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Paediatrics > Neonates, Infection, Haematology, Oncology, Cardiology > Flashcards

Neonates, Infection, Haematology, Oncology, Cardiology Flashcards

1
Q

Neonate/Newborn age

A

Neonate up to first 28 days

Newborn 0-2 months

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2
Q

Infant age

A

2 months- 1 year

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3
Q

Toddler age

A

1-2 years

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4
Q

Premature gestation

A

<38 weeks

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5
Q

Average weight of a newborn

A
  1. 5kg

7. 5 pounds

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6
Q

Meconium passage

A

24-48 hours post-delivery

Very dark green colour

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7
Q

APGAR score

A 
Appearance 
Pulse
Grimace
Activity (Tone)
Respiratory effort
<3= Very low
7+= Normal
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8
Q

Guthrie Heel Prick

A

1 week

PKU, Hypothyroidism, CF, Haemaglobinopathies

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9
Q

When is Resus generally given to neonates?

A

> 23 weeks gestation

albeit it is remarkable if a <28 week survives

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10
Q

Mechanisms to support a premature neonate

A

Thermoregulation
Ventilation- CPAP, High flow O2 via nasal cannula
Avoid formula milk (NEC)- use umbilical vein
Sufactant via ET tube

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11
Q

How are premature neonates fed?

A

No suck reflex
Central access and parenteral nutrition via the umbilical vein
Then Train parents to give NG feeds +/- Discharge

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12
Q

Meconium stained liquor in the presence of what would make you call the neonatal team?

A

Haemodynamic stress RR>60, HR>160<1000
Grunting
T>38
<95% sats

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13
Q

Process of newborn resus

A

1) Dry baby and start clock
2) Assess Tone, HR, Breathing
3) Airway opening and 5 rescue breaths 250ml bag
4) HR increase? If not check chest movements and repeat inflation breaths
5) HR<60 + Chest movements= CRP! 3:1

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14
Q

Describe the chest compressions used in neonatal resus

A

3:1 Compressions: Breaths
1/3rd Depth
~100/min
Reassess every 30s

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15
Q

Describe the inflation breaths used in neonatal resus

A

2-3s per breath

Make sure chest is moving

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16
Q

Position of the head when doing airway manoeuvres in neonates

A

Neutral

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17
Q

When do you assess APGAR score?

A

1, 5 & 10 minutes

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18
Q

What constitutes a good (score of 2) grimace on APGAR?

A

Sneezes, Coughs, Pulls away

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19
Q

When is Neonatal jaundice always pathological?

A

<24 hours

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20
Q

Physiological jaundice

A

> 24 hours
Resolution in 14 days
Usually beacuase of immature hepatic function and poor feeding

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21
Q

Causes of unconjugated jaundice with onset <24 hours

A 
Sepsis
Haemolytic disease
TORCHES
G6PD
Spherocytosis
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22
Q

Key Investigations for neonatal jaundice

A 
Urgent serum bilirubin needed with 2 hours 
Blood film 
Coombs
Haematocrit 
Blood groups 
\+ LFTs, FBC, TFTs
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23
Q

Causes of Unconjugated jaundice onset >24 hours

A 
Sepsis 
Haemolytic disease
TORCHES
Metabolic disorders
HYPOthyroidism 
Breast milk
Physiological
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24
Q

What hepatic abnormality does conjugated jaundice usually indicate?

A

POST-HEPATIC PROBLEM

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25
Q

Key distinguishing features of conjugated jaundice

A

Typically post-hepatic
Dark Urine, Pale Stools (NO BILE)
Pruritis

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26
Q

What is the direct bilirubin level in conjugated jaundice

A

> 25 umol/l

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27
Q

Causes of conjugated jaundice

A 
Liver disease
Biliary atresia
Choledochal cyst
CF
Hepatitis 
Iatrogenic 
Metabolic
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28
Q

Coomb’s test

A

+ve= Haemolytic disease of the newborn

Demonstrates a reaction between mum and foetus

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29
Q

Biliary atresia

A

Conjugated jaundice
No biliary tree
INR is very high
No vitamin ADEK absoprtion

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30
Q

LFTs in Biliary atresia

A

Transaminase rise

GGT most raised

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31
Q

Definitive Treatment for biliary atresia

A

Kasai’s Hepatoportoenterostomy

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32
Q

Management of jaundice

A

Continue to breast feed, adequate hydration
Treat cause
Phototherapy?
Blood Transfusion?

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33
Q

Phototherapy treatment for jaundice

A

Makes bilirubin water soluble for excretion

> Blue line= Treat
Can repeat bilirubin test in 24 hours if within 50 of blue line and no RF

Stop when >50 micromol/litre below blue line

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34
Q

How do you measure bilirubin?

A

1st 24 hours/<35 wks gestation= Serum

> 35 weeks/>24 hours= Transcutaneous bilirubinometer (if >250 micromol/l then also do serum)

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35
Q

Indications for intensifying Jaundice Phototherapy

A

No fall after 6 hours
rising >8.5 micromol/l per hour
Pre-exchange

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36
Q

Monitoring of bilirubin during jaundice phototherapy

A

4-6 hours post start

every 6 hours later

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37
Q

Indications for an exchange blood transfusion in neonatal jaundice

A

Serum Bili >450 (> Red line)

If only just > Red try Phototherapy 1st?

