an urgent situation (e.g. an outbreak at the child’s school) then a shorter period of 1 month can be used in younger children.
Mx of scarlet fever?
10 days of oral penicillin V
Causes of obesity in children?
- growth hormone DEFICIENCY
- hypothyroidism
- Down’s syndrome
- Cushing’s syndrome
- Prader-Willi syndrome
What is an umbilical granuloma?
An overgrowth of tissue which occurs during the healing process of the umbilicus.
On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.
Mx of an umbilical granuloma?
1) regular application of salt to the wound
2) if this does not help then the granuloma can be cauterised with silver nitrate.
Cause of a wide pulse pressure in PDA?
There’s increased systolic pressure due to increased stroke volume from left-to-right shunting, while diastolic pressure decreases because of runoff into the pulmonary arteries during diastole.
Diagnostic investigation in intestinal malrotation?
upper GI contrast study
100-120 Mx of an an unborn with exomphalos?
Caesarean section is indicated to reduce the risk of sac rupture
What is the chest compression rate in paeds?
100-120 bpm
What is the most common complication of measles?
Otitis media
When is the men B vaccine given?
2, 4 and 12 months
Small testes in precocious puberty indicate what as the cause?
An adrenal cause
What is the most common type of JIA?
Pauciarticular/oligoarticular (up to 4 joints)
At what age would the average child acquire the ability to crawl?
9 months
What is the triad of features in shaken baby syndrome?
1) subdural haematoma
2) retinal haemorrhages
3) encephalopathy
What inheritance pattern do mitochondrial diseases follow?
A maternal inheritance pattern
ALL of the children of an affected mother will inherit a mitochondrial condition.
Mx options in head lice?
- wet combing
- malathion
- dimeticone
Mx of pityriasis versicolor?
Ketoconazole 2% shampoo
At what age should an infant have little to no head lag on being pulled to sit?
3 months
What is Epstein’s pearl?
A congenital cyst found in the mouth (common on the hard palate).
Often mistaken for neonatal teeth.
At what age would the average child acquire a good pincer grip?
12m
At what age should a child have a palmar grasp?
6 months
At what age can a child draw a circle?
3y
At what age can a child build a tower block of 3-4?
18m
What 2 vaccines do teenagers receive between 13-18y?
1) men ACWY
2) tetanus/diphtheria/polio
What are plethoric lung fields?
A sign of increased blood flow in the lungs, and are often visible on CXR i.e. increased pulmonary perfusion.
Causes of plethoric lung fields?
1) Left-to-right cardiac shunts, such as ASD, VSD, and PDA
2) Transposition of the great arteries
What should be suspected in increasing head circumference in a child less than 18 months?
Raised ICP
Who should children with intussusception be referred to?
Paediatric surgeons
What age are night terrors commonly seen?
4-7 y/o
Features of night terrors?
The child awakes from stage 4 deep slow wave sleep and appears terrified and hallucinating.
The child is unresponsive to anyone around them.
After less than 15 minutes the child falls asleep again and the following morning has no recollection of the events (different from nightmares).
Give 6 examples of live vaccines
1) MMR
2) Polio
3) BCG
4) Influenza (nasal, not the injection)
5) Rotavirus
6) Chickenpox
Give 2 examples of toxin vaccines
1) diphtheria
2) tetanus
What does the term ‘valency’ in vaccinology refer to?
This denotes the number of distinct antigenic components or serotypes a vaccine can protect against.
Vaccination schedule: 2 months old?
1) 6 in 1
2) Rotavirus
3) Men B
What does the 6 in 1 contain?
- tetanus
- polio
- diphtheria
- pertussis
- Hib
- hep B
Vaccination schedule: 3 months old?
1) 6 in 1
2) Rotavirus
3) Pneumococcal (PCV)
Vaccination schedule: 4 months old?
1) 6 in 1
2) Men B
Vaccination schedule: 1 year old?
1) MMR
2) Men B
3) Pneumococcal (PCV)
4) Hib/Men C
Vaccination schedule: yearly from 2 to 10 years?
Annual influenza (nasal)
Vaccination schedule: 3 years and 4 months?
1) MMR
2) DTaP/ IPV (4-in-1 pre-school booster)
What does the 4 in 1 pre-school booster vaccine contain?
- diphtheria
- whooping cough
- tetanus
- polio
Vaccination schedule: 12/13 years old?
HPV (one dose)
Vaccination schedule: 14 years old?
1) 3-in-1 teenage booster: tetanus, diphtheria, polio
2) Meningitis ACWY
Who is recommened for annual influenza vaccination?
a
1) Age ≥65
2) Chronic respiratory disease (including asthmatics who use inhaled steroids)
3) Chronic heart disease (heart failure, ischaemic heart disease, including hypertension if associated with cardiac complications)
4) CKD
5) Chronic liver disease: cirrhosis, biliary atresia, chronic hepatitis
6) Diabetes mellitus
7) pregnant women
8) immunosuppression due to disease or treatment (e.g. HIV)
9) asplenia or splenic dysfunction
How many doses of the pneumococcal vaccine is given in the child UK vaccine schedule?
2 (3m, 12m)
Acute tonsillitis is the inflammatory infection of which tonsils?
Palatine tonsils
What is the 1st line investigation in acute tonsillitis in those who require it?
Rapid antigen test for GAS, followed by throat culture.
if antibiotics are indicated in tonsillitis, what is 1st line?
phenoxymethylpenicillin (or erythromycin if penicillin allergic) for 7-10 days
Give some indications for Abx in tonsillitis
1) history of rheumatic fever!
