more extra Flashcards
paed bls what pulse do you feel under age of one
brachial pulse
what is oppositional defiant disorder
paed psychiatric diagnosis in which children show persistent defiant and hostile behaviour towards figures of authority, like a parent or teacher. The behaviour is not significant enough to be a serious disability in social functioning, unlike the more serious diagnosis of conduct disorder.
what is conduct disorder
examples of problems
Conduct disorder is a diagnosis given to patients under the age of 18 years old who show behaviour and attitudes that
continuously
disrespect and violate the rights of other people. It is more common in males.
continuously - conduct
Common problems include:
physical agression
destructive behaviour
stealing
1 - A 12 year old boy is taken to the GP by his mother, asking for help because her son is “out of control”. He is frequently in trouble for physical fighting at school, lighting fires in the school and severe temper tantrums when things do not go his way. He has been found shoplifting from local stores and last week his mother found him throwing stones at their cat, which she felt could have caused serious injury if she had not stopped him.
2 - An 11 year old girl is brought to the GP because her mother is ‘beyond despair with her’.
The mother reports that her daughter is consistently hostile and angry towards her. She always does the opposite of what she asks her to do, shouts at her mother if she tries to get her to do anything, and insults her mother at every opportunity. Otherwise, the girl is fit and well. She has not yet reached puberty. She is getting on well at school, although occasionally her report card mentions that she talks back to teachers. She has lots of friends and gets on well with her younger brother.
what is conduct and what is oppositional defiant disorder
Conduct disorder
This boy presents with a history in keeping with conduct disorder, characterised by a repetitive and persistent pattern of dissocial, aggressive or defiant behaviour. Common presentations include stealing, bullying, lying, fighting, fire-setting and cruelty to animals. Temper tantrums which are not age-appropriate can also be seen
Oppositional defiant disorder
This 11 year old girl shows persistent defiant and hostile behaviour towards her mother, a figure of authority. Given that this is having an impact on their relationship, but she is otherwise getting on well socially with her peers and performing well at school, there is no significant debility that would be more consistent with conduct disorder
intersusseption imaging modality and what will it see
Abdominal ultrasound will demonstrate the target/doughnut sign - concentric rings of hyper- and hypo- echogenicity.
A 3 month old boy, corrected for gestational age, born in May, with trisomy 21 has a ventricular septal defect. He is currently on a high-calorie nastrogastric feed and furosemide.
What prophylactic therapy is indicated for this patient?
Palivizumab
This is a premature boy under the age of six months (corrected) approaching bronchiolitis season. He has significant acyanotic heart disease, requiring furosemide to prevent from him being symptomatic. He meets the indications for RSV prophylaxis. Palivizumab is a monoclonal antibody that minimises the risk of infection by RSV. It is given subcutaneously once a month during bronchiolitis season
A 14 year old boy with learning difficulties presents to the GP with his parents for follow up of anxiety. He has suffered from severe anxiety in social situations since early childhood, and often bites his hands to help himself cope. He also has epilepsy which is well controlled on valproic acid.
On inspection, he appears well but will not make eye contact with you. He has a long thin face, a large jaw and his ears stick out prominently. He repeats everything you say to him. His chest is clear to auscultation. Heart sounds I + II are present, with a 2/6 systolic murmur with mid-systolic click loudest at the apex.
What is the most likely underlying genetic abnormality in this patient?
fragile x syndrome
children sepsis signs
Symptoms in children with sepsis may include:
Generally feeling unwell
Lethargy
Poor social interaction
Altered conscious level
Continuous crying in babies
Pale or mottled skin
Rash
Decreased urine output
Poor feeding or oral intake
Cool peripheries
Signs may include:
Increased respiratory rate
Increased respiratory effort
Bradycardia or tachycardia
Fever
Signs of dehydration
It is important to note that fever is not necessarily always present.
children sepsis signs
Symptoms in children with sepsis may include:
Generally feeling unwell
Lethargy
Poor social interaction
Altered conscious level
Continuous crying in babies
Pale or mottled skin
Rash
Decreased urine output
Poor feeding or oral intake
Cool peripheries
Signs may include:
Increased respiratory rate
Increased respiratory effort
Bradycardia or tachycardia
Fever
Signs of dehydration
It is important to note that fever is not necessarily always present.
