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ISCE prep > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Risk factors for neonatal sepsis

A 
Previous baby with GBS
Current GBS colonisation
Current bacteriuria
Intrapartum temperature >38
Membrane rupture for over 18 hours
Evidence of maternal chorioamnionitis
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2
Q

Early onset neonatal sepsis usually caused by

A

Group B strep

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3
Q

Management for neonatal sepsis

A

IV benzylpenicillin with gentamycin
Measure and monitor CRP
Maintain adequate oxygen sats, fluid and electrolytes and glucose

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4
Q

Management for neonatal meningitis

A

Cefotaxime and acyclovir

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5
Q

Diagnosis of neonatal respiratory distress syndrome

A

CXR with ground glass appearance with indistinct heart border
Tachypnoea, intercostal recession, expiratory grunting and cyanosis

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6
Q

Treatment for neonatal respiratory distress syndrome

A

Maternal corticosteroids during pregnancy if possible

Post-natal oxygen, assisted ventilation, exogenous surfactant

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7
Q

When do adequate amounts of surfactant begin to be produced?

A

35 weeks

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8
Q

Treatment of neonatal seizures

A

Check glucose, turn on side to prevent aspiration risk
1st line- phenobarbital as slow injection
2nd line- phenytoin
Can use benzodiazepines

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9
Q

Features of necrotising enterocolitis

A 
Abdominal distention
Bilious vomiting
Faecal occult blood
Temperature instability 
Lethargy
Discolouration
Mucosal sloughing 
DIC
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10
Q

Diagnosis of Necrotising Enterocolitis

A

Abdo XR for pneumatosis intestinalis

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11
Q

Treatment of necrotising enterocolitis

A

NBM
NGT
IV antibiotics
Referral to surgery

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12
Q

Features of meconium aspirate syndrome

A 
Resp distress
Airway obstruction 
Pulmonary vasoconstriction 
Persistent pulmonary hypertension
Infection 
Chemical pneumonitis 
Pneumothorax
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13
Q

Transient tachypnoea of the newborn management

A

Oxygen to maintain saturations

Usually settles within 24 hours

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14
Q

Jaundice <24 hours is always

A

Pathological

Measure serum bilirubin to determine management

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15
Q

Causes of early jaundice <24 hours

A

Sepsis
Rhesus incompatibility
ABO incompatibility
Red cell anomalies- hereditary spherocytosis or G6PD

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16
Q

What is kernicterus?

A

Severe hyperbilirubinaemia and acute bilirubin encephalopathy sequalae

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17
Q

Causes of pysiological jaundice 2-14 days

A

Usually physiological- accelerated breakdown of RBC, decreased excretory capacity and low activity of UDPGT

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18
Q

Management of jaundice 2-14 days

A

Monitor unconjugated bilirubin levels and monitor for kernicterus
Phototherapy
Exchange transfusions using warmed blood via umbilical vein
IVIg if haemolytic disease

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19
Q

Causes of prolonged jaundice- >14 days

A

Unconjugated- same as early causes and UTI, Crigler-Najjar and Gilbert’s
Conjugated- hypothyroidism, biliary atresia, cystic fibrosis

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20
Q

Omphalocele vs gastroschisis

A

Omphalocele- sealed abdominal contents protruding through the umbilical ring
Gastroschisis- no covering of peritoneum

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21
Q

Features of congenital diaphragmatic herniation

A 
Difficulty resuscitating at birth
Respiratory distress
Bowel sounds in one hemithorax
Cyanosis 
Pulmonary hypoplasia
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22
Q

Hirschsprung disease clinical features

A

Delayed passage of meconium >48 hours
Abdo distension
Tight anal sphincter
Explosive discharge of stool and gas

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23
Q

Diagnosis of Hirschsprung disease

A

Rectal suction biopsy of aganglionic section

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24
Q

Treatment of Hirschsprung’s disease

A

Excision and colostomy

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25
Q

Cyanotic cardiac malformations

A

All the Ts
Tetralogy of Fallot
Transposition of the great arteries
Tricuspid valve abnormalities

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26
Q

Patent ductus arteriosus signs

A

Continuous machinery murmur, left subclavicular thrill, wide pulse pressure

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27
Q

Patent ductus arteriosus treatment

A

Indomethacin/ ibuprofen to inhibit prostaglandin production and close the duct

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28
Q

Tetralogy of Fallot

A

Large ventricular septal defect
Pulmonary valve stenosis
Right ventricular hypertrophy
Overriding aorta

‘boot shaped heart’ on CXR

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29
Q

Pyloric stenosis clinical features

A

Projectile non-bilious vomiting
Hungry after feed- alert and anxious
Dehydration and electrolyte imbalance
Weight loss
Usually 2-8 weeks
Visible gastric peristalsis after test feed
Palpable olive shaped pyloric mass (from the hypertrophic pyloric sphincter muscle)

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30
Q

Pyloric stenosis electrolyte imbalance

A

Hypochloraemic, hypokalaemic metabolic acidosis

31
Q

Diagnosis of pyloric stenosis

A

Test feed

USS abdomen

32
Q

Management of pyloric stenosis

A

IV rehydration and correction of electrolyte imbalance
Ramstedt pyloromyotomy once stabilised
Start feeding 6 hours post operation

33
Q

Clinical presentation of GORD

A

Onset usually before 8 weeks and tends to resolve by 12 months
Regurgitation of feed, heartburn, epigastric pain, cough, hoarseness, distressed behaviour when feeding
Failure to thrive