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38
Q

Kernicterus

A

Unconjugated bilirubin in hyperbilirubinaemia collects in the basal ganglia
= Dystonic Cerebral palsy

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39
Q

Prolonged jaundice

A

> 2 weeks in term
3 weeks in preterm
LIKELY BREASTFEEDING but ?Biliary atresia

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40
Q

What is raised serum bilirubin?

A

> 100 mmol/L

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41
Q

Signs of HIE

A

Low APGAR (<5 at 5 mins)
Acidosis PH <7
Early encephalopathy
Bradycardia, Reduced Tone, Respiratory depression

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42
Q

Management of HIE

A

RESUS
IV/Art line
Avoid hyperthermia aim: 33-36 using cooling mat
Room air
? Fluid resus ? Omit milk and feed slowly
Treat seizures

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43
Q

Classification of birthmarks

A

Vascular (Red, Pink, Purple)

Pigmented

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44
Q

Salmon Patch/Stork mark

A

Most common vascular birthmark
Crying= Inc with blood= More noticeable
Eyelids, neck, forehead
Flat red/pink

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45
Q

Port Wine stain

A

Rare, Mostly permanent
Glaucoma if on eyelid
Hormone sensitive
Darker than Stork marks

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46
Q

What syndrome are port wine stains associated with?

A

Sturge-Weber Syndrome (SEIZURES + LEARNING DISABILITY)

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47
Q

Treatment of port wine stain

A

Laser

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48
Q

Strawberry mark

A

Infantile Hemangioma
Red and Raised
May initially increase in size
?Topical propanolol

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49
Q

Cafe-Au-Lait Spotys

A

Coffee coloured spots

GP review ?NFT1 if >6 by age 5

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50
Q

Mongolian Blue Spots

A

Look Like Bruises
Usually Buttocks
Gone by age 4

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51
Q

Cephalohaematoma

A

Subperiostal bleed + Suture lines limit the swelling
Complicated delivery increases risk
JAUNDICE IS A COMPLICATION

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52
Q

Pathophysiology of Rhesus Haemolytic disease of the newborn

A

F Rh +ve M Rh-ve
Foetal blood haemorrhages into maternal circulation
Anti-IGD production
Foetal RBC haemolysis at increasing severity with subsequent pregnancy

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53
Q

Post-natal presentation of Rhesus Haemolytic disease

A

Hyperbilirubinaemia + Jaundice
Hepatosplenomegaly
Hydrops fetalis
Throbocytopenia and Leucopenia

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54
Q

Hydrops fetalis

A

Fluid accumulation in abnormal compartments

Ascites/Pericardial effusion/Pleural effusion/Skin Oedema

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55
Q

Neonatal blood sample results in Rhesus haemolytic disease

A

Low Hb, High reticulocytes, Low platelts, High serum bilirubin

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56
Q

Management principles in haemolytic disease of the newborn

A 
Close supervision
O-ve ready 
Jaundice management as per
Blood transfusion if severe anaemia 
Oral folic acid 250mcg/kg/day
Weekly Hb check
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57
Q

Sufactant production and deficiency

A

Usually produced by week 30 via T2 pneumocytes

Deficiency leads to alveolar collapse, Hypoxia and shunting (No V but Q there)

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58
Q

RDS presentation

A

Likely <32 weeks gestation

Haemodynamic compromise, see-saw breathing, Grunting

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59
Q

RDS on CXR

A

Ground Glass Appearance

Generalised atelectasis, Airbronchograms, Decreased lung volume

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60
Q

RDS on a blood gas

A

Respiratory acidosis on blood gases as no ventilation

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61
Q

Management of RDS

A

Position: PRONE
ET Sufactant (Curosurf/Survanta)
? Intubation ?CPAP via Nasal Cannula
Gentamicin and Penicillin and stop once congenital pneumonia is excluded

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62
Q

Complications of RDS

A

Major one is Bronchopulmonary dysplasia caused by mechanical ventilation
O2 needed >28 days of life
Steroids and diuretics needed

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63
Q

Prevention of RDS

A

Betamethasone/Dexamathasone 2X12 hourly

Give to Mother 1-7/7 before birth

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64
Q

What is generally thought to indicate fetal viability?

A

24+ weeks

500G

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65
Q

Respiratory complications of prematurity

A

RDS
Chronic lung disease
Apnoea of prematurity

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66
Q

CNS complications of prematurity

A

IVH
Periventricular leukomalacia
Retinopathy

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67
Q

Diagnosis of IVH

A

Cranial USS

Head circumference is also a good indication

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68
Q

Perventricular leukomalacia

A

White matter softens near ventricles

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69
Q

Retinopathy screening

A

From 28 days

Or if <1.5kg

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70
Q

Pathphysiology and treatment of retinopathy of prematurity

A

Abnormal vessel growth ?Proliferated by oxygen

Treat with laser therapy

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71
Q

Presentation of NEC

A

Distension, Billious vomiting, Bradycardia, Erythema, Apnoea
PR bleeding
PREMATURE BABY

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72
Q

AXR signs of NEC

A 
Intramural gas
Gas in the portal tree
Asymmetrical dilated bowel loops 
Pneumoperitoneum 
Air inside and outside bowel wall (Rigler's)
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73
Q