when does hand preference normally develop by
Hand dominance normally develops by 2 years and children <18 months old should not have a hand preference. This may indicate spastic hemiplegia or cerebral palsy
threshold for walking concern
18month
three main facial abnormalities of FAS
short palpebral fissures, smooth philtrum and thin upper lip
20kg 7yr old in DKA how much fluid bolus do you give
400ml/0.9% NaCl over 15min
diagnostic values of DKA
Ketonaemia: 3mmol/L and over
Blood glucose over 11mmol/L
Bicarbonate below 15mmol/L or venous pH less than 7.3
congential heart block caused by
linked to prescene of what antibodies
It is most commonly associated with maternal Systemic Lupus Erythematosus. It is linked to the presence of maternal anti-Ro and/or anti-La antibodies, although the exact mechanism is poorly understood.
Symptoms of heart block in children can vary, from asymptomatic to severe heart failure
Neonates may be noted to be bradycardic or be in circulatory shock
Most commonly, children do not have symptoms for the first few years of life, and then present with pre-syncope (feeling faint) and syncope (fainting)
Management
If children with heart block are symptomatic, they will require a pacemaker.
A six-year old girl presents to ED with her mother, who is worried. Over the last week and a half the child has had a fever with a headache. In the last two days the child has developed diarrhoea and a red rash covering her cheeks that spares the nasolabial folds. She is also complaining of pain in her knees. The child has been otherwise well, and has completed her vaccines. What is the most likely diagnosis?
rash that spares nasolabial folds
slapped cheek - lace like rash
complciations
Red cell aplasia
Parvovirus infection also reduces erythropoiesis.
especially sickle cell anaemia and hereditary spherocytosis that rely on erythropoiesis, infection can precipitate a severe anaemia, causing an aplastic crisis
Infection in the first half of pregnancy can also cause severe foetal anaemia that can precipitate hydrops foetalis and subsequent miscarriage
Cardiomyopathy
anemaia can cause what in preg
hydrops fetalis
A 14-year-old boy presents to the GP with abdominal pain, arthralgia and a non-blanching purpuric rash on his shins. He is normally fit and well; however, for the last week he has been suffering from coryzal symptoms. The doctor suspects a diagnosis of Henoch-Schonlein Purpura.
Which of the following is the next best step in the management of this patient?
urine dip
classic triad of symptoms of HSP
arthralgia
abdo pain
purpura - extensor surfaces
factors affecting foetal growth leading to intrauterine growth restriction
Maternal BMI and nutritional status (including poor weight gain during pregnancy)
Co-morbidities such as diabetes, anaemia, hypertension, infection, sickle cell anaemia, pulmonary or cardiovascular disease, renal disease, coeliac disease
Cigarette smoking, alcohol and substance abuse
Structural uterine malformations
Chromosomal defects
Multiple pregnancy
Vertically transmitted infection (e.g. CMV, rubella, toxoplasmosis)
Utero-placental insufficiency
Pre-eclampsia
An 18-month-old girl is brought into the Paediatric Emergency Department following a witnessed seizure. The girl’s mother explains that she was crying inconsolably prior to the event. During the episode, the girl’s mother describes seeing her collapse, followed by her first going limp, then having some rhythmic movements of her hands and feet and seeing a slight blue tinge in her face. The episode lasted for 30 s. Following this, the girl’s mother says she was ‘completely fine’ and was running around as if nothing had happened.
Given the most likely diagnosis, which of the following would be the definitive management plan?
reassure and discharge
breath holding spell
what is stridor
musical noise heard during inspiration from partial obstruction of the larynx or large airways.
croup, epiglottisi, and trachiestiis
differnce between croup epilgootis and bacterial tracheitis
Croup
The child would present with cough and coryzal symptoms and in moderate and severe cases with inspiratory stridor.
The symptoms will worsen at night and this is the most common time for these patients to be brought into A&E.
Epiglottitis
The child classically presents with a high temperature, inspiratory stridor and is struggling to breath and drooling.
