General Paediatrics Flashcards
1
Q
what is the alternative name for croup?
A
laryngotracheobronchitis
2
Q
what is are some differentials for croup that you must rule out?
A
epiglottis or foriegn body because can cause obstruction
3
Q
describe the signs and symptoms of croup?
A
barking cough
inspiratory stridor
signs of hypoxia (if obstruction present)
signs of increased WOB (subcostal recession etc)
coryzal prodrome
symptoms worse at night
4
Q
what is the cause of croup?
A
viral infection- parainfluenza
5
Q
what should you exclude or consider in a child with a prolonged fever?
A
kawasaki disease
6
Q
what is the diagnostic criteria for kawasaki disease?
A
Fever for 5 days or more, plus
4 out of 5 of:
- polymorphous rash
- bilateral (non purulent) conjunctival injection-=mucous
- membrane changes, e.g. reddened or dry cracked lips, strawberry tongue, diffuse redness of oral or pharyngeal mucosa
- peripheral changes, e.g. erythema of the palms or soles, oedema of the hands or feet, and in convalescence desquamation
- cervical lymphadenopathy (> 15 mm diameter, usually unilateral, single, non purulent and painful)
7
Q
what are some important causes of fever in a child that you have to exclude?
A
meningitis/encephalitis meningococcal sepsis osteomyelitis septic arthritis UTI
8
Q
what are some important causes of prolonged fever in a child to exclude?
A
kawasaki
malignancy
autoimmune
HSP
9
Q
what can cause projectile vomiting in a child?
A
pyloric stenosis
10
Q
what defines ‘failure to thrive’ in a child?
A
If a child falls across two major centiles= failure to thrive
if the baby’s weight is less than the 3rd centile= failure to thrive (not as sensitive)
11
Q
what is the general cause of febrile convulsions in a child?
A
viral infections
12
Q
what age group do febrile convulsions generally occur?
A
from 6months to 6yrs of age
13
Q
what are some symptoms of a febrile child which may think they are very unwell?
A
bulging fontanelles non blanching rash reduced conscious state focal neurological signs status epilepticus neck stiffness bile stained vomiting mottled skin tachycardia/tachypnoea/severe increased WOB
14
Q
what is the first thing you need to ask yourself if a neonate/infant presents with vomiting and fever?
A
Bilious or non bilious?- is the vomit green?
15
Q
what are some causes of bilious vomiting in an infant? you’re in GP land. what would you do?
A
obstruction (mal-rotation, volvulus, duodenal atresia, necrotising enterocolitis)
- refer for surgical admission + fluid resuscitation in hospital
16
Q
what are some causes of non-bilious vomiting in an infant?
A
intussuception 5mths-3yrs old, pyloric stenosis 3-6 weeks post birth, infection/sepsis)
Or metabolic causes (e.g. adrenal insufficiency) + CNS causes
17
Q
what are the measurements we need to take for a child’s growth chart?
A
height weight head circumference (until 2 years old)
18
Q
what are signs of respiratory distress in a child?
A
intercostal recession and subcostal recession + tracheal tug + nasal flare + head bobbing + grunting + paradoxical abdominal movements
19
Q
what are the 2 bacterial/viral causes of tonsilitis we have to exclude in a child
A
Strep throat (bacterial) EBV (viral)
20
Q
what are some consequences of strep throat
A
Post strep glomerulitiis Rheumatic fever tonsil abscess acute OM cervical adenitus acute bacterial sinusitus
21
Q
what are some acquired causes for stridor?
A
croup epiglottitis bacterial tracheitis retropharyngeal abscess quinsy dipthethria foreign body
22
Q
what are some congenital causes for stridor?
A
subglottic stenosis
vocal cord palsy
laryngomalacia
23
Q
what is the age usually seen for inhaled foreign body?
A
6months to 4yrs
24
Q
what are some examination findings for inhaled foreign body in a child?
