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Y5 Paediatrics > Misc Paeds > Flashcards

Misc Paeds Flashcards

1
Q

6 indications for Abx therapy in URTI in children?

A

Centor 3 or more Kids under 2 with bilateral OM Otorrhoea and AOM Systemic unwellness Complications from disease Significant comorbidities

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2
Q

How long would you expect acute OM to last?

A

Around 4 days

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3
Q

How long would you expect acute pharyngotonsilar infection to last?

A

1 week

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4
Q

How long would expect a common cold to last?

A

1-1.5 weeks

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5
Q

How long would you expect rhinosinusitis to last?

A

2.5 weeks

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6
Q

How long would you expect a cough/bronchitis to last?

A

3 weeks

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7
Q

3 biochemical criteria supportive of DI?

A

HyperNa Low urine osmolality High plasma osmolality

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8
Q

What is the diagnostic investigation of choice for DI? How do you interpret it?

A

Water deprivation test - normally should increase urine osmolality (concentrate) In cranial DI, urine osmolality stays low and plasma stays high but giving ADH (desmopressin) resolves this In nephrogenic DI, urine osmolality stays low and plasma high despite giving desmopressin

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9
Q

6 causes of cranial DI?

A

Idiopathic Craniopharyngioma Head injury Pituitary surgery Histiocytosis X DIDMOAD

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10
Q

4 causes of nephrogenic DI?

A

Genetic - ADH or aquaporin 2 genes Metabolic - high Ca or low K Drugs - demeclocyline, lithium Tubulointerstitial disease

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11
Q

Abx management for human bite?

A

Co-amoxiclav

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12
Q

Abx management for campylobacter?

A

Clarithromycin

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13
Q

What is the most common cause of childhood nephrotic syndrome?

A

Minimal change nephropathy

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14
Q

What is the pathophysiology behind minimal change nephropathy and what does biopsy show?

A

GBM damage via T cell/cytokines Leads to polyanion and albumin loss Biopsy shows podocyte fusion

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15
Q

What are two examples of proteins which leak out in minimal change nephropathy?

A

Transferrin Albumin

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16
Q

Management of minimal change nephropathy in kids?

A

Steroids PO - 80% responsive, if not renal biopsy Next line is cyclophosphamide

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17
Q

Prognosis of minimal change nephropathy?

A

1/3 full recover, isolated episode 1/3 frequent exacerbations, burns out by adulthood 1/3 infrequent exacerbations

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18
Q

Steps for newborn resuscitation?

A

Dry baby, maintain temp and start clock Assess tone, breathing and pulse If no breathing, 5 rescue breaths with open airway and feel for pulse response If no rise in pulse, recheck breathing technique - if okay and HR absent or under 60, commence chest compressions ratio 3:1 and reassess every 30s

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19
Q

Do you need to exclude kids with hand foot and mouth disease from school?

A

No - manage conservatively

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20
Q

What type of cyst contains keratin plugs?

A

Epidermal cysts

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21
Q

What age is aspirin contraindicated below?

A

16

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22
Q

How might choanal atresia present?

A

Cyanosis episodes in newborn, worse during feeding

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23
Q

Treatment for scalded skin syndrome?

A

Flucloxacillin

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24
Q

What interventions are recommended for a child with BMI over 91st centile?

A

Tailored clinical intervention

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25
Q

What interventions are recommended for a child with BMI over 98th centile?

A

Tailored clinical intervention and assess for comorbidites/underlying cause

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26
Q

What is the most common cause of childhood obesity? 5 other organic causes?

A

Lifestyle factors Also growth hormone deficiency, hypothyroid, Cushing’s, Prader Willi and Downs syndrome

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27
Q

5 areas of complications of obesity in children?

A

MSK - SUFE, OA, Blount’s disease, pain CVD risk long term Neurological - benign intracranial hypertension OSA Psychological

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28
Q

What is Blount’s disease?

A

Severe, progressive bowing of the legs in kids related to obesity

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29
Q

Below what age is transcutaneous measurement of bilirubin inappropriate?

A

Less than 24 hours - do serum bilirubin with breakdown

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30
Q

Going from 3m - 4 years, outline the developmental process of speech language and hearing in kids?