They are normally very irritable and it is not advisable to disturb these children as they can cry which will result in an obtunded airway.
Bacterial Tracheitis
The child presents with symptoms which are intermediary between those of croup and epiglottitis.
Patients may present with difficulty breathing and shortness of breath combined with a temperature.
what virus i didnt no can cause joint stiffness
parovirus
the one that causes slapped cheek
absolute contraindications for breastfeeding
Infants of mothers with TB infection
Infants of mothers with uncontrolled/unmonitored HIV
Infants of mothers who are taking medications which may be harmful e.g. amiodarone
An 8 year old boy presents to the GP with a runny nose, sore throat and cough that he has had for the past 2 days.
He reports feeling OK and asks if he can play football this afternoon, but his mother is worried. He is normally fit and well.
He appears well with a respiratory rate of 20 and saturations of 100%. On ENT examination, his throat is pink with no swelling or exudate of the tonsils, and his tympanic membranes are visible with no bulging or effusion. On auscultation of the chest, you hear a soft systolic murmur at the left sternal edge. The murmur does not radiate and there is no thrill on palpation. He has never been noted to have a murmur before.
What is the most appropriate management for this murmur?
if persists after this what do you do?
Review again in 2 weeks
This patient is presenting to the GP with a common cold and a soft systolic murmur at the left sternal edge. This is most likely to be an innocent murmur. Innocent murmurs are very common in children (up to 30% of children at some point), and can be precipitated by febrile illness. As this child currently has a mild viral infection, the best option is to review the murmur in a few weeks once the infection has resolved, to see if the murmur has disappeared with the infection. The infection is likely to be a mild viral upper respiratory tract infection, as evidenced by a lack of tonsillar exudate, angry red throat and no sign of ear infection (bulging tympanic membrane with effusion)
Soft
Systolic (note: all diastolic murmurs are pathological)
Sensitive (changes with the child’s position / alongside respiration)
Short (not holosystolic)
Single (no additional sounds)
Small (localised, non-radiating)
if persist echo
parovirus 19 infection durign the first 20 weeks of perg can lead to what condition
hydrops
A 1 year old girl is brought in to A/E by her parents as they are concerned about her breathing. She has been feeling unwell with the flu over the last few days. The parents describe a barking cough. They think she has had all her immunisations. She has a high grade fever. A constant high-pitched sound on inspiration can be heard and she has a hoarse voice.
Humidified oxygen, dexamethasone and nebulised adrenaline is given. The symptoms do not improve.
What is the most likely diagnosis?
bacterial trachietis
A 9 month old boy is rushed into the paediatric emergency department with an ongoing seizure which has failed to terminate following initial treatment with buccal midazolam. Following a full DRABC assessment and further treatment with IV lorazepam his seizure is successfully terminated and he is transferred to the paediatric high dependency unit for further management. On review it is noted that he has 4 large hypo pigmented macules each measuring over 2cm in diameter on his back and torso. There is also noted to be angiofibromas on the nose. Ophthalmological examination reveals the presence of a small retinal hamartoma in the right eye. An electroencephalogram (EEG) is requested and shows evidence of hypsarrhythmia. An echocardiogram comes back as normal.
The paediatric consultant requests an MRI head and in the meantime asks you what is most likely to be the diagnosis?
Tuberous sclerosis complex
Correct. Tuberous sclerosis complex is the most likely diagnosis given the history and you would expect the MRI head to show evidence of benign tubers in the cerebral hemispheres. The hypo pigmented macules described (ash leaf spots) and angiofibromas of the nose are all characteristic of tuberous sclerosis. Tuberous sclerosis is also associated with epilepsy and the hypsarrhythmia if a classic finding on electroencephalogram
42%
The disease has 2 genetic loci:
TSC1, found on chromosome 9q34 - hamartin;
TSC2, found on chromosome 16p13 - tuberin;
The clinical phenotype can result from a mutation in either of these genes.
