General paeds Flashcards
1
Q
when does pyloric stenosis tend to present?
A
2-4 weeks
2
Q
what is pyloric stenosis caused by
A
hypertrophy of the circular muscles of the pylorus
3
Q
projectile vomiting typically 30 mins after a feed:
A
pyloric stenosis
4
Q
what would the blood look like in pyloric stenosis
A
alkalosis due to persistant vomiting
hypokalaemic
hypochloraemic
5
Q
treatment for pyloric stenosis
A
Ramstedt pyloromyotomy
6
Q
A mother brings her 14-month-old son into surgery. Since yesterday he seems to be straining whilst passing stools. She describes him screaming, appearing to be in pain and pulling his knees up towards his chest. These episodes are now occurring every 15-20 minutes. This morning she noted a small amount of blood in his nappy. He is taking around 50% of his normal feeds and vomited once this morning. On examination he appears irritable and lethargic but is well hydrated and apyrexial. Abdominal examination is unremarkable. What is the most likely diagnosis?
A
intussusception
7
Q
what agegroup is usually affected y intussusception?
A
6-18 months
8
Q
list the common features of intussusception
A
- paroxysmal colic abdominal pain
- during episodes of pain the infant will characteristically draw their knees up and turn pale
- vomiting
- blood stained stool - red currant jelly
- sausage mass in the right LQ
9
Q
Investigation for intussusception
A
ultrasound scan may show a target like mass
10
Q
treatment of intussusception
A
reduction by air insufflation under radiological control
if this fails or the child has signs of peritonitis then resort to surgery
11
Q
A 2-month-old boy is brought to the afternoon surgery by his mother. Since the morning he has been taking reduced feeds and has been ‘not his usual self’. On examination the baby appears well but has a temperature of 38.7ºC. What is the most appropriate management?
A
Admit to hospital - any child <3 months with a temp >38 is a red flag in NICE guidelines- urgent referral to pediatrician
12
Q
A 5-week-old baby is suffering from projectile vomiting after feeds. The vomit is profuse but not bile-stained and occurs within minutes of a feed. On examination, an olive-sized pyloric mass can be palpated. What is the most likely electrolyte abnormality seen in this infant?
A
hypochloraemic hypokalaemic metabolic alkalosis
13
Q
what is the treatment for Wils’ tumour?
A
nephrectomy
chemo
radiotherapy (if advanced disease)
good prognosis of 80% cure rate
14
Q
give 7 features of an atypical UTI
A
Seriously ill Poor urine flow Abdominal or bladder mass Raised creatinine Septicaemia Failure to respond to treatment with suitable antibiotics within 48 hours Infection with non-E. coli organisms.
15
Q
What antibiotics can you use to treat children aged more than 3 months with a lower UTI
A
trimethoprim, nitrofurantoin, cephalosporin, amoxicillin `
16
Q
A 3-year-old boy presents with 6 days of fever, increasing irritability and a rash. His mother is worried because she has been giving him Calpol and ibuprofen for the last few days but has seen no improvement. On examination his temperature is 38.9C, respiratory rate is 30 breaths/min, and heart rate is 136 beats/min. On further inspection, the child is noted to have bilateral conjunctivitis with no exudate, cervical lymphadenopathy, erythema of the oral mucosa, and a non-vesicular rash that is spreading from his hands and feet. What immediate treatment should be given?
A
High dose aspirin and a single dose of intravenous immunoglobulin
17
Q
Give 6 features of Kawasaki disease?
A
- high grade fever for >5 days (resistant to antipyretics)
- rash spreading from palms and soles, peels
- strawberry tongue
- conjunctivitis
- cervical lymphadenopathy
- bright red cracked lips
18
Q
what is a complication of Kawasaki disease
A
coronory artery aneurysm
19
Q
Management plan for Kawasaki disease?
A
- high dose aspirin
- IV immunoglobulin
- echocardiogram to screen for coronory artery aneurysms
20
Q
what is the risk of using aspirin to treat children#?