A

3m - turns to sound, squeals 6m - double syllable noises 9m - mama/dada, understands ‘no’ 12m - knows and responds to own name 12-15m - knows 2-6 words, understands simple commands 2 years - combines 2 words, points to body parts 2.5 years - at least 200 word vocab 3 years - 3-5 word sentences, what and who questions, colours and counts to 10 4 years - why, where and how questions

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31
Q

When would you expect a child to be able to count to 10 and name colours?

A

3 years old

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32
Q

How long should kids with chickenpox be excluded from school for?

A

Until all vesicles are crusted over

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33
Q

From 3m-4yrs, outline the developmental process of gross motor skills in kids?

A

3m - little-no head lag, lies on tummy with good head control, will sit if held with curved back 6m - lies on back kicking and holding feet, pulls to sit and rolls from front to back. Sits with curved back on own 7-8m - sits without support 9m - pulls to stand, crawls 12m - cruises 13-15m - walks unsupported 18m - squats to pick up toys and crawls upstairs 2 years - runs, walks up/downstairs with rail 3 years - stairs without rail, rides tricycle 4 years - hops on 1 leg

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34
Q

When would you refer a child who can’t sit without support?

A

12m

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35
Q

When would you refer a child who can’t walk unsupported?

A

18m

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36
Q

When would you refer a child without a first word?

A

18m

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37
Q

What is the recommended diet for CF patients?

A

High calorie, high fat with pancreatic enzymes with every meal Vitamin supplementation

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38
Q

What is the recommended chest physio programme for CF patients?

A

At least BD chest physio and postural drainage Pretty much from diagnosis

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39
Q

How would you take a sample to test for pertussis?

A

Nasal swab

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40
Q

Give two examples of inactivated vaccines?

A

IM flu Rabies

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41
Q

Give 6 examples of fragment vaccines?

A

Diphtheria Pertussis HBV Meningitis Pneumonia HiB

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42
Q

What type of vaccine is tetanus?

A

Detoxified exotoxin

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43
Q

Outline the APGAR score criteria?

A
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44
Q

When is the APGAR score completed routinely? When else?

A

Normally 1 and 5 minutes of life

May be repeated at 10, 15, 20 if concerned/less than 7 after 5 mins

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45
Q

What are the 3 areas of results of APGAR scoring?

A

0-3 = very low

4-6 = moderately low

7-10 = good

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46
Q

What is the first sign of puberty in males? When does it occur?

A

Testicular enlargement - around 12 years old (10-15)

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47
Q

What testicular volume signifies the onset of puberty?

A

Over 4mls

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48
Q

When do boys’ height spurts occur?

A

Around 14 years

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49
Q

What is the first sign of puberty in females and when does this occur?

A

Breast development - around 11.5 years (9-13)

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50
Q

When do girls’ height spurts occur? What about menarche?

A

Age 12 - before menarche (Age 13)

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51
Q

What counts as precocious puberty in girls? What about boys?

A

Under 8 years in girls

Under 9 years in boys

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52
Q

What 3 normal variants of physical changes may occur in pubertal kids?

A

Gynaecomastia

Asymmetrical breast development

Diffuse thyroid enlargement

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53
Q

What precaution should be taken for babies born at less than 28 weeks when receiving first set of vaccines? Why?

A

Have them in hospital - due to risk of apnoea

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54
Q

What are the 4 things that can be used to assess in the area of fine motor/vision development in kids?

A

General development - eyesight, hand function

Bricks and towers

Drawing

Book pages

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55
Q

When is hand preference abnormal before?

A

18m - especially if shown before 12m

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56
Q

Outline general fine motor/vision development from 3-12m?

A

3m - reaches, briefly holds; fixes and follows 180d; alert to human faces

6m = palmar grasp, transfers at 7m; looks everywhere

9m = early pincer; points

12m = refined pincer; bangs toys together

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57
Q

Outline brick towers from 15m - 3 years?

A

15m = two bricks

18m = 3

2 years = 6

3 years = 9

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58
Q

Outline drawing development from 18m - 5yrs?

A

18m - scribbles in circle

2 years - copies vertical line

3 years - circle

4 years - cross

5 years - square and triangle

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59
Q

Outline how kids interact with book pages from 15m - 3 years?

A

15m - looks at book, pats pages

18m - turns pages several at a time

2yrs - turns pages one at a time

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60
Q

When should you refer a non-smiling child?

A

10 weeks

61
Q

When should a child be using a knife and fork?

A

5 years

62
Q

When should a child be using a spoon and fork?