Clinical features
Infantile spasms with hypsarrhythmia seen on electroencephalogram
Skin: Ash leaf macules; Shagreen patches; facial angiofibromas; subungual fibromas
Neurological/Cognitive: Learning disabilities; Sub-ependymal nodes; Seizures/Epilepsy
Renal: Angiomyolipomas
Cardiac: Cardiac rhabdomyomas
Management
Angiofibromas <2mm in diameter will respond to laser therapy
Angiofibromas >2mm in diameter require dermabrasion or surgical resection
Many patients with renal disease will require anti-hypertensive therapy
Tubers should be regularly imaged and may require surgical resection
auto domiannt
Ash leaf macules
tuberous sclerosis
A 2 month old baby boy is seen by the GP because of difficulty breastfeeding and poor weight gain.
The mother reports that although the baby has a good latch and a strong suck, he gets really tired and out of breath after a few minutes of feeding. This has been getting worse since he was about a week old. He was born by spontaneous vaginal delivery at 39+6 weeks after a normal pregnancy and antenatal scans.
On inspection, he is active, alert and smiley. There is a 2/6 pan-systolic murmur loudest at the lower left sternal edge. The lung fields are clear to auscultation. His abdomen is soft with no organomegaly. His temperature is 36.9 degrees. Plotting his weight on his growth chart shows he has dropped two centiles between 6 and 8 weeks of life.
Which of the following is the best investigation to definitively diagnose this patient’s underlying condition?
left lower sternal edge pansystolic murmur - VSD
echo
A 2 year old girl is brought to A&E at night with a fever and noisy breathing. Her parents say she has had a cough and a runny nose for the last 2 days.
On examination, there is a harsh rasping sound on inspiration. Her respiratory rate is 36, oxygen saturations are 95% and temperature is 38.9 degrees.
What pathogen is most commonly responsible for the most likely diagnosis?
parainfluenze croup
epiglotois caused by
haemophilus influenza
glandualr fever caused by
EBV
acute asthma exacerbation attack what do you give
doses
Systemic corticosteroids should be used in conjunction with nebulised short acting bronchodilators in the management of acute asthma exacerbations. NICE recommends that they are started early in treatment. Oral steroids are given if possible, as there is no clinical benefit to giving IV unless unable to tolerate the oral form.
The doe of prednisolone given is 20mg (ages 2-5) or 30-40mg (ages >5)
sitting without suppor t
7 motnhs
9 limit
simles to stimuli
week 5
limit 8
picner grip
10m
limit 12
walking
12
limit 18
is speakign 1-2 words at 18months pathological
yes should be 6-10
neonatal resus do you start breahtign through air or oxygen
air first then 02 this is to reduced free radicals
A 14-year-old boy attends the GP due to ongoing joint pain. Three weeks ago he was seen in A&E for shoulder pain and stiffness following a minor fall and he was discharged with no concern. In clinic today, he reports that the pain has gotten progressively worse and he has noticed that over the last week his shoulder has become more swollen.
On examination there is a generalised, smooth, tender swelling just below the right shoulder joint, with reduced range of movement in all directions. There are no overlying skin changes. His doctor suspects that the pain and swelling may be due to malignancy.
What is the most important next step in this patient’s management?
xray within 48hr
osteosarcoma
Pain and swelling with a prolonged onset are characteristic
Typically occurs in the metaphyses of long bones
A 7-year-old presents to the paediatric accident and emergency department complaining of “pain in my tummy”. His father says his son had a sore throat a few days ago. On examination there is pain in the right iliac fossa, but there is no guarding. Urine dipstick is normal. Which of the following is the most likely diagnosis?
mesenteric adentiis
what disease where if you give amoxicllin a widespread maculopapular rash occurs due to hypersensitivity reaction
glandualr fever and EBV
what disease where if you give amoxicllin a widespread maculopapular rash occurs due to hypersensitivity reaction
glandualr fever and EBV
broad spec abx used to treat sepsis before culture
cephalexin
broad spec abx used to treat sepsis before culture
cephalexin
. The preceding history of feeling light headed and sweaty is classically seen during
vasovagal episode
hypoperfusion
what throat cysts dotn move on swallowing
branchial cyst
thyroglossal do
branchial cyst
remnant of what
sx
ant or post to sternocleidomastoid
late childhood ?