A
Reye’s syndrome - encephalopathy
21
Q
A 6-month-old baby who was born in Bangladesh is brought to surgery. Around one week ago he started with coryzal symptoms. His mother reports he has not been feeding well for the past two days and has started to vomit today. Her main concern is a cough which occurs in bouts and is so severe he often turns red. No inspiratory or expiratory noises are noted. Clinical examination reveals an apyrexial child with a clear chest. What is the most likely diagnosis?
A
Whooping cough - perussis
22
Q
what organism causes whooping cough?
A
gram negative bacteria bordetella pertussis
23
Q
how do you diagnose whooping cough?
A
nasal swab culture for bordatella pertussis, PCR & serology (more widely used)
24
Q
management of pertussis?
A
oral macrolide - e.g. clarithromycin, azithromycin, erythromycin - to reduce the spread, but has not been shown to alter the course of the illness
also a vaccination is offered to all pregnant women
25
What are complications of whooping cough?
pneumonia
bronchiectasis
subconjunctival haemorrhage
seizures
26
A 2 year old boy presents to the GP with his mother. She is worried that he is not growing at the same rate as the other children at his play group. His mother describes foul smelling diarrhoea about 4-5 times a week, accompanied by abdominal pain.
On examination he has a bloated abdomen and wasted buttocks. He has dropped 2 centile lines and now falls on the 10th centile.
What is the most appropriate initial investigation?
IgA TTG antibodies - coeliacs disease
27
A 1-year-old boy presents with bilious vomiting, abdominal distension and has been constipated since birth and did not pass meconium until he was 3 days old. Height and weight are at the fifth percentile. On examination, the abdomen is distended and a PR examination causes stool ejection. What is the likely diagnosis?
Hirschprung disease
28
How does Hirschprung disease usually present?
bilious vomiting, abdominal distension, constipation, failure to pass meconium in the 1st 48h.
29
How can you diagnose Hirschprung disease
biopsy of the colon shows absence of ganglia -
30
what is Hirschprung disease
congenital bowel disease caused by an aganglionic segment of bowel due to a developmental failure of the parasympathetic auerbach and meissner plexuses
31
A neonate is born at 38 weeks gestation via spontaneous vaginal delivery. The birth weight was 4.5kg. In the newborn postnatal check the attending doctor notes that there is adduction and internal rotation of the right arm. What is the most likely diagnosis?
Erb's palsy
32
What is the limit for diagnosis of fetal macrosomia?
birth weight >4kg
33
what causes Erb's palsy?
damage to the upper brachial plexus (C5-C6) most commonly from shoulder dystocia.
34
Describe Erb's palsy
damage to upper bracial plexus (C5-C6) commonly due to shoulder dystocia during a difficult birth - nerve damage causes a distinctive pattern of adduction and internal rotation of the forearm - the waiters tip
35
which nerve roots are affected in Erb's palsy
C5-C6
36
what are the risk factors for shoulder dystocia?
fetal macrosomia
DM
High BMI
prolonged labour
37
At what age would the average child acquire the ability to walk unsupported?
13-15 months
38
A male child from a travelling community is diagnosed with measles. Which one of the following complications is he at risk from in the immediate aftermath of the initial infection?
pneumonia
39
how long is measles infectious for?
infective from prodrome until 4 days after the rash starts
40
how is measles spread?
droplets
41
What are the white spots on the buccal mucosa called in measles?
Koplik spots
42
describe the rash commonly seen in measles
Starts behind the ears then spread over whole body, discrete maculopapular rash which then becomes blotchy and confluent
43
What is the condition Characterized by a history of primary measles infection usually before the age of 2 years, followed by several asymptomatic years (6–15 on average), and then gradual, progressive psychoneurological deterioration, consisting of personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, and coma.
SSPE - subacute sclerosing panencephalitis
44
what should you do if a child without a measles vaccination comes into contact with an infected person?
