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AKT > Paediatrics 1 > Flashcards

Paediatrics 1 Flashcards

1
Q

Top two common organisms causing infection of the newborn eye (ophthalmia neonatorum)

A

Chlamydia trachomatis
Neisseria gonorrhoea

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2
Q

short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis
=
Gene
RF
AD/AR

A

Achondroplasia
FGFR 3 gene
Advancing maternal age
AD

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3
Q

Acute epiglottitis is caused by which organism

Sx (4)
What is the tripod position?

Mx (3)

A

Haemophilus influenzae

Generally unwell
High temp
Stridor
Drooling

Sitting, leaning forward, neck extended - helps them breathe

Mx anaesthetics, oxygen, IV abx

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4
Q

XR may show what in acute epiglottitis?

A

Thumb sign

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5
Q

XR in croup can show what?

A

Steeple sign

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5
Q

Which leukemia is the most common affecting children?
Peak incidence age

A

ALL
2-5yo

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6
Q

Name five poor prognostic factors with children with ALL

A

Age <2 or >10
WCC >20 at time of diagnosis
Non-caucasian
Male
T or B cell surface markers

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7
Q

Name seven features of ALL

A

Anaemia
Neutropenia
Thrombocytopenia
Testicular swelling
Bone pain
Hepatosplenomegaly
Fever

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8
Q

What is HbH disease?
Type of anaemia
Number of alpha globulin alleles affected

A

Alpha thalassemia
3 alpha globulin alleles are affected leading to a
Hypochromic microcytic anaemia with splenomegaly

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9
Q

Life threatening asthma attack
Sats
PEF
Chest signs (2)

A

<92%
<33%
Silent chest
No respiratory effort

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10
Q

Severe asthma attack
Sats
PEF
Chest signs (2)
HR >5yo and 1-5yo
RR

A

<92%
33-50%
HR > 125 (>5yo), >140 (1-5yo)
RR >30 if >5yo >40 if 1-5yo
Too breathless to talk or feed
Accessory muscle use

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11
Q

Moderate asthma attack aged 2-5yo
Sats

Moderate asthma attack >5yo
sats
PEF

A

> 92%

> 92%
50% PEF

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12
Q

Mild - mod asthma Mx
How often
Max number of puffs
How many times to repeat before referring to hospital?

A

SABA with spacer
1 puff every 30-60 seconds
Max 10 puffs

Can repeat and then refer to hospital

Prednisolone 3-5 days

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13
Q

Pred dosing
2-5yo
>5yo

mg/kg

A

20mg OD
30-40mg OD

1-2mg/kg

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14
Q

5-16yo asthma mx (7)

A
  1. SABA
  2. SABA + paeds low dose ICS
  3. SABA + paeds low dose ICS + LTRA
  4. SABA + paeds low dise ICS + LABA
  5. SABA + MART (combined low dose ICS + LABA)
  6. SABA + MART (mod dose ICS)/ SABA + mod dose ICS + LABA
  7. SABA + MART (high dose ICS) / SABA + high dose ICS + LABA/ SABA + theophylline/ SABA + seeking advice from expert
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15
Q

Low
Mod
High dose ICS doses

A

200
200-400mcg
>400mcg

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16
Q

Mx asthma <5yo
(4)

A
  1. SABA
  2. SABA + 8 week trial of paeds mod ICS
    Then stop and monitor sx

If sx didn’t resolve during 8 week trial then ?alternative diagnosis
If sx resolved and then reoccured within 4 weeks of stopping ICS rx then restart ICS at paediatric low dose ICS
If sx resolved and then reoccurred >4 weeks after stopping then repeat 8 week trial of paeds mod dose ICS

  1. SABA + paeds low dose ICS + LTRA
  2. Stop LTRA and refer
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17
Q

DSM-V definition of ADHD
(Three main symptoms)
How many features in children up to 16 and >=17yo

Common age range of diagnosis

A

Inattention
Hyperactivity
Impulsivity

Children up to 16yo have to have six features
17yo and over have to have five features

3-7yo

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18
Q

Non pharmacological Mx ADHD (2)

Drug therapy is offered to which age group

A
  1. 10 week watch and wait period to see if symptoms are persistent
  2. Refer to CAMHS or paeds with special interest in behavioural disorders