A
tracheal deviation reduced air entry localised wheeze fever? stridor
25
describe bronchiolitis
acute viral infection of the Lower respiratory tract
26
what age group do we see bronchiolitis?
common under 1yr old but can present up to 2yrs
27
what are some examination findings for bronchiolitis?
```
subcostal recession
hyperinflated chest
fine inspiratory crackles
wheeze
mild fever
tachypnoea
```
28
how do we treat bronchiolitiis?
supportive management only
29
how might we assess the severity of asthma in a child?
night symptoms?
increased frequency of exacerbations
no. of hospitalisations
how often are they using their puffer?
30
what is the BMI definition of overweight for a child aged between 2-18yrs?
For children 2 – 18 years or age, overweight is defined as BMI above the 85th centile on BMI chart
31
what is the BMI definition of obese for a child aged between 2-18yrs?
Obese is defined as BMI >95th centile on CDC BMI chart or above the 97th centile on WHO BMI chart
32
how might we assess whether a child less than 2 yrs old is overweight?
For children under 2 years, overweight is defined as above the 97th percentile on WHO growth charts and gaining weight rapidly.
33
describe pyloric stenosis
Hypertrophic Pyloric Stenosis (HPS) is due to progressive thickening of the circular muscle of the pylorus. This leads to gastric outlet narrowing.
The condition usually presents between 2 and 6 weeks of age.
projectile, non-bilious vomiting
hypochloremic hypokalemic metabolic alkalosis can be associated
34
what are the main features of ADHD?
hyperactivity
impulsivity
inattention/easy distractibility
35
describe a general fluid replacement order for a dehydrated child in hospital?
give boluses of 10-20mls/kg every hr- normal saline
36
for a child with moderate dehydration due to vomiting, how might you fluid resuscitate them (think route)?
NGT tube even if the child is vomiting
37
for fluid maintenance, what types of fluid can we use in children?
plasma lyte
normal saline with glucose (NaCL 0.9 or 0.45% + 5% dextrose)
consider if K+ is required
38
what are some signs of severe dehydration in a child?
Very delayed CRT > 3 secs, mottled skin
Other signs of shock (tachycardia, irritable or reduced conscious level, hypotension)
Deep, acidotic breathing
Decreased tissue turgor
39
what are the Kocher's criteria for differentiating septic arthritis and transient synovitis in a child?
1. Inability to weightbear
2. high fever
3. high ESR in first hour >40
4. high WCC >12
4/4 criteria would be a strong indicator of septic arthritis
40
what are some ddx for a child with an acute limp?
```
septic arthritis
osteomyelitis
Perthe's- AVN of capital femoral epiphysis
slipped upper femoral epiphysis
bony malignancy
```
41
how might we differentiate between septic arthritis and osteomyelitis in a child?
osteomyelitis- subacute onset, pain on movement, swelling/fever/erythema may be late onset, tenderness/localised pain
septic arthritis- acute onset, more likely to present with a high fever, pain on movement and at rest, loss of movement/range of motion
42
what are the ddx for asthma in a young child?
```
tracheomalacia
viral respiratory infection
inhaled foriegn body
cystic fibrosis
reflux
```
43
what are some complications of pertussis?
```
rib fracture
subconjunctival haemorrhage
pneumonia
Otitis Media (most common)
fainting post cough
respiratory muscle fatigue--> apnoea
encephalopathy and seizure
```
44
what are some classical features of pertussis?
inspiratory whoop
uncontrollable violent coughing associated with vomiting
prodrome of mild respiratory illness
45
what are some signs/symptoms of intussuception in a baby?
```
red current jelly stools, bloody diarrhoea
vomiting +++ nonbilious--> bilious
colicky abdo pain
abdominal mass- sausage shape
pallor and lethargy
signs of hypovolemic shock
```
46
tell me about transient synovitis of hip?
Commonest reason for a limp in the pre-school age group.
Usually occurs in 3-8 year olds
History of recent viral URTI (1-2 weeks)
Child usually able to walk but with pain
Child otherwise afebrile and well
Mild-moderate decrease in range of hip movement - especially internal rotation.