Offer the MMR within 72 hours - the measles induced antibody develops faster than that following natural infection
45
A 5-year-old boy from a travelling community presents to the Emergency Department with breathing difficulties. On examination he has a temperature of 38.2ºC, stridor and a toxic looking appearance. A diagnosis of acute epiglottitis is suspected. Which organism is most likely to be responsible?
Haemophilus influenzae type B
46
What are the classic features of acute epiglottitis?
- no history of Hib vaccine
- rapid onset
- high temp
- generally unwell
- stridor
- drooling of saliva
47
what are the complications of undescended testicles/
infertility
torsion
testicular cancer
psychological
48
how common are undescended testes?
2-4% term male infants, but more common if preterm.
49
when should a baby be referred due to an undescended testicle?
3 months, ideally seeing a surgeon before 6 months and having surgery around 1 year
50
what investigation should be considered first in a baby presenting with projectile vomiting after every feed?
Abdominal ultrasound - looking for hypertrophy of the circular pylorus muscles indicating pyloric stenosis
51
what is the stepwise approach to managing bed wetting
1. look for underlying cause/trigger - e.g. UTI (if recent onset), diabetes, constipation
2. advise on fluid intake and toileting before bed
3. advise reward system e.g. star chart, e.g. for using the toilet before bed
4. consider enuresis alarm or drugs, depending on age. alarm if <7 and desmopressin if >7
52
A 2-year-old boy is brought into the emergency department following a 1 week history of fever, lethargy and irritability. The symptoms came on suddenly over a matter of hours and have not dissipated despite the GP's recommendation of anti-pyretics. He has had a reduced appetite and diarrhoea during this time. Earlier this morning a widespread red rash appeared on his body..
On basic observations the child appears toxic looking, is tachycardic and has a temperature of 39.2�C. Examination reveals a widespread maculopapular rash, left-sided cervical lymph node enlargement and a swollen, erythematous tongue.
Given the likely diagnosis what is the most important investigation in this child?
echocardiogram - to look for coronory aneurysms which is the greatest cause of mortality in Kawasaki disease
53
At what age would the average child start to smile?
6 weeks
54
What is the treatment of an acute exacerbation of asthma in a 7 year old boy who is not in respiratory distress?
Give oral prednisolone for ~3 days - 30-40kg for children >5
55
A 7-month-old infant is brought to the emergency department with a 2 day history of vomiting and diarrhoea. Vomit and stools are both unremarkable. His father describes the infant as lethargic and unsettled for the last 3 days. The infant has also had 6 episodes of uncontrollable crying where he draws his legs up to his chest for a few minutes at a time. He is afebrile. On examination the infant appears pale and lethargic and a small mass is palpated in the right upper quadrant. You decide to investigate with a plain abdominal x-ray which shows no sign of obstruction and an ultrasound scan which shows a target sign. What is the most likely diagnosis?
intussusception
56
What is the classsic finding on abdominal USS in intussusceptioon/
target sign
57
what are the features of migraine?
```
headache lasting 4-72h
bilateral/unilateral
pulsating
mod/severe
worse on exercise
Nausea +/- vomiting
photophobia +/- phonophobia
```
58
what is the first line treatment for migraine in children
ibuprofen
| sumatriptan nasal spray for children >12 but not well tolerated because nasty taste in throat
59
What is the genetic cause of adrenal hyperplasia
deficiency of the 21-hydroxylase enzyme - responsible for synthesis of aldosterone and cortisol
60
what is the most common cause of Hirsutism
PCOS
61
A 3 year old is brought by his Mum to your surgery. He has had a fever and has been refusing to eat. Mum has noticed some spots on his hands and buttocks. On examination the child has a mild vesicular rash to the hands, buttocks, face and a few spots on his ankles. His temperature is 38.1�C. Your records state that he had chicken pox when he was 9 months old. What is the most likely diagnosis?
hand foot and mouth disease
62
what is the pathogen causing hand foot and mouth disease?
intestinal viruses - most commonly coxsackievirus A16 and enterovirus 71.
63
What are the classical clinincal features of hand foot and mouth disease?
sore throat, fever, anorexia, cough, abdo pain
oral ulcers
later see vesicles on palms and soles of the feet, and also sometimes buttocks, legs and genitals.