Treatment of NEC

A

Broad Abx- Cef + Vanco
Stop feeds 7-10 days
IV fluids and parenteral nutrition (?TPN ?NG)
Laparotomy if deterioration as could be perforation

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74
Q

TORCHeS

A

Congential infections

Toxoplasmosis, Rubella, CMV, Herpes, Syphilis

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75
Q

Post-natal management of a premature baby

A 
ICU
Delay cord clamping 
Resp support
BREAST FEED or Parenteral via umbilical vein 
Minimal handling 
Keep warm
Monitoring 
Benpen or Gent
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76
Q

IUGR/Small baby definition

A

Birth Wx <10th centile

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77
Q

Causes of small baby

A 
Constitutional 
Multiple pregnancy
Maternal abuse- smoking etc
Genetics
Placental insufficiency
TORCHeS
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78
Q

Symmetrical vs Asymmetrical growth restriction

A

Symmetrical- Early insult e.g infection ? Constitutional

Asymmetrical- Late insult like placental problem, head sparing effect

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79
Q

Complications of small baby/IUGR

A 
Foetal death
Hypothermia/Glycaemia
NEC
Polycythaemia
BM/Hepatic compromise- Low platelets and coagulopathy
Retinopathy
Meconium aspiration
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80
Q

Discharge of Small baby/IUGR

A

Feeding well, Weight increasing, no thermoregulatory support room temp=Body temp
Mum capable

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81
Q

When would you admit a small baby to a neonatal ward

A

Consider if Wx<1800g

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82
Q

Talipes Equinovarus ‘Club foot’

A

Inversion
Adduction of forefoot
Plantarflexion deformity

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83
Q

Talipes treatment

A

Ponseti method- Gradual correction via plaster cast

?Surgery if >2 years old

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84
Q

Live vaccines

A

MMR, TB. FLU, Rotavirus, Chicken Pox, Sabine vaccine

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85
Q

CI to vaccines

When do you delay

A

Hx Anaphylactic reaction (Consider in controlled environment), Egg allergy
Live: Immunocompromised

Delay: Evolving neurology, Acutely unwell, IG given recently

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86
Q

Inactivated/Killed vaccines

A 
Polio
Pertussis
HiB
Men C/B
Tetanus/Diphtheria (Toxoid)
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87
Q

Administration of a vaccine

A

Thigh (Infant)
Deltoid (Older)
IM (SC if bleeding disorder)

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88
Q

Vaccines in preterm infants

A

Give at chronological age

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89
Q

6 in 1 vaccine

A

Diptheria,Tetanus, Whooping, Polio, HiB, Hep B

2/12, 3/12, 4/12

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90
Q

When is MMR given

A

12-13 months, 3-4 years

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91
Q

Men ACWY

A

14 Years
Students
Foreign travel

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92
Q

4 in 1 pre-school booster

A

3-4 years

Diphtheria, Tetanus, Whooping, Polio

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93
Q

PCV

A

Pneumococcal vaccine

3 months

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94
Q

BCG

A

TB vaccine
Live attenuated
If lived in a high risk country or parents from a high risk region
At birth

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95
Q

Side effects of the MMR

A

5-10/7 later a rash/fever

Mild mumps 2 weeks later

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96
Q

3 in 1 teenage boost

A

Tetanus, Diphtheria, Polio

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97
Q

HPV vaccination

A

Boys and Girls

12-13 years

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98
Q

Annual flu vaccine

A

2-8 years

Likely Nasal Spray

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99
Q

Oral Rotavirus vaccine

A

2 months, 3 months

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100
Q

Men B and Men C vaccinations

A

Men B- 2 months, 4 months, 12 months

Men C given with HiB at 12-13 months

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101
Q

Complications of Measles, Mumps and Rubella

A

Measles- Encephalitis, SSP, Pneumonia
Mumps- Infertility, Deafness, Meningitis, Encephalitis
Rubella- Dangerous in pregnancy

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102
Q

Which type of vaccines classically require multiple boosters

A

Inactivated toxin vaccines

Tetanus, Diphtheria

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103
Q

Bacterial Neonatal meningitis causes

A

GBS
Listeria
E.Coli

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104
Q

Bacterial Infant meningitis causes

A

S.Pneum
N.Meningitidis,
HiB

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105
Q

Neonatal/Infant meningitis symptoms

A 
Non-specific
Fever without focus
Poor feeding
Irritable
Cold peripheries
Seizures
Respiratory distress
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106
Q

Signs of meningitis

A 
Decreased consciousness
Bulging fontanelle 
Bulging fontanelle
Cushing's- HTN, Bradycardia, Low RR
Brudzinski's and Kernig's
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107
Q

Brudszinski’s and Kernig’s signs

A

Meningeal irritation

Brudzinski’s- Pain on knee extension when hip flexed

Kernig’s- Flexion of the head= Hip flexion (90% sensitivity!)

