Medicine Flashcards
By what age does infantile colic usually resolve?
6 months
What is the dosing of IM benpen in children for meningitis?
25mg/kg
What is athetosis?
Continuous stream of slow, flowing, writhing involuntary movements
By what age does flat feet tend to resolve?
4-8 years
What is meant by Hemiballismus?
repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limb
What is the natural history of a capillary haemangioma?
Increase in size rapidly for the first 6 months and then start to resolve. Fifty per cent will have resolved by 5 years of age, 70% by 7 years and 90% by 9 years.
What is the antibiotic of choice for meningitis in children?
Ceftriaxone
Darier’s disease is associated with which vitamin deficiency?
Vitamin A
Chédiak-Higashi disease is associated with which vitamin deficiency?
Vitamin C
Gaucher’s disease occurs due to deficiency of which enzyme?
Beta-Glucosidase
What is the most common congenital cardiac defect?
VSD
What is the most common cyanotic cardiac defect?
Tetralogy of Fallot
What is the inheritance pattern of the thalassaemias?
Autosomal recessive
In which area of the world is alpha-thalassaemia most prevalent?
SE Asia
In which area of the world is beta-thalassaemia most prevalent?
Mediterannean
What is the genetic basis of beta-thalassaemia?
Point mutation in beta chain gene on chromosome 11
In what pattern is sickle cell disease inherited?
autosomal recessive
What is the specific genetic change which results in HbS?
A to T change at codon 6 of beta-Hb gene
What is the correct position for a paediatric LP?
L3-4
What are the causes of cyanotic heart disease?
5Ts + P
TGA
Truncus arteriosus
TOF
TAPVD
Tricuspid atresia
Pulmonary atresia
Which organism is frequently found in infected cat/dog bites?
Pastuerella multocida
Why are NSAIDs NOT recommended in chicken pox?
Increased risk of necrotising fasciitis
What is the school exclusion period for measles?
4 days from the rash onset
What is a normal HR for a newborn?
100-180
What is the normal HR for an infant (1 month - 1 year)?
80-140
What is the normal HR for a toddler (1-3 years)?
80-130
What is the normal HR for a child aged 3-6?
80-110
What is the usual treatment for VWB disease?
Desmopressin
What is the most common symptom reported by caregivers in Munchausen’s syndrome by proxy?
Apnoeas
Which factor is deficient in Haemophilia C?
Factor XI
What is Lutembacher Syndrome?
Concomittant ASD and Mitral stenosis
Hartnup disease is a disorder of…
Amino acid metabolism
What is the most common cause of delayed puberty?
Constitutional
Give examples of extensively hydrolysed formulas.
Aptamil Pepti
Cow and Gate Pepti-Junior
Pregestimil
Nutramigen
Isolated development of breast tissue before the age of 8 in girls without any other signs of puberty is called…
Premature letharche
What is the peak age for GORD?
1-4 months
What is generic advice for GORD?
Feed at 30 degrees
Sleep on back
Ensure not overfeeding
How much feed is recommended for infants?
150mls/kg/day
What is the step-wise Mx for formula-fed infants with GORD?
Ensure not overfed
Smaller, frequent feeds
Thickeners
Alginate trial 1-2 weeks
What is the management for breast-fed infants with GORD?
Trial alginate therapy if FTT/excess distress
Are PPIs recommended for GORD in children?
No, only if FTT/distress/failed medical therapy
What is the management of CMPA in formula-fed babies?
Switch to eHF, if fails of severe, consider AAF
How should cow’s milk be re-introduced to children with CMPA?
In hospital due to risk of anaphylaxis
What is Niemann-Pick disease?
lysosomal storage disorder caused by the deficiency of the enzyme sphingomyelinase
What is Lennox-Gastaut syndrome?
A seizure disorder characterised by epileptic seizures, psychomotor delay, low IQ, and behavioural disorders
Which EEG pattern is found in Lennox-Gastaut Syndrome?
Slow spike-wave complexes in inter-ictal period
What is the gold-standard investigation for primary ciliary dyskinesia?
Bronchial brush biopsy
What PEFR suggests a moderate exac of asthma?
50-70%
What PEFR suggests a severe exac of asthma?
33-50 %
What PEFR suggests a life-threatening exac of asthma?
< 33%
A child being too breathless to feed/talk suggests which severity of asthma exac?
Severe
What are the signs of a life-threatening asthma exac?