64
what pathogen causes Roseola Infantum/
Herpesvirus 6 (HHV6)
65
What is characterised by a 3-5 day high fever followed by a 2 day maculopapular rash which starts on the chest and spreads to the limbs. This generally occurs as the fever is disappearing.
Roseola infantum (aka sixth disease- caused by infection with herpesvirus 6 (HHV6)
66
What is the most common pathogen associated with croup?
Parainfluenza virus
67
what respiratory condition in kids is characterised by a Hx of stridor and barking cough?
Croup (URTI)
68
A 3-year-old boy is brought into the emergency department with cough and noisy breathing following a 3-day history of coryzal symptoms. On examination, he is afebrile but has harsh vibrating noise on inspiration, intercostal recession and a cough. He is systemically well. what is the likely diagnosis and causative organism?
croup - parainfluenza virus
69
what is the treatment of croup?
oral dexamethasone - to all children regardless of severity
- if not available then can use prednisolone
- if respiratory distress nee dhigh flow oxygen and maybe nebulised adrenaline
70
The parents of a 14-month-old girl present to their GP. They have noticed that in some photos there is no 'red eye' on the left hand side. When you examine the girl you notice an esotropic strabismus and a loss of the red-reflex in the left eye. There is a family history of a grandparent having an enucleation as a child. What is the most likely diagnosis?
retinoblastoma
71
what might the absence of a red reflex, strabismus, and visual problems in a child indicate?
retinoblastoma
72
A neonate is born at 32 weeks gestation via spontaneous vaginal delivery. There was no meconium staining of the liquor. Shortly after delivery he develops cyanosis, tachypnoea, grunting and sternal recession. What is the most likely diagnosis?
neonatal respiratory distress syndrome
73
What vaccinations are required at the 6 week baby check?
4 different Ones:
- DTaP/IPV/Hib (diphtheria, tetanus, polio, pertussis, h.influenza B)
- men B
- PCV (pneumococcal conjugate vaccine)
- rotavirus
74
What organism most commonly causes meningitis in neonate-3 months?
Group B strep - usually acquired from mother at birth
75
What is the most common type of congenital diaphragmatic hernia?
Bochdalek hernia - majority on the left side
76
A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face
Scarlet fever
77
A 4-year-old boy presents with fever, malaise and a 'slapped-cheek' appearance
Parvovirus B19
78
A 3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted
Rubella
79
Describe scarlet fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
'Strawberry' tongue
Rash - fine punctate erythema sparing face
80
Fever, malaise, muscular pain
| Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
Mumps
81
A 10-year-old boy presents to the general practitioner (GP) with a sore throat. On examination, he has tonsillitis with exudate and cervical lymphadenopathy. The patient's temperature is 38.1�C, respiratory rate is 24 breaths/min, and his heart rate is 104 beats/min. Auscultation of the chest is clear. The patient denies having a cough and there is no history of allergies. How should this patient be managed?
Phenoxymethylpenicillin & analgesia
82
What are the debtor criteria for a sore throat indicating antibiotic Tx?
- presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
- history of fever
- absence of cough
83
What are the NICE indications for antibiotics for a sore throat?
features of marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
Centor criteria=
- presence of tonsillar exudate
-tender anterior cervical lymphadenopathy or lymphadenitis
- history of fever
- absence of cough
84
What is the most likely causative organism in a patient with a sore throats with 3 of the centor criteria?
Group A beta haemolytic streptococcus (40-60% chance)
85
What organism causes scarlet fever
Group A haemolytic streptococci
86
What's the most common complication of scarlet fever?
Otitis media
87
Management of ADHD
specialist assessment is required in all cases
unless a food diary has shown a link between diet and behaviour there is no basis for recommending the avoidance of artificial colourings or the use of fatty acid supplements
methylphenidate (Ritalin) - side-effects include abdominal pain, nausea, dyspepsia. Growth is not usually affected but it is advised to monitor growth during treatment every 6 months. The BNF also advises monitoring for psychiatric disorders and checking blood pressure/pulse every 6 months
atomoxetine
88
A 3-year-old boy is brought to surgery by his father. He is currently being managed with paracetamol for a middle ear infection but his father is concerned his heart is racing. What is the normal heart rate of a 3-year-old?
