Other Flashcards
Waiter’s tip posture
Erb’s palsy
Palsy associated with shoulder dystocia
Erb’s palsy
Nerve root levels in Erb’s palsy
C5-6
What signs of base of skull fractures may be seen?
Mastoid eccymosis battle sign
Panda eyes
Haemotympanum
CSF leaf
Contrast or non-contrast enhanced CT for head injury?
Non-contrast enhanced
Normal CT scan means can send home in a paediatric head injury - true or false
True
In head injury, any worrying symptoms should have appeared X hours after the injury
8
What is Salter Harris?
Classification growth plate fractures
What is the growth plate also known as?
Physis
Accidental injuries often involve bony prominences - true or false
True
What type of fracture is suspicious for NAI?
Metaphyseal corner fractures
Posterior or lateral or anterior rib fractures - which is suspicious for NAI?
Posterior and lateral
Spiral or transverse fractures in long bones is suspicious for NAI?
Spiral fractures in long bones
What type of brain haemorrhage is seen in shaken baby syndrome?
Subdural haemorrhage
Name 3 bones (other than posterior ribs) for which fracture to should raise the suspicion of NAI?
Sternal, spinous process, scapular
Any fracture in a baby too young to crawl/walk is a red flag for NAI - true or false
True
What HLA type is associated with celiac disease?
HLA DQ2
Is fecal calprotectin specific to Crohn’s?
Non-specific marker of GI inflam
Initial blood tests for celiac disease
Total IgA + tTG, FBC, LFTs, U&Es, CRP, ferritin
Is biopsy always indicated for diagnosis of celiac disease in children?
If classical S+S + tTG >10X upper limit - can diagnose on bloods - then do blood test for EMA antibodies + HLA
What type of cancer is associated with celiac disease?
T cell lymphoma
What is toddler’s diarrhoea?
Up to 10 loose stools a day but no other symptoms - thriving
(Still do Ix tho to exclude other causes)
(Improves by age 5-6)
What is Mittelschmerz?
Unilateral lower abdo pain related to ovulation
What is the first and second line management for reflux in an infant?
1st Gaviscon
2nd add ranitidine
What is the first line management of constipation in a child?
Softener eg Laxido
Porphyria cutanea tarda is due to a defect in which enzyme?
Uroporphyinogen decarboxylase
What is the presentation of porphyria cutanea tarda?
Painful blistering skin lesions in response to light
What is the commonest type of porphyria?
Porphyria cutanea tarda PCT
What enzyme is defective in acute intermittent porphyria?
Porphobilinogen deaminase
What is the presentation of acute intermittent porphyria? what age range?
Abdo + neuropsychiatric symptoms 20-40yr
Urine turns red upon standing =
Acute intermittent porphyria
Raised urinary porphobilinogen =
Acute intermittent porphyria
What is seen in the eyes in Down’s syndrome?
Brushfield spots
Single palmar crease =
Down’s syndrome
What is the phenotypic appearance of Down’s syndrome?
Small lot set ears, protruding tongue, upsplanting palpebral fissures, epicanthic folds, flat occiput
What type of cancer is associated with Down’s syndrome?
Leukaemia
What gastrointestinal problems are associated with Down’s syndrome?
Hirshsprung’s
People with Down’s syndrome are at increased risk of autoimmune disorders - T or F
True
eg thyroid, celiac
People with Down’s syndrome are at increased risk of epilepsy - T or F
True
Are epicanthic folds seen in Down’s syndrome or fetal alcohol syndrome?
Both
Is microcephaly seen in Down’s syndrome or fetal alcohol syndrome?
FAS
Is thin upper lip seen in Down’s or FAS?
FAS
Is a smooth philtrum seen in Down’s or FAS?
FAS
What is micrognathia?
Small jaw
What age range gets infantile colic?
0 - 3 months
What is the presentation of infantile colic?
Episodes of crying for >3hr/day, >3/7, for >3wk in otherwise healthy child
(Knees drawn up to chest, red face, difficult to console, clenched fists)
What age to children get reflex?
Before 8wk old
What is the presentation of reflux in children?
Vomiting / regurgitation following feeds
Are any investigations required for reflux in infants?
Nope clinical diagnosis
What advice should be given to parents whose children have reflux?
Consider over-feeding Trial smaller but more frequent feeds Infants should sleep on their back Feed at position 30 degrees head up Hold upright during feeding and for as long as possible after feeding Trial thickened formula
What is the 1st line Mx of infants with reflux other than lifestyle advice?
Gaviscon (alginic acid)
What is the role of PPIs in the Mx of reflux in infants?
Not recommended for simple reflux. If faltering growth or refusing feeds may be trialed.
What are the criteria for a diagnosis of constipation in children >1yr old?
For >1mth - 2 of:
- <3 poos/wk
- Faecal incontinence (overflow)
- Painful/hard movements
- Large stools
High or low fibre diet causes constipation?