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108
Q

Signs of raised ICP

A 
Headache, Vomiting, Papilloedema 
Mental state change, Pupilliary irregularity
Hemiparesis
HTN
Squint
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109
Q

CI to a Lumbar puncture

A

Focal neurology, seizures
Shock
Abnormal clotting
Meningococcal septicaemia

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110
Q

Bacterial infection as indicated by LP

A

Cloudy CSF
High Neutrophils>Lymphocytes
High Protein
Low Glucose

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111
Q

Viral infection as indicated by LP

A

Clear/Cloudy CSF
Lymphocytosis
Normal glucose
Potentially normal protein

112
Q

TB as indicated by LP

A

Slightly cloudy CSF

High lymphocytes, V high protein, Low Glucose

113
Q

Empirical management of Bacterial meningitis

A

IV Cefotaxime and Amoxicillin if <3/12

IV Ceftriaxone

Alter once organism known

114
Q

Abx of choice of Meningococcal/Pneumococcal/Hi meningitis

A

Cefotaxime

115
Q

Delayed complications of Meningitis

A

Hearing loss
Focal paralysis
Seizures
CP

116
Q

Hearing test post-meningitis

A

6/52 post-discharge

117
Q

Meningitis chemoprophylaxis

A

Same house, > 5 hours per day in room with meningococcal child

Give Cipro or Rifampicin

118
Q

Meningococcal septicaemia

A

N.Meningitidis G-ve diplococci inducing bacteraemia and vasculitis

Fever, Mottled, pain, Cold peripheries, breathing problems

Later have non-blanching rash +/- Confusion

119
Q

Treatment of Meningococcal Septicaemia

A

IM BenzylPenicillin or IV Cefotaxmine

120
Q

Meningitis vs Meningococcal septicaemia

A

Speticaemia is likely to induce a rapidly spreading purpuric rash
Purpura are 2-10mm

121
Q

Neonatal sepsis treatment- Abx

A

<1 month- Try Benzyl and Gent

1- 3 months- Cefotaxime

122
Q

Petechial spot vs Purpura vs Ecchymosis

A

Petechial spots are <2mm

Purpura are 2-10mm

Ecchymosis >10mm

123
Q

What is purpura

A

Non-blanching red/purple discolouration of the skin, 2-10mm

124
Q

Causes of purpura

A 
Meningococcal sepsis
Thrombocytopenia
HSP 
Viral infection
Vasomotor straining
Trauma
VWD
125
Q

Presentation of sepsis in children

A 
Tachypnoea/Cardia
Bradycardia
Dry nappies
Mottled/Ashen appearance
Non-blanching purpuric rash
Low sats
126
Q

Neonatal conjunctivitis

A

Sticky eyes D3-D4, non-infective

Gonococcal- 1st 48 hours, purulent discharge

Chlamydial- 7-10 days LATER

127
Q

Infective vs Allergic conjunctivitis

A

Latter has bilateral chemosis and swelling

Former may have purulent discharge and eyes stuck together

128
Q

Common causes of infective conjunctivitis

A

Adenovirus
G+ve Cocci
H.Influ

129
Q

Varicella Zoster Virus

A

Chicken pox
Highly infectious
Spread via respiratory droplets a direct contact with lesions

130
Q

Describe the rash in chicken pox

A 
Starts on head/trunk then spreads
Red macule (Flat) -> Papule-> Vesicle-> Pustule -> Crusting
131
Q

When is Chicken Pox infectious

A

4 days before rash till around 5 days after

Once crusted over it is no longer infectious

132
Q

How can you manage chicken pox related itching

A

Calamine lotion, chlorphenamine (>1 yr), cooling baths, short nails

133
Q

School exclusion in chicken pox

A

5 days post-skin eruption

134
Q

When in chicken pox is varicella IG given

A

Immunocompromised- prophylaxis

Baby born with chicken pox within 7/7 of mother contracting VZV

135
Q

When would you consider Aciclovir for chicken pox

A

Severe systemic infection, pneumonia, Encephalitis, Immunosuppressed, Babies

136
Q

Complications of VZV

A

Secondary bacterial infection
Encephalitis
Purpura fulminans- Disseminated Haemorrhagic chicken pox
Pneumonitis

137
Q

VZV vs HZV

A

VZV is chicken pox

HZV is shingles in later life when latent VZV is reactivated

138
Q

Triad of symptoms classically seen in Infectious Mononucleosis/Glandular fever

A

Exudative pharyngitis (Sore throat)
Generalised tender lympthadenopathy
Pyrexia

139
Q

Lympthadenopathy in EBV vs tonsilitis

A

Tonsilitis only enlarges the upper anterior cervical chain

In EBV it is generalised and tender

140
Q

Investigations to confirm Dx of Infectious Mononucleosis

A

> 10% Atypical lymphocytes on blood film + +ve EBV serology + Number of lymphocytes increases to 85% of leucocytes/RBC

Mono Spot test (Low sensitivity)

Raised LFTs, IgM,IgG

141
Q

Complications associated with Infectious Mononucleosis

A

Hepatitis and Splenomegaly

Aseptic Meningitis, Encephalitis, Guillan-Barre Syndrome

Orchitis, ITP, Pneumonia

142
Q

Presentation of Cow’s Milk Protein Allergy

A

Presents in 3/12 of forumla feeding
Faltering growth
Multi-system involvement- GI, Dermatology, Resp wheeze

143
Q

Management of Cow’s Milk Protein Allergy

A

Hydrolysed formula and if that doesnt work try AA formula
Dietician support
Mum may have to not have Cow’s milk
Majority resolve by 1 year

144
Q

The Atopic March

A

General order in which atopic pathology develops

Eczema-> Food allergy -> Hayfever -> Asthma

145
Q

Investigations for food allergy

A

Gold standard is a supervised challenge

Skin Prick test -> if not suitable then try Radioallergosorbent test (RAST/ELISA) which grades amount of IgE reacting