90-140bpm
89
Describe newborn resuscitation
Newborn resuscitation
1. Dry baby and maintain temperature
2. Assess tone, respiratory rate, heart rate
3. If gasping or not breathing give 5 ventilation breaths
4. Reassess (chest movements)
5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
90
What are the 5 sections of the APGAR score?
HR, respiratory effort, colour, muscle tone, reflex irritability
91
how common id developmental dysplasia of the hip (DDH) in newborns?
1-3%
92
What are 6 risk factors for developmental dysplasia of the hip in newborns?
- female (6X more likely)
- breech presentation
- family Hx
- firstborn
- oligohydraminos
- birth weight >5kg
93
what tests should you do to look for developmental dysplasia of the hip?
Barlow test - to test dislocation of an articulated femoral head
Ortolani test - to relocate a dislocated femoral head
94
What type of cerebral palsy is most common after an intraventricular haemorrhage?
spastic diplegic - due to the proximity of the corticospinal tracts
95
what is the difference between a caput succedaneum an a cepalohaematoma in a newborn?
caput succadaneum = extraperitoneal collection of blood due to the pressure on the head during birth
cephalohaematoma = swelling in head, develops after birth due to bleeding between the periosteum an the skull. Most common = parietal. Does not cross suture lines.
96
What infection presents with a grey pseudomembrane on the tonsils/pharynx?
Diptheria
97
what is the most common chromosomal abnormality in 1st trimester miscarriages?
trisomy 16
98
how does the risk of miscarriage change with increasing maternal age
21% between ages of 35-40 and increases to 41% above 40
99
in the second trimester what is the most common cause of miscarriage?
incompetent cervix
100
What investigation should you do if you suspect epilepsy?
EEG - or 24h ambulatory EEG, or ideally telemetry
101
What are the first line anti-epileptic drugs for Focal seizures?
valproate, carbamezapine, lamotrigine
102
What are the causes of shock in children?
1. Hypovolaemia (dehydration/gastroenteritis/DKA/trauma-blood loss)
2. Maldistribution of fluid (septicaemia, anaphylaxis)
3. Cardiogenic (arrythmia, HF)
103
what should be the volume of fluid you deliver to a child needing initial fluid resus?
20ml/kg in under 10 mins
104
How do you calculate maintenance fluids for children in 24h?
using body weight:
1st 10kg - 100ml/kg
2nd 10kg - 50ml.kg
remaining kg - 20ml/kg
105
what volume of maintenance fluids over 24hours would you need for a 45kg 15 year old?
2000ml
106
What volume of maintenance fluids would you give PER HOUR to a 7kg child?
4x7 = 28ml/hour
107
What is the most common cause of septic shock in childrenin the UK?
Meningicoccal infection
108
What are the commonest causes of shock in neonates
GBS or E.coli (from birth canal)
109
Why can myocardial dysfunction occur in septic shock?
circulating cytokines and toxins depress myocardial contractility
110
What is lactate a marker of?
cellular hypoxia - a level >4mmol/L is 27% mortality
111
what are the sepsis 6
1. Oxygen >92%
2. Empirical Abx
3. Fluid resus
4. Blood cultures
5. urine output
6. Serum lactate & FBC
112
What is the glass test for meningococcal purpura?
parents should suspect meningococcal disease if their child is febrile and they have a rash which does not blanch when pressed under a glass
113
What is the most common anaphylactic reaction to in children
foods
114
What are the doses of adrenaline you should give in an anaphylactic reaction - to <6years, 6-12 year old and adult/child 12-18 years
```
<6 = 150 ug (0.15 ml)
6-12 = 300 ug (0.3ml)
12-18 = 500 ug (0.5ml)
```
115
What is the medical management of status epilepticus?