5 or more yo

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19
Q

Drug treatment in ADHD
1st line
2nd line
If you benefit from 2nd line but can’t tolerate SE

A

1st line methylphenidate (six week trial)
If inadequate reponse
2nd line lisdexamfetamine
3rd line dexamfetamine (if you benefit from lisdexam but can’t tolerate SE)

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20
Q

SE methylphenidate (3)

Monitoring (2)

A

AP
Nausea
Dyspepsia

Height and weight every 6 months
Baseline ECG

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21
Q

ADHD adults mx (2)

A
  1. Methyl or lisdexam
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22
Q

Autism
Features (3)

A

Impaired social communication
Repetitive behaviours
Intellectual/ language impairment

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23
Q

AD conditions
Disease is passed on to what percentage of children?

A

50%

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24
Q

AR conditions
Two heterozygote parents
What percentage will have the condition?
Will be a carrier?
Will be unaffected

A

25%
50%
25%

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25
Q

Age range for benign rolandic epilepsy?
What is it? (when and type of seizure) (2)
EEG shows
Seizures stop by

A

4-12yo
Seizures typically at night, partial +/- secondary generalisation
EEG shows centro-temperoral spikes
Seizures stop by adolescence

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25
Q

Bronchiolitis
Age range
Organism
Worse when?

A

<1yo (peak 1-9 months)
RSV
Worse in winter

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26
Q

Bronchiolitis Ix (1)

Mx (3)

A

Immunofluorescence of nasopharyngeal secretions

Humidified O2 if O2 <92%
NG feeding
Suction

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27
Q

What is Sever disease?

A

Calcaneal apophysitis
Overuse injury in sporty kids

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28
Q

What is the differences between cephalohaematoma and caput succedaneum

A

Cephalohaematome
Develops hours after birth
Parietal region
Takes months to resolve

Caput succedanaeum
Present at birth
Forms over vertex and crosses suture line
Resolves within days

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29
Q

Complication of cephalohaematoma

A

Jaundice

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30
Q

Chickenpox
Infectivity period

A

4 days prior to rash until 5 days after rash

31
Q

Chickenpox features

A

Fever initially
Itchy rash on head and trunk and then spreads
Macular then papular then vesicular

32
Q

Mx chickenpox (3)
What may increase risk of secondary bacterial infection?

A

Keep cool
Calamine lotion
School exclusion

NSAIDs

33
Q

Heel prick test tests for which four conditions

A
  1. Hypothyroidism
  2. PKU
  3. CF
  4. MCADD
33
Q

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
=

A

Measles

33
Q

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
=

A

Mumps

33
Q

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
=

A

Rubella

33
Q

Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
=

A

Erythema infectiosum

34
Q

Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
=

A

Hand, foot and mouth disease

34
Q

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
=

A

Scarlet fever

35
Q

Codeine use in children rule
Breastfeeding yes or no

A

> 12yo for pain that is not controlled by paracetamol or ibuprofen
No

36
Q

Name five acyanotic congenital heart coditions

A

VSD (most common)
ASD
PDA
Coarctation
Aortic valve stenosis

37
Q

Name three cyanotic congenital heart conditions

A

ToF (presents 1-2months old) most common
Transposition of the great arteries (presents at birth)
Tricuspid atresia

38
Q

Red flags for constipation in children (7)

A

From birth
Passage of meconium >48 hours
Ribbon stools
Faltering growth (amber)
Weakness in legs
Locomotor delay
Distension

39
Q

Mx constipation

A
  1. Movicol
  2. add Senna (stimulant)
  3. Substitute stimulant for osmotic e.g lactulose
40
Q

Cow’s milk protein intolerance
Age of onset
Features (5)

A

Present usually in the first 3 months of life
Regurgitation
Vomiting
Diarrhoea
Urticaria
Colic symptoms

41
Q

Cow’s milk protein intolerance
Ix (3)

A

Skin prick
Patch testing
RAST IgE for cow’s milk protein

42
Q

Cow’s milk protein intolerance Mx
Formula fed (2)

Breastfed (3)

A
  1. Extensive hydrolysed formula
  2. Amino acid based formula
  3. Continue breastfeeding
  4. Eliminate cow’s milk protein from maternal diet
  5. eHF milk when breastfeeding stops until 12 months of age
43
Q

Croup
Age range
Organism
Season

A

6 months - 3 years
Parainfluenza
Autumn

44
Q

Croup features (4)