2) Centor criteria ≥3
3) unilateral peritonsillitis
4) an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
5) features of marked systemic upset secondary to the acute sore throat
What does the feverPAIN criteria consist of?
1) Fever over 38°C.
2) Purulence (pharyngeal/tonsillar exudate).
3) Attend rapidly (3 days or less)
4) Inflamed tonsils
5) No cough or coryza
≥4 –> abx
What are some potential complications of acute tonsillitis?
1) acute otitis media
2) peritonsillar abscess
3) acute sinusitis
Complications of a tonsillectomy can be 1ary or 2ary.
What is the difference?
1ary: <24 hpurs
2ary: 24 hours to 10 days
How may pain change after a tonsillectomy?
The pain may increase for up to 6 days following a tonsillectomy.
What are peritonsillar abscesses usually a complication of?
Untreated or partially treated tonsillitis, although it can arise without tonsillitis.
What is trismus?
Refers to when the patient is unable to open their mouth
What is the most common organism causing a quinsy?
GAS
Management of a quinsy?
Refer to ENT –> incision & drainage of abscess under GA.
Abx before & after surgery.
What is typical Abx of choice in quinsy?
Broad spectrum e.g. co-amoxiclav
What is OM often preceded by?
Viral URTI
What is the most common bacterial cause of OM?
Strep. pneumoniae
What is the most common bacterial cause of rhinosinusitis?
Strep. pneumoniae
what age is a risk factor for otitis media?
<4 y/o
What are 3 conditions affecting ciliary motility that predispose to OM?
1) CF
2) Kartagener’s
3) Primary ciliary dyskinesia
What are some extrinsic factors that predipose to OM?
1) passive smoking
2) not receiving pneumococcal vaccine
3) bottle feeding
4) use of dummy
Not receiving which vaccination can predispose to OM?
pneumococcal
Pathophysiology of OM?
OM occurs secondary to oedema and narrowing of the eustachian tube.
An oedematous eustachian tube prevents the middle ear from draining, predisposing it to the colonisation of bacteria.
What will relieve earache in OM?
Rupture of the TM will resolve the pressure differential and relieve pain.
OM is a clinical diagnosis.
However, you must first exclude what serious complications?
1) mastoiditis
2) meningitis
3) intracranial abscess
In which groups with OM is it recommended to prescribe Abx?
1) ≤2 y/o with bilateral OM
2) perforated TM (OM with ear discharge)
3) <3m w/ fever >38
4) systemically unwell
5) high risk of complication
1st line Abx in OM?
Oral amoxicillin (5-7 days)
What does myringotomy involve?
surgically draining the middle ear
When is hearing loss as a complication of OM more common?
with recurrent OM
How can OM lead to facial paralysis?
The corda tympani branch of the facial nerve runs through the middle ear.
What is glue ear?
OM with effusion –> when fluid accumulates in the middle ear.
What is the commonest cause of conductive hearing loss and elective surgery in childhood?
Glue ear
What investigation should children with glue ear be referred for?
Audiometry
What is chronic suppurative otitis media (CSOM)?
Persistent inflammation of the middle ear that results in the discharge of pus from the ear.
Caused by bacterial or fungal infections.
Where is CSOM more common?
In developing countries
Risk factors: poor hygiene, malnutrition, and exposure to polluted environments.
Congenital CMV features?
- hearing loss
- low birth weight
- petechial rash
- microcephaly
- seizures
Why should you never perform a throat examination on a patient with croup?
Due to risk of airway obstruction
What 2 characteristics may be associated with Perthe’s?
- short stature
- hyperactivity (disruptive behaviour)
What genetic syndrome is supravalvular aortic stenosis associated with?
William’s syndrome
Features of William’s syndrome?
- Short stature
- Learning difficulties
- Friendly, extrovert personality
- Transient neonatal hypercalcaemia
- Supravalvular aortic stenosis
1st line investigation in SUFE?
Plain XR of both hips: AP and frog-leg views
Triad of features in transient synovitis?
1) hip pain
2) limp
3) recent infective illness
Is fever a typical symptom of transient synovitis?
No
Describe the Barlow test for DDH
attempted dislocation of a newborns femoral head
Features of congenital rubella?
- bilateral cataracts
- sensorineural deafness
What is a key sign of late decompensated shock in paeds?
Hypotension
Testes in Fragile X?
macroorchidism –> due to the overproduction of FSH in puberty
Why is mitochondrial inheritance only via the maternal line?
As the sperm contributes no cytoplasm to the zygote.
Inheritance of mitochondrial disease in men vs women?
None of the children of an affected male will inherit the disease.
All of the children of an affected female will inherit the disease.
Give a key example of mitochondrial disease
Leber’s optic atrophy
Inheritance of Noonan syndrome?
Autosomal dominant
What are the 3 key features that are often associated with Noonan syndrome?
1) pulmonary stenosis
2) pectus excavatum
3) webbed neck
Mode of inheritance of Prader-Willi syndrome?
Imprinting
Inheritance of achondroplasia?
Autosomal dominant
What % of cases of Perthe’s disease are bilateral?
10%
Failure to respond to abx in how long indicates an atypical UTI?
48h
What epilepsy syndrome is characterised by partial seizures at night?
Benign rolandic epilepsy
Neonatal resuscitation guidelines
1) Dry baby
2) 5 inflation breaths
3) If HR <60bpm, start chest compressions with 3 compressions to each breath
What does nasal flaring fall under on the paediatric traffic light system?
Amber
Below what age is phimosis (a non-retractable foreskin) normal and will likely resolve with time?
<2 y/o