A branchial cyst is an embryological remnant from the development of the branchial arches which form parts of the head and neck. It manifests as a painless cystic mass anterior to the sternocleidomastoid muscle just below the ear that typically becomes apparent in late childhood. They can be managed conservatively, or surgically excised.
surgical exploration immediately used in
testicualr torsion
what abx work in the same way as pencillins so cannot be given if allergy suspected to penillin
cephalosporin such as Cefalexin - beta lactam
maternal risk factors for congential heart disease
rubella
thalidomide, isotretinoin, lithium, alochol
Maternal diabetes increases the risk of congenital cardiac disease, although this only applies to poorly controlled type 1 and 2 diabetes, and not gestational diabetes. This is likely because by the time gestational diabetes has developed, the heart is mostly formed.
why does gestational diabetes not affect congential heart disease
heart already formed by the time gestational diabetes has developed
You are an FY2 doctor in paediatrics. A nurse calls you to assess a 3-hour old baby boy who looks blue. He was born by forceps delivery at 40 weeks’ gestationn.
On inspection, the baby appears cyanotic around the lips, inside the mouth and at the extremities. On auscultation of the chest, the lung fields are clear. Heart sounds S1 and a loud single S2 are heard, with no other sounds or murmurs. You note from the observation chart that the baby is tachypnoeic, tachycardic and afebrile. An echocardiogram shows the aorta originating from the right ventricle.
Which of the following conditions is most likely to be present in the mother?
Type 1 diabetes mellitus
This infant with early onset peripheral and central cyanosis with respiratory distress, a single loud S2 and an echo showing the aorta originating from the right ventricle has features consistent with transposition of the great vessels. In transposition of the great vessels, failure of the aorto-pulmonary septum to spiral means that the aorta comes out of the right ventricle and the pulmonary trunk out of the left ventricle. This gives a classic ‘egg-on-a-string’ appearance on chest X-ray. This often occurs with other shunts (like ventricular septal defects) which allows some mixing to keep the baby alive. Transposition of the great arteries is the most common cardiac defect in infants of diabetic mothers. This applies to mothers with type 1 and 2 diabetes, rather than gestational diabetes. The mechanism of this is not properly understood, but it is generally thought that insulin dysregulation contributes to abnormal fetal development
antiphospholipid syndrome in preg associated with increased risk of what
In pregnancy, antiphospholipid syndrome is associated with an increased risk of miscarriage from clotting in the placental circulation
JIA treatment
Intra-articular methylprednisolone acetate injection
A is a diagnosis of exclusion for children <16 years old who have persistent joint swelling (>6 weeks)
cn cause anterior uveitis
A 3 year old boy is brought to A&E by his mum with vomiting and lethargy.
Two days ago, he got a fever and developed red spots that turned into little blisters all over his body. He was eating and drinking a bit less than normal, but reasonably well. His mum gave him some aspirin this morning (she had run out of paracetamol that she normally gives him for fevers), and a few hours later he started vomiting and became really tired. He is normally well and takes no regular medicines and has no known allergies. His vaccines are up to date. He does not have a rash, headache or neck stiffness.
On inspection, he appears unwell and is slurring his words. He is tachypnoeic and saturations are 100% in air, heart rate 110, capillary refill 2 seconds and temperature 38.0. His liver is palpable 1cm below the costal margin.
Which of the following investigations would confirm the most likely diagnosis in this case?
liver biopsy as reye syndrome
A 17 year old girl presents to the GP with pain above her knee. She has not suffered any trauma and has been having this pain for 4 months now.
The pain is present throughout the day and is often worse in the morning. On examination, a small mass can be felt superior to the patella and there is tenderness to touch.
Passive and active movements of the knee are normal and there is no damage to the cruciate ligaments.
Osteosarcoma
This is the correct answer. In an adolescent, localised pain of several months duration with no traumatic event or associated injury and an associated mass on examination is highly suggestive of osteosarcoma.