Low fibre
Overflow soiling can be a sign of fecal impaction in a child?
Yes
If fecal impaction is suspected, should a PR exam be carried out in a child?
No - only by a specialist
What is the 1st line Mx of fecal impaction in a child?
Polyethylene glycol 3350 + electrolytes (Movicol AKA macrogol)
What is the 2nd line Mx of fecal impaction in a child if Movicol doesn’t lead to disimpaction after 2wk?
Add a stimulant laxative
Are dietary interventions the 1st line of fecal impaction in children?
No do not use dietary interventions alone
What is the best and most reliable method for diagnosing peanut allergy?
Oral food challenge
Peanuts are a legume - T or F
True
What are the doses of adrenaline for anaphlaxis in age <6yr, 6-12yr and >12yr?
<6yr 150mg
6-12yr 300mg
>12yr 500mg
When a patient is in anaphylaxis it is recommended to lie flat and elevate their legs - T or F
True (to ensure blood flow to vital organs)
What is the Mx of anaphylaxis?
IM adrenaline +
High flow O2 +
Prednisolone +
Chlorphenamine antihistamine
How is cow’s milk protein allergy diagnosed?
RAST (total IgE and specific IgE for cow’s milk protein)
or clinical Dx following exclusion
Breastfeeding is a RF for cow’s milk protein allergy - T or F
False breastfeeding is protective
What is the Mx of cow’s milk protein allergy in an infant?
Extensively hydrolysed formula
(2nd line amino acid based formula)
(kids grow out of it, re-introduce milk after 1yr)
If breastfeeding and a child has cow’s milk protein allergy - should mum’s eliminate cow’s milk protein from their diets?
Yes (also give Ca supplements)
When is the newborn baby examination performed?
6 - 24 hours of life
What is the Moro reflex?
Head extension causes abduction followed by adduction of the arms
What age should the Moro reflex disappear?
3-4mth
What is the grasp reflex?
Flexion of fingers when object placed in palm
What is the rooting reflex?
Stroke babies cheek and they turn their head towards
assists in breastfeeding
What age should the grasp reflex disappear?
4-5mth
What age should the rooting reflex disapear?
4mth
Sensorineural deafness + haematuria (renal failure) =
Alport’s syndrome
All pregnant and breastfeeding women should take a daily vit D supplement - T or F
True
What genetic syndrome cause friendly extroverted personalities?
William’s syndrome
Breasfeeding is protective for SUDI - T or F
True
Lower SES is a RF for SUDI - T or F
True
Room sharing is a RF for SUDI - T or F
False room sharing is protective
Bed sharing is a RF for SUDI - T or F
True
Parenteral smoking is a RF for SUDI - T or F
True
Dummies / pacifiers is a RF for SUDI - T or F
False - protective
Is hypothermia or hypothermia a RF for SUDI?
Hyperthermia eg over-wrapping, head covering
What sleeping position is. major RF for SUDI?
Prone (lying on front)
Is prematurity / low birth weight a RF for SUDI?
Yes
What gender is SUDI more common in?
Male babies
Keeping the cot clear of lots of blankets / teddies is a RF for SUDI?
No you recommend that
Following SUDI, families are offered bereavement services and bereavement counselling - T or F
True
(parents also get increased support in next pregnancy eg resuscitation training and movement monitors that alert parents if baby stops breathing)
What is clubfoot also known as?
Talipes equinovarus
What is the 1st line Mx of clubfoot?
Ponseti casts
XR shows onion skin appearance
Ewing’s sarcoma
XR shows sunburst pattern
Osteosarcoma
Medical word for bone infection?
Osteomyelitis
Commonest infecting agent in osteomyelitis?
Staph aureus
Imaging modality of choice in osteomyelitis?
MRI
ABx in osteomyelitis?
IV fluclox for 6wk
Neck lump in children derived form remnants of thyroglossal duct
Thyroglossal cyst
Thyroglossal cyst or branchial cyst - which one is located laterally and which is located in the midline?
Thyroglossal cysts in midline
Branchial cysts laterally
Neck lump lymphatic malforomation
Cystic hygroma
Thyroglossal cyst / branchial cyst / cystic hygroma
- which is the huge sized one
Cystic hygroma
What drug class is associated with cleft lip / palate?
Antiepileptics
Choice of antibiotic for tonsillitis if penicillin allergy?
Clarithromycin
Gower’s sign + calf pseudohypertrophy
DMD
Caput or cephalohaematoma - which crosses sutures?
Caput
Caput or cephalohaematoma - which goes away in a day which in months?
Caput day
Cephalohaematoma months
Separation of the great toe
Down’s syndrome
What are you checking for with the red reflex in newborn examination?
Congenital cataract and retinoblastoma
During the newborn exaination, where do you auscultate for coarctation?
Midscapular area posteriorly