Skin patch testing for contact dermatitis

146
Q

Presentation of allergy in a child

A 
Diarrhoea +/- Blood/Mucus
Faltering growth 
Skin changes- Erythema 
Wheeze
Anaphylaxis
147
Q

Clinical Diagnosis of Kawasaki Disease

A

Unexplained Fever > 5 days >38.5 degrees

+4/5 of:

  • Non-purulent bilateral conjunctivitis
  • Lips/Oral changes (E.G. Erythema)
  • Extremity changes (E.G palmar erythema)
  • Polymorphous Rash
  • Cervical lymphadenopathy
148
Q

Ages in which Kawasaki Disease is most commonly seen

A

<5 years

149
Q

Management of Kawasaki Disease + Who must review these patients?

A

High dose IV Ig- 2g/kg over 12 hours
Aspirin- 30-50mg/kg/day QDS then low dose for 6 weeks
Cardiac review- ECHO!

150
Q

Scarlet Fever vs Kawasaki Disease

A

In scarlet fever the rash is Blanching and Punctate

There will also be exudative tonsillitis and respoonsiveness to penicillin V in scarlet fever

151
Q

Key complications of Kawasaki disease

A

Coronary artery aneurysms

+ Coronary thrombosis, MI, Dysrhythmias, Reye Syndrome

152
Q

What does Aspirin cause in children

A

Reye syndrome- Liver and Brain swelling-> Encephalitis

N.B. only used in Kawasaki’s

153
Q

What is the Measles virus

A

Morbillivirus
RNA Paramyoxovirus
Spread by respiratory droplets

154
Q

When is measles infective

A

Infective 4/7 before rash onset till 4/7 after rash onset

155
Q

Triad of Cs in Measles

A

Conjucntivitis
Cough
Coryzal

156
Q

Mouth changes pathognomonic of measles

A

Koplik spots

White spots opposite the molars

157
Q

Describe the rash associated with measles

A

Maculopapular
FACE AND BEHIND EARS INITIALLY
then can spread
Become blotchy and confluent

158
Q

Investigations for measles if doubt about diagnosis

A 
Buccal swab 
IgM levels 
Blood film 
LFTs
oral fluid test- measles RNA
159
Q

What happens to WBC levels in measles

A

Leucopenia

Lymphopenia

160
Q

Complications of measles

A

ACUTE OTITIS MEDIA

+LRTI, Pneumonitis, Febrile convulsions, Encephalitis, SSP

161
Q

What is Subacute Sclerosing Panencephalitis

A

Late complication of mealses 1-7 years post infection

White matter damage- Fatal

162
Q

Periorbital vs Oribital Cellulitis

A

Periorbital is less serious: Erythema/Oedema and tenderness around eye, can progress to orbital involvement

Orbital: Limited occular movement, Decreased acuity, Evolving occular proptosis

Both need IV Abx

163
Q

Common causes of periorbital cellulitis

A

Staph A

HiB

164
Q

Which method of delivery has the lowest risk of vertical transmission of HIV

A

C-section

165
Q

Triad seen in Foetal Rubella Syndrome

A

Cardiac changes
Cataracts
Deafness

166
Q

Presentation of Rubella

A

Prodrome illness with mild fever

Maculopapular rash starting on the face and spreading over the whole body lasting up to 5 days +/- Lymphadenopathy

167
Q

What Virus causes Rubella

A

Togavirus

168
Q

When is Rubella infectious?

A

7 days before symptoms

4 days after onset of rash

169
Q

Normal Temperature

Low grade and High grade fever

A

Normal= 36.5-37.5
Low grade= >37.5
High grade= >38.5

170
Q

3 important vital sign measurements in a child with fever

A

HR
RR
CRT

171
Q

Red flag signs in a child with fever

A 
Pale/Mottled/Ashen/Blue
Weak high pitched cry
Not responding/Cannot stay awake
Grunting 
RR>60
Chest indrawing 
< 3 months and Temp >38
Non-blanching rash
Neck stiffness
Focal neurology/seizures/Status
Bulging fontanelle 
Decreased skin turgor
172
Q

Features indicating you should have a low threshold for a septic screen in a child with fever

A 
No localising features
< 3 months
Systemically unwell
Features of a potentially serious infection 
Behavioural change
Predisposition to infection
173
Q

Features indicating you should have a high threshold for a septic screen in a child with fever

A

Older child
Not systemically unwell
Localising features

174
Q

What is the septic screen

A 
Blood cultures
Urine dipstick and culture
FBC, CRP, U&amp;Es
LP
CXR
\+/- Stool culture if bloody diarrhoea
175
Q

Non-infectious causes of fever

A 
Thyrotoxicosis/Hyperthyroidism 
JIA
IBD
Dehydration 
Malignancy
176
Q

Amber flags in a child with fever

A 
Pallor reported by carer
Wakes with prolonged stimulation 
Temo >39 in 3-6/12
Low O2 sats, High RR but <60
Nasal flaring 
Crackles
Tachycardia
Decreased UO
Poor feeding 
Rigors
Not weight bearing
177
Q

How do you manage a Child with fever + Red flag signs

A

Urgent referral to paediatrics

Septic screen

178
Q

Clinical dehydration vs Shock

A

Both show inc HR, RR, Decreased turgor and decreased UO

In shock there is pale cole extremities, prolonged CRT, and decreased consciousness