A

3 years

63
Q

What is the normal duration of oral steroids for acute asthma attacks? What is different about kids who are already on oral steroid maintenance?

A

3 days

If on maintenance, increase dose to 2mg/kg up to 60mg

64
Q

What is the most common headache in kids?

A

Migraine

65
Q

What are the 4 areas of social/emotional development to assess in kids?

A

Smiling and shyness

Drinking and eating

Dressing

Playing

66
Q

What are the biochemical characteristics of congenital adrenal hyperplasia?

A

21 B hydroxylase deficiency causes increased plasma 17 hydroxyprog, 21 deoxycortisol and urinary adrenocortical metabolites

67
Q

What system is used to assess hirsutism in kids?

A

Ferriman Gallwey scoring system - looks at different body areas

68
Q

Most common cause of hirsutism?

A

PCOS

69
Q

3 causes of hypertrichosis?

A

Porphyria cutanea tarda

Anorexia

Ciclosporin

70
Q

What age group is roseola most commonly seen in?

A

6m-2yrs

71
Q

What is enucleation and what is it most commonly done for in kids?

A

Taking out whole eye

Rb

72
Q

When and how is the flu vaccine normally given? Contraindications?

A

Starting at 2-3 years then annually via nasal spray

Is live so immunodeficient kids need the IM one, other usual CIs incl egg allergy

73
Q

Empirical management of non-red flag constipation in kids? What if this doesn’t work?

A

Advise good fluid and fibre intake

Movicol satchets first line

+/- stimulant after couple of weeks

Can use stimulant with lactulose if movicol no good

74
Q

First line med for localised impetigo? Second line?

A

Topical fuscidic acid

Topical retapamulin

75
Q

2 medication options for severe/extensive impetigo?

A

Oral fluclox, or oral erythromycin if pen allergic

76
Q

4 features of hyponatraemic dehydration?

A

Jerky muscle twitches and movements

Increased muscle tone and reflexes

Convulsions

Drowsiness/coma

77
Q

What valve disease is traditionally associated with William’s syndrome?

A

Supravalvular AS

78
Q

What syndrome do these kids have? Features?

A

William’s syndrome

Cardiac - supravalvular AS

Small stature, reduced growth

Developmental delay and learning difficulties

‘Happy puppet’

Sensitive hearing

Renal abnormalities

Hypercalcaemia

79
Q

What syndrome is this describing?

A

Turner syndrome

80
Q

What syndrome does this baby have? Features?

A

Edwards

Prominent occiput, low set ears, small mouth/jaw

Small head

Clenched fists w/ overlapping fingers

Flexed big toe and prominent heels

81
Q

What is this syndrome?

A

Patau

82
Q

Management of nephrogenic DI?

A

Thiazide diuretic to increase Na excretion and lower serum osmolality

83
Q

What is the ratio of chest compressions to breaths in neonatal resus?

A

3:1

84
Q

Most common cause of diarrhoea in kids in UK?

A

Rotavirus

85
Q

What causes head lice? Diagnosis and treatment?

A

Pediculosis capitis

Diagnose with fine tooth combing of wet or dry hair

Don’t exclude from school - treat if live lice with malathion shampoo, wet combing

86
Q

Symptoms of threadworm infection? Management?

A

Perianal itching worse at night, +/- vulval Sx

Management is hygiene advice for whole household + antihelminth - mebendazole for over 6m olds, single dose for whole house

87
Q

What happens if a kid missed MMR? When can they have it?

A

Can have a single dose and then repeat in 3m

Or repeat in 1m if over 10 years old or a current outbreak

88
Q

What is the first carpal bone to ossify in kids?

A

Capitate

89
Q

Which forearm bone head ossifies first in kids?

A

Radial

90
Q

Management of kids with sickle cell?

A

Admit anyone in ?crisis or with a fever, because fever could be serious infection due to hyposplenism

Fluid and analgesia, and keep relatively cool

91
Q

What type of hypersensitivity reaction is responsible for scabies? What happens?

A

Delayed type 4 hypersensitivity reaction, causing pruritis and linear tracks between fingers/web spaces

92
Q

2 treatment options for scabies? Who do you treat?

A

Malathion or permethrin first line

Treat whole household and close physical contacts, note that itch may last 4-6 weeks

93
Q

What does this patient have? What is the cause/association and what treatment is required?

A

Norwegian/crusted scabies, often seen in HIV

Needs ivermectin and isolation

94
Q

What is toddler’s diarrhoea? Management?