Severe limitation of hip movement suggests septic arthritis.
Transient synovitis is a diagnosis of exclusion.
47
tell me about perthes disease?
```
Avascular necrosis of the capital femoral epiphysis.
Age range 2-12 years (majority 4-8yrs)
20% bilateral
Present with pain and limp
Restricted hip motion on examination
```
48
tell me about slipped upper femoral epiphysis?
Late childhood/early adolescence.
Weight often > 90th centile.
Presents with pain in hip or knee and associated limp.
The hip appears externally rotated and shortened.
There is decreased hip movement - especially internal rotation.
May be bilateral.
49
what is the most common cause of constipation in kids?
functional constipation
50
how might we manage functional constipation in kids?
Position – footstool to ensure knees are higher than hips. Lean forward and put elbows on knees.
Toilet sits –5 minutes three times a day, preferably after meals. Praise child for sitting on toilet, keep toileting a positive experience.
A healthy diet and adequate fluid intake is important for children’s general health and wellbeing.
Excessive cow milk intake may exacerbate constipation in some children.
oral laxatives like movicol can be used
51
how might we manage nappy rash in infants?
Use disposable nappies.
Increase the frequency of nappy changing and cleansing the skin.
Application of a barrier cream at every change. Effective barrier creams include zinc paste, white soft paraffin and vaseline.
Letting the child spend as long as possible without a nappy on, lying on a soft absorbent sheet that is changed as soon as it is wet. Sunlight plays a role.
If there is associated candidal infection, leading to erythema in the folds and satellite pustules then topical anti-candidal therapy (an imidazole or nystatin) should be applied. This therapy is often combined with 1% hydrocortisone to reduce the associated inflammation.
52
what level of BP is ABNORMAL for children?
if BP is majorly low; this is not normal as it can mean that the child has lost up to 30% of their blood volume.
Other than this, BP is not a reliable measure in children.
53
define a neonate
baby less than 28 days corrected
54
at what ages do infants nose breathe?
4-6months exclusively through the nose
55
what are the 3 top causes of lumps in children?
congenital
inflammatory
cancer
56
what are some causes of apnoea?
```
whooping cough
obstruction
OSA
acidosis
anaemia
patent ductus arteriosus
```
croup (may require intensive care in this case)
57
what is the most common respiratory pathogen causing infection in kids?
RSV
58
what are some signs of pathological paediatric murmurs?
all diastolic murmurs
pansystolic murmurs
murmurs associated with failure to thrive or cardiac failure
murmurs with a palpable thrill
59
in which states can a child's murmur become accentuated?
can become accentuated in anaemia or fever (high output states)
60
what is vesicoureteral reflux. What might it cause?
abnormal retrograde flow of urine back up to kidneys due to impaired valve-like mechanism at the vesicoureteral junction
predisposes UTIs and hydronephrosis
61
define colic?
uncontrolled crying for >3hrs per day for 3 or more days of a week in an otherwise well healthy infant
62
what are the differentials for colic?
GORD/reflux
cow's milk allergy
malabsorption
63
when might we consider cow's milk allergy as a cause for prolonged crying in an infant and what can we try?
when a crying baby (crying for prolonged periods of time) is vomiting, having diarrhoea or has feeding difficulties, and history of atopy/eczema consider cow's milk allergy.
can try a cow's milk free diet either by choosing cow's milk free infant formula or asking the mother to avoid cow's milk in her diet
64
what is the triad of symptoms for henoch schloens purpura?
purpuric rash on the extensor surfaces of limbs (mainly lower) and buttocks, joint pain/swelling and abdominal pain.
65
how much formula does an infant require per day?
150mls/kg a day
66
how often do infants require breastfeeding?
every 3-4 hourly or demand breastfeeding
67
what are the typical characteristics of an innocent murmur in a child?