Hypotension and bradycardia will then develop as they decompensate

179
Q

Causes of Iron deficiency anaemia in Children

A

Nutrition- Delayed introduction of iron rich foods post breastfeeding, Cow’s milk enteropathy, Diets

Adolescent females- Menstruation, Growth spurts

Obstetrics- Preterm, LBW, Multiple pregnancy

Others- Malabsorption, Rarely blood loss, parasites

180
Q

What does Iron deficiency anaemia present as on a FBC/Haematinics

A 
MICROCYTIC HYPOCHROMIC ANAEMIA 
Low Hb
Low MCV
Low MCH
Low MCHC
Low Ferritin
181
Q

How do you prevent Fe deficiency anaemia in high risk groups

A

Iron supplements for preterm infants
Iron containing diet- fortified milk formula, meat, green veg, beans, Vit C
Avoid prolonged cow’s milk consumption

182
Q

Management of Iron deficiency Anaemia

A

5mg/kg oral ferrous sakt in 2-3 divided doses
Continue for 3/12 after Hb has normalised to increase stores
Transfusion if no response

183
Q

Max dose of oral iron a day for children

A

200mg/day

184
Q

Most common central paediatric malignancy and paediatric brain tumour

A

Malignancy= Medulloblastoma

Paed brain tumour= Pilocytic astrocytoma

185
Q

Low grade astrocytomas

A

Gliomas
Mostly Pilocytic astrocytomas
NF1 can lead to low grade gliomas on the optic pathway

186
Q

High grade gliomas

A

Difficult to manage as complete resection is hard
Mostly supratentorial
Diffuse brainstem gliomas are inoperable

187
Q

Primitive Neuroectodermal tumours (PNET)

A

This category of tumours comprises the most common cause of malignant brain tumours in childhood
Medulloblastoma is in this category- Cerebellum and aggressive
Peak 2-6 years
20% have mets to the spine at Diagnosis

188
Q

What sign do Ependyomas classically cause?

A

Obstructive Hydrocephalus as these are periventricular tumours

189
Q

Examples of CNS Germ cell tumours

A

Teratoma, Germinoma

Secreting tumours so look for markers

190
Q

Common presentation of cranipharyngioma

A

Visual field loss and pituitary dysfunction

B/C NEAR PITUITARY GLAND as squamous remenant of Rathke’s Pouch that doesn’t mature into the anterior pituitary gland

191
Q

Presentation of retinoblastoma

A 
Absent or abnormal light reflex
Leukocoria 
Squint 
Visual disturbance 
Uni- or bilateral
192
Q

Epidemiology of retinoblastoma

A

18 months is most common age at presentation
Unilateral- 2-3 years
Bilateral- 0-12 years
BUT 90% 5 year survival with treatment

193
Q

Aetiology of retinoblastoma

A

Loss of TSG on chromosome 13

~10% Hereditary

194
Q

What is Haemophilia?

A

X-Linked recessive disease

A- F8 production is defective
B- F9 production is defective (Less common)

195
Q

Presentation of haemophilia

A

Haemathorases, Easy brusing, Epistaxis, IM Intracranial

If severe (<1% activity) then there will be spontaneous bleeding 
In moderate (1-5% activity) bleeding is secondary to trauma
If mild they will rarely bleed (5+% activity)
196
Q

Haemathorases

A

Bleeding into joint space- can be a sign of haemophilia

Swollen, Painful, Tender, Warm, Limited movement, cannot weight bear

197
Q

APTT and PT results in haemophilia

A

APTT is increased

PT is normal as this looks at F7

198
Q

What method of injection is best in haemophiliacs

A

IV, SC

IM can cause bleeding +/- Compartment syndrome and nerve compression

199
Q

Haemophilia and surgery

A

Prophylactic DDAVP/desmopressin + Factor + Aminocaproic acid (Anti-fibrinolytic)

May need haematology input

200
Q

Haemophilia prophylaxis and on demand drugs if severe

A

A= Octocog alpha (F8) every 48 hours +/- Desmopressin (stimulates VWF production)

Nonacog alpha used in B

201
Q

Triad of symptoms in HSP

A

Buttocks +/- Lower leg papular purpuric rash
Non-destructive polyarthritis
GI involvement- Colicky abdo pain +/- Haematemesis

202
Q

Why is a dipstick a key investigation for HSP

A

HSP can lead to Glomerulonephritis

The dipstick can detect haematuria and proteinuria

203
Q

What is HSP

A

IgA immune complex mediated small vessel vasculitis commoly seen post-infection
Especially in pre-pubertal boys

204
Q

Management of HSP

A

NSAIDS for polyarthritis
IV steroids if abdo pain and N&V
?Renal input

Most resolve in 6 weeks

205
Q

Most common childhood malignancy

A

Leukaemia

Specifically Acute lymphoid leukaemia

206
Q

Pathophysiology of ALL vs AML

A

ALL- Malignant proliferation of B/T cell precursors in the bone marrow

AML- Cells of granulocytic/Monocytic lineage

207
Q

Age at which Leukaemia commonly presents

A

2-6 years

208
Q

Symptoms suggestive of leukaemia

A 
Malaise, Anorexia
Anaemia= Lethargy, Pallor
Neutropenia= Frequent, severe infections 
Bruising 
Lympthadenopathy 
Organomegaly
209
Q