A

Benign condition in young kids age 1-5, causing smelly paler stools with undigested food often lots of times in day

But otherwise well and gaining weight, normal dev.

Management is largely conservative, targetting the 4 Fs (keep Fat in diet, good Fluid, not too much Fruit juice, try altering Fibre)

95
Q

What GI problem can occur transiently post-gastroenteritis?

A

Lactose intolerance

96
Q

What is the most common cause of persistent diarrhoea in kids, especially those past breastfeeding?

A

Cows milk protein intolerance

97
Q

What are the 5 options for hearing testing in kids and at what age is each appropriate?

A

Newborn - AOAE +/- AABE if abnormal

6-9m - distraction testing

18m-2.5 years - familiar object recognition (tests speech too)

Over 2.5 years - performance testing, speech discrimination, PTA

98
Q

What are the two major divisions of bedwetting?

A

Primary (never been dry)

Secondary (prev been dry for at least 6m)

99
Q

What is nocturnal enuresis defined as?

A

Involuntary nighttime wetting in a child of 5 years or more in absence of neuro/urinary defects

100
Q

Ix and management of nocturnal enuresis? Stepwise approach depending on age?

A

Look for contributing factors e.g. constipation, DM, recurrent UTI

Initially fluid intake, diet and toileting advice

Reward systems e.g. star chart for toileting before bed

Then if under 7 try enuresis alarms

If over 7 or not worked try desmopressin

101
Q

What type of murmur does ASD cause?

A

Pulmonary stenosis-like (over same area, systolic) causing fixed splitting of S2 (on insp/exp)

102
Q

Murmur in kid that is systolic over pulmonary area, with fixed S2 splitting. Diagnosis?

A

ASD

103
Q

What type of CP is associated with IVH? Why?

A

Spastic diplegic, because of close anatomical relation of corticospinal tracts

104
Q

Describe the rash associated with seborrheic dermatitis in kids? Management? When does it resolve?

A

Yellow flakes on red rash on face, scalp, nappy area, flexures

Initially baby shampoo/oils, more severe try topical steroids

Resolves by 8m

105
Q

What diet may be of use in IBS?

A

FODMAP diet

106
Q

Explain the pathophysiology of G6PD deficiency? How is it inherited?

A

Reduced G6PD leads to reduced glutathione leads to increased red cell susceptibility to oxidative stress and intravascular haemolysis in response to certain stressors

XL recessive inheritance

107
Q

How is hereditary spherocytosis inherited and what does it cause?

A

AD in Europeans, causes extravascular haemolysis

108
Q

8 things which may trigger haemolysis in G6PD?

A

Quinine based drugs - antimalarials, cipro

Sulfa-based - sulfasalazine, sulfonamides, sulfonylureas

Nitrofurantoin

Infection

Broad fava beans

109
Q

What are these? When do they settle by?

A

Plagiocephaly (parallelogram head)

Brachycephaly (short head)

Settle by age 3-5 usually

110
Q

What are the 3 most common causes of nappy rash and how can you differentiate them?

A

Irritant dermatitis spares creases; usually due to urinary ammonia and faeces

Seborrhoeic dermatitis

Candida - white discharge involving flexures, can have satellite lesions

111
Q

General management of nappy rash?

A

Disposable nappies

Barrier cream

Mild steroid cream

112
Q

When is antbiotic treatment indicated for whooping cough and what depending on age?

A

If cough started within last 21 days

Clarithromycin if under 1m

Azith/clarith if over 1m

Erythromycin if pregnant

113
Q

When specifically is the Guthrie test done?

A

Day 5-9 of life

114
Q

Describe the natural history of strawberry naevi?

A

Often not present at birth but may develop rapidly in first month

Increase in size to around 6-9m before regressing by 10 years

115
Q

What antenatal procedure is a RF for strawberry naevus?

A

CVS

116
Q

4 complications of strawberry naevus? Management of these?

A

Bleeding

Ulceration

Visual field blocking

Occuring in windpipe - airway obstruction

B blockers if required

117
Q

What are the anaphylaxis adrenaline doses in kids?

A

Under 6 years - 150mcg

6-12 years - 300mcg

Over 12 adult - 500mcg

118
Q

What is a Still’s murmur?

A

A low pitched murmur heard under the LSE in kids, benign/innocent

119
Q

What kind of murmur in kids is always abnormal?