```
ejection systolic murmur
soft blowing sound
left sternal edge
symptom free child
no radiation
```
68
what are some differential diagnoses of congenital stridor?
```
laryngomalacia
laryngeal cyst/web
laryngeal stenosis
GORD
subglottic stenosis
```
69
A young child becomes profoundly cyanotic when agitated. What is your diagnosis and what is this called?
Hypercyanotic or tet episodes due to complete right ventricular outflow obstruction, usually related to
Untreated TOF
70
What are your ddx for an older child with liver derangement?
```
Hepatitis
Paracetamol overdose
Autoimmune cause
Wilsons
NASH
Other drug reactions
```
71
In what newborn period is jaundice abnormal?
In the first 24 hrs post birth
72
at what position should the baby be to accurately palpate the anterior fontanelle?
at 45 degrees
73
how might we assess skin turgor in a child?
pinching the abdomen lightly
74
what on history might give us a sense of cardiovascular function in an infant and why?
history of feeds
Feeding is the most metabolically demanding activity that occurs in infants, and so can be used as a form of exercise tolerance
75
what is the technical term for bedwetting?
nocturnal enuresis
76
what is the difference between primary and secondary enuresis?
primary= continously be wet for at least 6 months
| secondary- was dry for a period of time (6months) but relapsed
77
what are some causes of secondary enuresis to consider?
```
UTI
neurogenic bladder
Diabetes
epilepsy
sexual abuse
```
78
what does monosymptomatic nocturnal enuresis?
bedwetting without urinary incontinence during the day
79
when do we start treating nocturnal enuresis?
usually at 7 yrs and above
80
what is faecal incontinence usually associated with in children?
constipation
81
what are the medical causes of haematuria in children?
```
hypercalciuria
thin basement membrane disease
alport syndrome
GN-IgA
HSP
coagulopathy/bleeding disorder
```
82
If a child with haematuria complains of pain, what do we think?
think surgical cause
| such as calculi, tumour, stricture, trauma
83
if you have a child with microscopic haematuria what must you exclude?
illness in a child can cause microscopic haematuria. Wait until the child is well before checking the urine again
84
what are the complications of nephrotic syndrome in children?
infection, thrombosis, dehydration (because intravascular fluid leak out to extravascular spaces), effusions
85
if a child presents with nephrotic syndrome, what is our first line of action?
give steroids.
If the child responds to steroids= minimal change disease
If it doesn't respond by 4 weeks, refer for a renal biopsy
86
what is the most sensitive test for post streptococcal glomerulonephritis? what can it also indicate?
low C3, C4
low C3 and C4 can also indicate lupus/SLE or membrano-glomerulonephritis
87
how do we treat post streptococcal glomerulonephritis?
frusemide to manage fluid overload + fluid restriction
88
what is a long term complication of HSP?
nephritis, which looks like IgA nephropathy
89
what are the main causes of CKD in the age group from 0-4?
posterior urethral valve
| renal hypoplasia/dysplasia --> obstructive uropathy
90
a child lying in ED with abdo pain is drawing their legs up. what sort abdo pain may they have?
colicky abdo pain
91
how might we assess peritonism in a child with abdo pain?
Ask the child to suck their belly in as much as they can and then puff their tummy out to the level of your hand.
Ask the child to cough.
They may walk slowly with a hunched over posture
92
what are the two main causes of idiopathic nephrotic syndrome in children? which is more likely to progress to chronic kidney disease?
minimal change disease- usually steroid responsive and good prognosis
focal segmental glomerulosclerosis- Not immunosuppressive responsive and 60% progress to CJD
93
what is the clinical presentation of a child with IgA nephropathy?
episodes of macroscopic haematuria +/- abdominal flank pain often concurrent with viral infections
94
why are children with nephrotic syndrome at risk of thrombosis?
loss of anti-thrombin 3 in the urine
95
an ultrasound at 6 weeks confirms that a baby has dysplasia of the hips. what is your next line of action?
refer to orthopaedics