if IV access = 0.1mg/kg lorazepam, if no result in 10 mins, repeat
If no vascular access: diazepam 0.5mg/kg PR / midazolam 0.5mg/kg buccal. no response in 5 mins, get IV access and admin lorazepam. Eventually - give phenytoin IV
116
Give 4 things which can be done to help avoid SIDS (Given in the 'back to sleep campaign')
1. lie baby on back (not front or side)
2. Do not smoke during pregnancy or in the same room as the infant (20+ cigarettes increases risk 5 fold)
3. avoid overheating/heavy wrapping
4. place baby in feet to foot position (ie feet touching he bottom on the cot)
117
What is the commonest cause of death of childen 1 month-1year?
SIDS
118
What are the clinical signs of respiratory distress syndrome of the newborn?
- tachpnoea (>60bpm)
- increased/laboured work of breathing
- chest wall recession
- subcostal recession
- sternal indrawing
- nasal flaring
- expiratory grunting
- cyanosis
119
What is the significance of neonatal expiratoy grunting and why does it occur
indicates respiratory distress - it is a attempt to create a positive airway pressure to maintain functional residual capacity
120
give 4 reasons why preterm babies are particularly vulnerable to hypothermia
1. greater surface area:volume ratio - so lose more heat than is generated (related to mass)
2. skin is thin and het permeable so transepidermal water loss is important in 1st week of life
3. little subcut fat for insulation
4. cannot shiver or curl up for heat conservation
121
What is the age at which infants can suck milk?
35-36 weeks gestation
122
what is infantum subitum caused by?
HHV-6b (and maybe HHV-7) (Roseolovirus)
123
Which virus causes primary stomatitis?
HSV-1
124
what is Herpangina and what is is caused by?
Mouth blisters - oral viral infection by coxsackievirus. Self-limiting. Faeco-oral or droplets.
125
Which HHV is associated with pnemonitis?
CMV (HHV5)
126
A 37-year-old woman with a past history of intravenous drug use presents to her GP for her methadone prescription. On examination they note pale rigid lesions on the side of her tongue. Alongside her methadone the GP prescribes aciclovir.
Hairy leukoplakia
127
What vaccination is contraindicated in patients with an egg allergy and why?
Influenza vaccine - because the vaccines are cultured from fluid on chicken embryos - so there is small amount of egg protein in the vaccines
128
Treatment of an 18 year old with Meningitis.
ceftriaxone
129
Patient with an abdominal collection that contains gram –ve anaerobes.
metronidazole
130
35 year old household wife presents with an infected insect bite. In the past she has been treated with Penicillin and responded with facial swelling and acute shortness of breath.
erythromycin
131
C.difficile colitis where metronidazole has failed
vancomycin
132
Severe systemic infection before cause has been identified
cefuroxime
133
Long-term prophylactic treatment for post-splenectomy patients
penicillin V
134
Treatment for Atypical pneumonia caused by Legionella in individuals with penicillin allergy
erthyromycin
135
A 75 yr old lady develops severe wound infection following hip replacement. MRSA is isolated from the wound.
VANCOMYCIN
136
An 82 yr old gentleman, living at home, develops severe dyspnoea with a productive cough and fever. His PaO2 has fallen below 8kPa, and he is becoming confused.
Cefuroxime + macrolide
137
What is the way you assess CAP severity and HAP severity/.
CRB65 and CURB65
confusion (disorientated or AMT test low)
Urea nitrogen raised >7mmol/L
Resps >30/min
Blood pressure low (<90/60)
0-1 mild
2 - moderate
3-5 - severe
138
what should you give to a A 6 month old child whose father has just been diagnosed with tuberculosis.
isoniazid
139
What is the most common congenital infection?
CMV (3-4 in 1000 births in the UK)
140
What are the risk factors for congenital Toxoplasmosis?