Osteosarcoma is a primary malignant bone tumour where the malignant bone cells produce immature bone. This is the most common primary malignancy of bone in children and adolescents and most commonly affects the distal femur and proximal tibia
osteosarcoma most commonly affects where
prox tibia
This is the correct answer. This child has presented with an unexplained bone swelling and persistent pain, in this age group you need to make a very urgent
48hr referal xray as sarcomas
meconium ileus sign of
CF - bubbly appearance
uti management in kids under 3 months
This is correct. NICE guidelines state that any infant under 3 months of age with a suspected UTI should be admitted to hospital for IV antibiotics and further investigations. In addition, a temperature of 38 degrees or above in a baby younger than three months scores red on the NICE paediatric traffic light system.
fewer wet nappies possible concern for
sepsis
red flags in vomiting children
Projectile vomiting around 6-8 weeks of age: pyloric stenosis
Bile-stained (green) vomit and abdominal distention: intestinal obstruction
Bloody stool with vomiting: dysentery, intussusception
Paroxysmal coughing to the point of vomiting: whooping cough
Seizures/bulging fontanelle with vomiting: raised intracranial pressure
red flags in vomiting children
Projectile vomiting around 6-8 weeks of age: pyloric stenosis
Bile-stained (green) vomit and abdominal distention: intestinal obstruction
Bloody stool with vomiting: dysentery, intussusception
Paroxysmal coughing to the point of vomiting: whooping cough
Seizures/bulging fontanelle with vomiting: raised intracranial pressure
A 5-month-old baby is brought to the GP by his parents. They are concerned because he has had two episodes of vomiting. The vomit is green in colour and both episodes have been after feeding. They say he is gaining weight as expected and has otherwise been well up until now. Which part of the history would cause immediate concern?
Green vomit
Green or bilious vomit is a feature of intestinal obstruction, specifically obstruction distal to the second part of the duodenum which is where bile is secreted into the small intestine. Causes of bilious vomiting include malrotation, duodenal atresia and meconium ileus. This is a red flag symptom and warrants immediate hospital admission.
can 4 month old babies roll over
4-month-old babies cannot roll over yet;
can 4 month old babies roll over
4-month-old babies cannot roll over yet;
developmental dysplasia of the help best investigation
A hip ultrasound is the most appropriate investigation to evaluate the presence and severity of DDH. This should happen when the baby is between 4-6 weeks old.
A 3-year-old girl presents to the general practitioner with a 2-week history of fever and fatigue. She has presented to A&E 4 times in the last 6 months with recurrent infections. On examination, there is widespread painless lymphadenopathy and splenomegaly. In addition, there are petechiae on her forearms.
Which of the following is the next best investigation?
Full blood count
This patient presents with symptoms of bone marrow failure: fatigue indicating anaemia, recurrent infections indicating low white blood cells, and petechiae indicating thrombocytopenia. There are also signs of organ infiltration, given the painless widespread lymphadenopathy and splenomegaly. This is most likely in keeping with acute lymphoblastic leukaemia (ALL). This needs to be urgently investigated with a full blood count in the first instance.
best investigation for vesicoureteral reflux.
Micturating cystourethrogram
Vesicoureteral reflux is a condition in which there is abnormal backflow of urine into the ureters and kidneys. This is diagnosed with a micturating cystourethrogram which involves injecting dye through a urinary catheter to visualise the direction of flow of urine.
most common fractures associated with child abuse
- Radial
- Humeral
- Femoral
vaccines in the 6 in 1
Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b and hepatitis B
bowel loops seen in left side of thoracic cavity
congenital diaphragmatic hernia
When is the neonatal blood spot screening test typically performed in the United Kingdom
5th day of life
so between 5-9
rescue med for febrile seizure what do you give
rectal diazepam or buccal midazolam
what are febrile convulsions
Febrile convulsions are seizures provoked by fever in otherwise normal children. They typically occur between the ages of 6 months and 5 years
3 features of febrile convulsion
usually occur early in a viral infection as the temperature rises rapidly
seizures are usually brief, lasting less than 5 minutes
are most commonly tonic-clonic
mx of gastroschisis
Vaginal delivery with immediate repair would be indicated for gastroschisis, rather than exomphalos - given the defect and lack of a sac for protection, immediate surgery is required as this is an emergency.
mx of exomphalos
c section and staged repair
vsd increases risk of what
endocarditis
bacterial meningitis whilst LP what do you give
abx and dexa ( no dexa if under 3 months0