SpO2 < 92%
PEFR < 33%
Silent chest
Cyanosis
Exhaustion
Confusion/ reduced GCS
Poor resp effort
What are the RR cut offs for differentiating moderate and severe exac of asthma?
RR 30 in over 5s
RR 40 in under 5s
What are the HR cut offs for differentiating moderate and severe exac of asthma?
HR 125 in over 5s
HR 140 in under 5s
What is the step-wise asthma management for under 5s?
SABA then ICS or LTRA then one not tried
What is the step-wise management for asthma in over 5s?
SABA then LS ICS then LABA
What are the 3 shunts of foetal circulation?
Ductus venosus
Ductus arteriosus
Foramen ovale
Where does the ductus arteriosus join?
PA to descending aorta
Ductus arteriosus patency is promoted by…
Prostaglandin E2
Give examples of acyanotic heart lesions.
ASD, VSD, PDA, coarctation
Which congenital cardiac defect is associated with foetal alcohol syndrome?
ASD
What is the immediate treatment for hereditary angioedema?
C1 esterase inhibitor concentrate
What is the treatment for chlamydial conjunctivitis in a neonate?
Oral erythromycin
Unable to abduct eye with retraction on adduction suggests..
Duane Syndrome
ITP and coombs-positive haemolytic anaemia suggests…
Evan’s Syndrome
What are the 4 characteristic features of Tetralogy of Fallot?
VSD
RVH
RV obstruction/pulm stenosis
Overriding aorta
‘Boot-shaped heart’ on CXR suggests…
TOF
Cyanosis soon after birth, worse on feeding with systolic ejection murmur L sternal edge suggests…
TOF
How is TOF managed?
PGE1 and surgical repair
What is required for TGA to be compatible with life?
ASD/VSD/AVSD
How is TGA managed?
PGE1, can use balloon atrial septostomy, definitive = surgery
Which surgery is used to correct TGA?
Rastelli procedure
Truncus arteriosus is most commonly associated with which genetic syndrome?
DiGeorge Syndrome
Which type of ASD is more common?
Ostium secundum
Systolic ejection murmur with fixed splitting of S2 suggests…
ASD
Which ASDs may close spontaneously?
< 5mm
How may a VSD present?
asymptomatic, FTT, HF
Child with HF and pansystolic murmur L lower sternal edge suggests….
VSD
Which genetic syndromes are associated with VSD?
Trisomies and Noonan Syndrome
‘Blowing apex murmur’ suggests…
AVSD
‘Continuous machine-like murmur’ suggests…
PDA
How is PDA managed?
Term - surgery
Pre-term - usually Ibuprofen +/- surgery
What is the main complication of PFO?
Stroke in later life
Coarctation of the aorta is most associated with which genetic syndrome?
Turner Syndrome
Weak femoral pulses suggests…
Coarctation
‘Rib notching’ on CXR suggests…
Coarctation
What are the main complications of coarctation?
LVH, HTN and aneurysm
Baby born at 28 weeks with resp distress, CXR shows ground-glass appearance suggests…
RDS
Resp distress in term infant born by C-section suggests…
TTN
What are the main complications of congenital diaphragmatic hernia?
Pulmonary HTN/hypoplasia which persists following surgery
Which children with UTI should receive an acute USS?
Atypical UTI - non-EColi organism, sepis, AKI, failure to respond within 48h
What is the earliest age that weaning should be tried?
17 weeks (around 4 months)
What is the Somogyi effect?
Child experiences night-time hypoglycaemia with rebound hyperglycaemia
How is central precocious puberty treated?
GnRH agonist (to down regulate FSH/LH)
Faltering growth, hypoK, hypophosphatemia, metabolic acidosis and high urinary pH suggests…
Cystinosis
How is mid-parental height calculated?
Add 7cm to mean of parental heights for male children, subtract 7cm for females
Which electrolyte abnormalities are found in Addison’s disease?
Low Na, high K
Give causes of ambiguous genitalia.
CAH
Klinefelter Syndrome
Androgen insensitivity syndrome
5-alpha reductase deficiency
What is CAH?
Group of conditions affecting cortisol biosynthesis
What is the most common enzyme deficiency in CAH?
21-hydroxylase deficiency
What hormone profile would be present in Klinefelter’s?
Raised LH, low testosterone
What does 5-alpha reductase do?
Converts testosterone to DHT which drives development of male genitalia
How is 5-alpha reductase deficiency inherited?
AR