Blood results in Leukaemia

A

Anaemia
Thrombocytopenia
Neutropenia
PT increased

210
Q

Poor prognostic factors for ALL

A 
Age<2 years or >10 years
WBC>20x10^9/L
Non-caucasian 
Male
T or B cell surface markers
211
Q

ALL with orthopaedic involvement and on an X-ray

A

Patient may present with limb pain +/- Fractures

Radiological lucency (Lower density than surrounding tissue)

212
Q

Presentation of lymphoma

A

Progressive painless lymph node enlargement
Mediastinal/Intrathoracic/Cervical mass
B symptoms- Fever, Weight loss, Night sweats

213
Q

Epidemiology of Hodgkin’s vs Non-Hodgkin’s lymphoma

A

Hodgkin’s- Adolescents and young adults

Non-Hodgkin’s- Young children

214
Q

EBV is associated with increased risk of what lymphoma?

A

Hodgkin’s

215
Q

Reed-Sternberg cells

A

Hodgkin’s lymphoma

216
Q

Investigations in Lymphoma

A

CT scans
FDG PET scan (Tracer)
BM Aspiration
Isotope bone scan especially if B symptoms

217
Q

Ann Arbor staging

A

Hodgkin’s lymphoma

218
Q

Genetics of Sickle cell anaemia

A

Autosomal recessive
Inherited defect in HBA Beta chain
Increased in Carribean, African, Middle East, Indian

219
Q

Pathophysiology of Sickle cell anaemia

A

Long inflexible chains of Deoxy-HbS polymer

Vaso-Occlusion and haemolysis leads to increased viscosity and decreased blood flow

Therefore: Tissue Infarction and Haemolytic anaemia

220
Q

Onset and course of SC anaemia

A

Fluctuates between good health and crises

Homozygotes onset in 4/12 after HbS takes over from Foetal Hb

221
Q

Features of SC anaemia

A

Dactylitis, HYPOsplenism, Vaso-occlusive crisis in long bones, Avascula rnecrosis, Priapism, Nephropathy, retinopathy and decreased growth

222
Q

Key features of a SC crisis

A 
Pain B/C vaso-occlusion 
Lung collapse (Shadowing on X ray)
Severe anaemia as BM fails
Life threatening hypovolaemia as the spleen suddenly increases in size
Cerebrovascular occulsion... Stroke 
Priapism
223
Q

Acute management of a SC crisis

A

Analgesia
Antihistamine (Histamine increases SC adherence)
O2 and fluids (?150% of normal maintenance)
Transfusion if aplastic crisis or sequestration
?Abx

224
Q

Maintenance therapy in SC anaemia

A

Hydroxycarbamide to decreases crisis frequency
L-Glutamine to decrease pain
Lifetime penicillin prophylaxis + Vaccinations
Daily oral folic acid and high cell turnover
Repeated blood transfusion
BM transplant is curative

225
Q

What can precipitate a SC crisis

A

Hypoxia
Cold
Dehydration
Infection- Parvovirus B19

226
Q

What is Neuroblastoma? Peak Onset?

A

Solid malignant embryonal tumour arising from the sympathetic nervous system
Children <5 years

227
Q

Features of neuroblastoma

A 
Abdominal pain, distension and mass
Panda eyes (Perioribital bruising)
Horner's syndrome 
Airway or Vene cava compression 
Pallor and Wx loss
228
Q

Thalassemia pathophysiology

A

Defect in the synthesis of >1 globin chains
Either the alpha or Beta chain of the Hb molecule
Unlike SC anaemia these chains are missing

229
Q

Alpha vs Beta Thalassemia

A

Beta is the most common
Alpha is mostly asymptomatic, if 2-3 chains affected symptoms show, 4 chains usually means death in utero

Variable severity anaemia

230
Q

Genetics of Thalassemia

A

Autosomal Recessive

231
Q

Beta Thalassemia signs/symptoms

A 
Mild Hypochromic Microcytic Anaemia 
Large head
Misaligned teeth
Abd distension
Failure to grow
Lethargy
Jaundice 
Marked Hepatosplenomegaly in homozygotes
232
Q

Diagnosis of Thalassemia

A

Hb Electrophoresis
In Beta there will be high HBA2 and HbF
Alpha usually has normal levels

233
Q

Management of Thalassemia

A

Regular blood transfusions with chelating agent desferrioaxmine to prevent haemosiderosis

Folic acid

234
Q

What is a Wilm’s tumour?

A

Embryonal tumour of the kidney
Nephroblastoma
Classically a sproadic mutation
1/3rd involve WT1 on Chr 11

235
Q

Peak age of onset for a Wilm’s tumour?