Eating raw undercooked meat and contact with cat faeces
141
what are the most common clinical manifestations of congenital toxoplasmosis?
hydrocephalus, chorioretinopathy, intrcranial calcification
142
What are the common defects seen in congenital rubella (when infection was <8 weeks gestation)
Deafness, cataracts and congenital heart problems
143
At what gestational age is it the most risky for mothers to catch rubella?
<8 weeks gestation
144
What are the outcomes of CMV infection during pregnancy?
90% - babies born and develop normally
5% Born with clinical features e.g. blueberry muffin rash, sensorineural hearing loss, hepatosplenomegaly, jaundice. Most will go on to have neurodevelopmentla problems e.g. cerebral palsy, deafness, epilepsy, cognitive impairment.
5% - born fine but develop problems later in life e.g. sensorineural hearing loss
145
What is neonatal conjunctivitis often caused by?
maternal chlamydia - treated with erythromycin
146
How long are babies neonates?
1st 6 weeks of life - longr if prem
147
What is the management of a pregnant woman who tests positive for syphilis at screening?
Refer to a GUM doctor
Repeat the test - as there are commonly false positives
Treat for 1 month before delivery with ben penicillin G - 2 doses week inbetween
- careful assessment of the neonate at birth - MDT - paediatrics, obstetrics. midwives, neonate, GP, GUM
148
What are the antibody tests for syphilis?
Non-treponemal: cardiolipin: VDRL/RPR (venereal diseases research lab - detect damage to tissues caused by the spirochaete
Treponemal specific tests: treponemal enzyme immunoassay (EIA), TPPA (T. pallidium particle agglutination assay)
T. pallidium specific IgM antibody tests
149
What is the vaccination schedule up to 1 year?
8 weeks: DTaP/IPV/HiB + PCV + MenB + Rotavirus (8)
12 weeks: DTaP/IPV/HiB + Rotavirus
16 Weeks: DTaP/IPV/HiB + MenB + PCV
1 year = MMR + HiB/MenC + Men B + PCV
150
What are the signs of an innocent murmer?
```
innoSent
Systolic
Soft blowing
aSymptomatic
Left sternal edge
```
151
WHat is the most common cyanotic congenital heart disease?
Tetralogy of Fallot
152
What are the 4 features of the tetralogy of Fallot?
1. VSD
2. Aorta ovverride due to the VSD so blood goes from R-->L
3. subpulmonary artery stenosis causing RV outflow obstruction
4. RV hypertrophy
153
Which congenital heart defect is associated with Downs?
atrioventricular septal defect
154
which trisomy causes Patau's syndrome?
13
155
What features are seen in Patau's
```
microcephaly
cleft lip and palate,
polydactyly
severe heart defect
absence of one or both eyes (anopthalmia)
IUGR/miscarriage/infant death
```
156
what trisomy is edwards syndrome
18
157
what is the genetic malformation in Turner's syndrome
45 X (only 1 X chromosome)
158
What are the features of Turner's?
- women only!!
- SHORT STATURE (can give GH)
- ovarian dysgenesis so need to replace oestrogen at puberty to get secondary sexual characteristcs, and will be infertile (can have IVF)
- normal IQ
- neck webbing
- wide nipples
159
What is the genetic malformation in Klinefeler's syndrome?
47 XXY
160
features of klinefelter's syndrome
- 47 XXY
- common presentation is infertility
- gynecomastia in teens
- hypogonadism
- tall stature
161
Which cardiac abnormality is Di Georges syndrome most commonly associated with?
tetralogy of Fallot
162
3 things to treat RDS in neonates?
1. Steroids (antenatal corticosteroids)
2. Exogenous surfactant via Endotracheal tube (reduces mortality by 40%)
3. CPAP
163
best treatment for autisti spectrum disorder
Applied behavioural analysis (ABA) - reduce rituals, help language and social development, play and general skills. needs 25-30h week one on one
164
what is the most common cause of chronic stridor in infancy?
Laryngomalacia
165
most common cause of acute/subacute stridor?
Croup (laryngotracebronchitis)
166
treatment of croup
oral dexamethasone
nebulised steroids
sometimes nebulised adrenaline with oxygen but have to be careful of rebound