A

Diastolic

120
Q

What can’t a mother with galactossaemia do?

A

Breastfeed

121
Q

What percentage of kids with CP have hearing problems?

A

20%

122
Q

What is the classical triad of congenital rubella syndrome?

A

SN deafness

Eye problems - retinopathy, cataract, microphthalmia

Congenital heart disease - pulm art stenosis, PDA

123
Q

What disease is associated strongly with molloscum contagiosum now?

A

HIV - AIDS defining

124
Q

What does a jittery, hypotonic baby whose mum was taking labetalol suggest?

A

Hypoglycaemia

125
Q

When is persistent fisting abnormal? What broadly might it indicate?

A

Past 3m - hypertonia

126
Q

When is head lag definitely abnormal? What may it indicate?

A

4m - hypotonia

127
Q

What are 3 early (first year of life) gross motor signs that may indicate hypotonia?

A

Head lag past 4m

Not sitting propped up by 6m

Not sitting unsupported by 10m

128
Q

Before when is hand dominance abnormal? Give 3 differentials?

A

18m

E.g. hemiplegia, CNS problem or brachial plexus problem

129
Q

Define cerebral palsy?

A

A non-progressive insult to the immature brain causing persistent disorder of movement/posture occuring at less than 2year of age

130
Q

5 general gross motor signs of CP?

A

Abnormal gait/posture

Delay in reaching milestones

Hypertonic extremities/earlier hypotonia

Persistent primitive reflexes

Early hand dominance

131
Q

3 MSK complications of CP?

A

Scoliosis

Contractures

Hip/foot and other joint pathology

132
Q

How does spastic CP present and change over time? What are the 3 types?

A

Initially hypotonic floppy baby then spastic

Hemiplegic (stroke), diplegic (HIE/PVL prems) and quadriplegic (often global delay and seizures)

133
Q

What is the role of USS for premature babies’ heads?

A

For babies under 32 weeks scan at 7/14d for IVH

134
Q

What is the main role of surgery in CP? Give 4 examples?

A

Orthopaedic complications

E.g. scoliosis repair, tendon lengthening, osteotomy and selective posterior/dorsal rhizotomy

135
Q

What is the most common cardiac defect associated with Downs syndrome?

A

AVSD

136
Q

4 MSK complications of Down syndrome?

A

Scoliosis

Perthe’s disease

DDH

Foot problems

137
Q

What are 2 autoimmune problems associated with Downs syndrome that should be screened for? When?

A

Coeliac

Thyroid (usually hypo)

Screen around 10 years of age

138
Q

5 things to screen for in Downs syndrome?

A

Ophth - cataracts/squint

Hearing - audiology

Cardiac - AVSD and other abnormalities

Autoimmune pathology (TFT/coeliac)

Hip USS at birth

139
Q

Conservative medical approach to CF management?

A

Conservative - Early MDT involvement, chest physio BD, nutrition support with high calorie diet, immunisations, education and support for fam

Medical - Early treatment with abx esp to cover Hib/staph, bronchodilators, mucolytics

140
Q

Complications of CF split into birth/infancy, childhood and adolescence/adulthood?

A

Infancy - neonatal jaundice, meconium ileus, faltering growth

Childhood - growth problems, recurrent LRTI, nasal polyps, rectal prolapse

Adolescence/adulthood - bronchiectasis, 2 diabetes,infertility, pneumothorax

141
Q

Give 5 causes of acute limping child that can prevent at any age?

A

Ca

Septic arthitis

Osteomyelitis

JIA

Abuse

142
Q

What criteria can be useful in distinguishing septic arthritis from transient synovitis? Briefly outline it?

A

Kocher criteria - 4 things, 3 or 4 = septic arthritis

Non weight bearing on affected side

ESR over 40

Fever over 38.5

White cells over 12000

143
Q

What is the fluid bolus amount in paeds DKA? Why?

A

10ml/kg - cerebral oedema risk

144
Q

What is the general fluid bolus resus for paeds?

A

20ml/kg

145
Q

How to correct dehydration in kids?

A

If clinically shocked, add 100ml/kg on to normal maintenance over 24 hours

If not clinically shocked but dehydrated, add 50ml/kg over 24 hours

146
Q

Between what years is the nasal flu spray given generally?

A

2-7

147
Q

What is the risk of recurrent febrile convulsion after a first one?

A

30%

148
Q
A

Y5 Paediatrics (13 decks)

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