A

Stridor
Barking cough - worse at night
Fever
Coryzal sx

45
Q

Who should be admitted with croup? (4)

A

Moderate or severe
<6 months
Known upper airway abnormalities
Uncertainty about diagnosis

46
Q

Mx croup (2)

Emergency treatment (2)

A

Single dose dexamethasone 0.15mg/kg
OR
Prednisolone

Oxygen
Nebs adrenaline

47
Q

CF
AD/AR

Common organisms that colonise (2)

A

AR

Staph Aur
Pseudomonas aeruginosa

47
Q

Name four presenting features of CF

A

Recurrent chest infections
Meconium ileus
Steatorrhoea/ FTT
Liver disease

48
Q

Name six non presenting features of CF

A

Short stature
Rectal prolapse
Nasal polyps
DM
Delayed puberty
Infertility/ subfertility

49
Q

CF mx (6)

Pharmaclogical therapy (2)

A
  1. BD chest physio + postural drainage
  2. High calorie diet with high fat intake
  3. Minimise contact with other CF patients
  4. Vitamin supplementation
  5. Pancreatic enzyme supplements
  6. Lung transplant

Lumacaftor/lvacaftor

50
Q

Referral for developmental delay
Not smiling by
No sitting by
Cannot walk by

A

10 weeks
12 months
18 months

51
Q

Hand preference before what age is abnormal?
Could indicate?

A

12 months
Cerebral palsy

52
Q

Name seven risk factors for developmental dysplasia of the hip

A
  1. First born
  2. Oligohydramnios
  3. Positive FH
  4. Female
  5. Breech presentation
  6. Congenital foot deformity
  7. Birth weight >5kg
53
Q

Developmental dysplasia of the hip
Most common in which hip?
Who requires screening with an US? (3)

A

Left
1st degree FH, breech presentation K36 and above, multip

54
Q

What test is done at the six week check to check for developmental dysplasia of the hip?

A

Barlow - dislocate
Ortolani - relocate

55
Q

Ix of choice for DDH
Unless what age, in which case which scan?

A

US
Unless >4.5months - XR

56
Q

Most common cause of gastroenteritis in children (organism)

A

Rotavirus

57
Q

Gastroenteritis
Diarrhoea usually lasts for ? and stops within ?
Vomiting usually lasts for ? and stops within ?

A

5-7 days 2 weeks
1-2 days 3 days

58
Q

Who is a stool culture done on in gastroenteritis? (3)

A

Suspected septicaemia
Immunocompromised
Blood/mucous in stool

59
Q

High LH, low testosterone =

A

Klinefelters
Primary hypogonadism
XXY

60
Q

Low LH and low testosterone

A

Hypogonadotrophic hypogonadism
Kallman’s

61
Q

High LH normal/ high testosterone

A

Androgen insensitivity syndrome

62
Q

Low LH and high testosterone

A

Testosterone secreting tumour

63
Q

often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels
=

A

Klinefelter’s
XXY

64
Q

‘delayed puberty’
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal
patients are typically of normal or above average height
=
Inherited?

A

Kallman’s
X linked recessive

65
Q

‘primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol
=
Mx (3)

A

Androgen insensitvity syndrome
46XY

Raise child female
Orchidectomy (increased risk of testicular cancer with undescended testes)
Oestrogen therapy

66
Q

Congenital abnormality of the layrnx
Infants typical present at 4 weeks of age with:
stridor
=

A

Laryngomalacia

67
Q

Which vaccination should be deferred in children with an evolving or unstable neurological condition

A

DTP

68
Q

precocious puberty
cafe-au-lait spots
polyostotic fibrous dysplasia
short stature
=

A

McCune-Albright syndrome

69
Q

X linked recessive inheritance affects which gender?
Males sons are
Males daughters are

Each male child of a heterozygous female carrier has what chance of being affected

Each female child of a heterozygous female carrier has what chance of being carrier

A

Males only
Males sons are unaffected
Males daughters are carriers

Each male child of a heterozygous female carrier has a 50% chance of being affected

Each female child of a heterozygous female carrier has a 50% chance of being a carier

70
Q

Wilm’s tumour
Age
Features (3)

Mx

A

Under age of 5
Abdominal mass
Painless haematuria
Flank pain

Paediatric review within 48 hours

AKT (52 decks)

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