A

2-5 years

90% <7 years

236
Q

Presentation of a Wilm’s tumour

A

Visible, painless, unilateral, abdominal mass
+/- Distension
+/- Haematuria
+/- HTN

237
Q

What investigations must be done to exclude neuroblastoma in ?Nephroblastoma

A

Abdo USS + CT
CXR
Urine catecholoamines

Also do FBC, Coag studies, Renal function

238
Q

Treatment of a Wilm’s tumour

A

Nephrectomy + Chemotherapy +/- RT

239
Q

Cyanotic congential heart diseases

A

Tetralogy of Fallot
Transportation of the great arteries
Tricuspid atresia
Truncus arteriosus

240
Q

Non-cyanotic congential heart diseases

A

Coarctation of the aorta
ASD/VSD/AVSD
Patent DA

241
Q

What are the 7 S’ of an innocent murmur

A 
Soft
Systolic
Short
Sternal edge (L)
Symptomless
Sensitive to position change 
Sweet in pitch
242
Q

Still’s murmur

A

Flow murmur across the aortic valve
Changes with position
Musical sound

243
Q

Pulmonary flow murmur

A

Brief and high pitched
2nd LICS
Turbulent flow

244
Q

Venous Hum

A

Heard below clavicles

Continuous Hum caused by venous return

245
Q

When listening to a heart murmur what do you assess?

A

Position
Character
Grade

246
Q

Eisenmenger’s syndrome

A

When any L to R shunt leads to RVH

As a consequence the shunt is reversed to R to L

247
Q

Where do the umbilical veins drain

A

IVC

248
Q

What does the ductus arteriosus do?

A

Connects the pulmonary artery to the aorta

Blood flows down from the pulmonary artery into the aorta

249
Q

If a newborn becomes ill in the first few days of life what does it suggest about the congenital heart condition

A

That it is duct dependent

Think Coarctation of the aorta or Transportation of the great arteries

250
Q

What makes up the tetraology of Fallot

A

Overriding aorta
Large VSD
RVH
Stenotic pulmonary artery

251
Q

Symptoms of ToF

A

Intermittent cyanosis from birth
Tet spells where they become hypercyanotic
Will not thrive

252
Q

Murmur in ToF

A

Loud ejection systolic murmur B/C Stenotic pulmonary artery

253
Q

Heart shape in ToF on a CXR

A

Boot shaped

254
Q

Treatment of transportation of the great arteries

A

Prostaglandins to maintain the DA (Alprostadil)
Emergency atrial septostomy (ASD)
Atrial switch operation

255
Q

Commonest heart defect in Down’s syndrome

A

AVSD

256
Q

Murmur in ASD/AVSD

A

Split S2 as venous return overloads pulmonary valve

Soft ejection systolic murmur

257
Q

Shape of the heart in Transportation of the Great arteries on CXR

A

Egg on its side

258
Q

Commonest cardiac defect

A

VSD

ToF is the commonest cyanotic defect

259
Q

Murmur in VSD

A

Harsh Pansystolic

260
Q

When does VSD usually present

A

4-6 weeks as L to R shunt gets bigger
SoB on feeding
Recurrent infections
?HF

261
Q

Diagnosis of Congenital Heart Disease

A

Echocardiogram

262
Q

What maintains the patency of the ductus arteriosus

A

Prostaglandins

263
Q

What can precipitate a patent Ductus Arteriosus

A

Valproate, Congenital Rubella syndrome, Preterm, Hypoxia

264
Q

Murmur in patent Ductus Arteriosus

A

Machinery Hum- Continuous
Tricuspid area
+/- Subclavicular thrill

265
Q

What infection does congential heart disease increase your risk of

A

Endocarditis

266
Q

Treatment of Patent Ductus Arteriosus

A

Ibuprofen
Diuretics for HF
+/- Surgery

267
Q

How does Ductus Arteriosus closure impact Coarctation of the aorta

A

Leads to arterial constriction where some of this ductal tissue has extended into the aorta thereby increasing the obstruction

268
Q

Presentation of Coarctation of the Aorta

A

Radiofemoral delay (Subclavian artery not affected by the narrowing)
Discrepancy between pre- and post-ductal sats
Ejection systolic murmur
Shock and metabolic acidosis

269
Q

Management of Coarctation of the Aorta

A

IV prostaglandins to maintain the patency of the Ductus arteriosus
Diuretics if HF
Stent
Surgical correction post-diagnosis by echo

270
Q

Abx of choice for meningococcal sepsis

A

Cefotaxime

271
Q

Scarlet fever

A

Sandpaper rash- Fine punctate erythema on head and trunk but sparing palms and soles
Palatal petechiae- RED THROAT
Strawberry tongue that can intially be white

Caused by GAS

272
Q

Scarlet fever management

A

PO Penicillin V

Stay home from school for 24 hours post-starting Abx

273
Q

Urticaria

A

Raised red rash
Itchy
Wheals

274
Q

CI to lumbar puncture

A 
Local infection
Unconsciousness/Decreasing GCS
Meningococcal septicaemia likely
Bleeding disorder
Abnormal posture
Respiratory abnormality- Hyperventilation, Cheyne stokes 
Seizure >10 mins, focal seizure
Pupils abnormal 
Raised ICP
Focal neurology 
Shock
275
Q

Impact of positive pressure ventilation on a preterm baby

A

Can lead to pulmonary fibrosis and bronchopulmonary dysplasia so try and avoid

276
Q

How do baby radiographs differ from adults?

A

When supine the clavicles have a lordotic projection
Cardiothoracic ratio <0.6
Wide mediastinum because of big thymus
Very big gastric bubble and kinked trachea B/C crying

277
Q

Normal vital sign values for a child <1 year

A

HR 110-160bpm
RR 30-40
Temp 36.6-37.5
SBP- 70-90mmHg

Paediatrics (6 decks)

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