34
Q

Red flags when diagnosing GORD

A 
Persistent regurgitation after 12 months
Onset after 6 months
Faltered growth
Haematemesis
Bilious vomiting
Projectile vomiting 
Abdominal mass/distension 
Chronic diarrhoea 
Melaena
35
Q

Management of GORD

A 
Breast feeding advice + omeprazole
Smaller and more frequent feeding 
Gavison
Enteral tube feeding
Nissen Fundoplication
36
Q

Markers of dehydration in the neonate

A 
Increased thirst
Reduced skin turgor 
Dry mucous membranes
Sunken fontanelle and eyes
Reduced urine output
Tachycardia
Tachypnoea
Cool extremities 
Prolonged capillary refill
37
Q

IV fluid resuscitation regimen for neonates

A

First 10kg 100mL/kg
Second 10kg 50mL/kg
subsequent kg 20mL/kg

38
Q

IgE-mediated cow’s milk protein allergy vs non IgE-mediated

A

IgE mediated within 20-30 mins, up to 2 hours

Non-IgE mediated 2-72 hours after exposure

39
Q

Infant colic clinical features and management

A

Arching back, drawing knees up
Inconsolable crying
Paroxysmal, worse in the evening
Excessive flatus

Reassurance and treatment of any other causes- Cow’s milk protein allergy or GORD

40
Q

Age of Toddler’s diarrhoea

A

Between 1 and 5 years old

41
Q

Clinical features of coeliac disease

A 
Profound malabsorption after introduction of wheat to the diet
Failure to thrive
Abdominal distension
Buttock wasting
Non-specific GI symptoms 
Irritability
Anaemia with iron +/- folate deficiency
42
Q

Investigations for coeliac disease

A

IgA tissue tranglutaminase antibodies and total IgA
Consider IgG endomysial antibodies if total IgA is deficient
HLA genetic test and endoscopic biopsy

43
Q

What does a jejunal biopsy show in coeliac disease?

A

Lymphocytic infiltration and villous atrophy

44
Q

Disimpaction of constipation stepwise management

A
  1. Polyethylene glycol- Movicol and electrolytes
  2. Senna- stimulant laxative
  3. +/- lactulose (osmotic)
  4. Sodium citrate enema

Review within 1 week
Continue maintenance therapy

45
Q

Commonest serious respiratory infection of infancy

A

Bronchiolitis

80% caused by respiratory syncytial virus

46
Q

Supportive treatment for infants with bronchiolitis

A

Humidified oxygen via nasal cannulae if sats <92% OA
If respiratory failure then CPAP
Cannot tolerate oral feeding then NG or IV fluids if not able to tolerate NG

47
Q

Treatment for high risk infants with bronchiolitis

A

Palivizumab

48
Q

Antibiotic treatment of pneumonia

A

Amoxicillin first line, macrolide added if no response
If mycoplasma or chlamydia is suspected then macrolide
Influenza then use co-amoxiclav

49
Q

Most likely cause of a bacterial pneumonia in children?

A

Strep pneumoniae

50
Q

What is an abnormal fractional exhaled nitric oxide

A

Above 35ppb

51
Q

CENTOR criteria

A

Tonsillar exudate
Tender anterior cervical lymphadenopathy
Absence of cough
Fever >38 degrees

52
Q

Infectious mononucleosis maculopapular rash exacerbated by

A

Antibiotics particularly penicillin

53
Q

Scarlet fever caused by

A

Group A streptococcus =

Strep pyogenes

54
Q

Clinical presentation of scarlet fever

A 
Fever lasting 24-48 hours
Punctuate erythematous rash- sandpaper texture 
Desquamation
Strawberry tongue 
Tender adenopathy
55
Q

Clinical presentation of Kawasaki disease

A 
Mucocutaneous lymphadenopathy 
High grade fever for >5 days, resistant to antipyretics 
Widespread maculopapular rash
Strawberry tongue, red or cracked lips 
Desquamation 
Painless lymphadenopathy
56
Q

Management of Kawasaki disease

A

High dose aspirin

Echocardiogram screening for coronary artery aneurysms

57
Q

Clinical features of measles

A

Conjunctivitis
Fever
Koplik spots on the buccal membrane
Rash- starting behind the ears and spreading to the whole body- discrete maculopapular rash that becomes blotchy and confluent

58
Q

Complications of measles

A 
Otitis media- most common 
Pneumonia- most common cause of death 
Encephalitis 
Sub-acute sclerosing panencephalitis- 10 years later
Febrile convulsions
59
Q

Mumps clinical features

A

Fever
Malaise
Myalgia
Unilateral progressing to bilateral parotitis

60
Q

Complications of mumps

A

Orchitis
Hearing loss
Meningoencephalitis
Pancreatitis

61
Q

Erythema infectiosum clinical features

A

Lethargy
Fever
Headache
‘Slapped cheek’ rash

62
Q

Cause of erythema infectiosum

Synonyms

A

Parvovirus B19

Slapped cheek or 5th disease

63
Q

6 in 1

A 
Diphtheria 
Tetanus
Pertussis
Polio
Hib 
Hep B
64
Q

Childhood vaccination schedule

A 
6 in 1 at 2,3,4
Then at 1 give HiB once more (4 in 1)
Rotavirus at 2 and 3
If it divides by 2 give Men B
If it divides by 3 give PCV

MMR at 1 and 40 months (with HiB, Men C, Men B, PCV at 1)
HPV at 12-13 y/o
Men ACWY at 14 y/o

65
Q

Management of laryngotracheobronchitis (croup)

A

Stat dose of oral dexamethasone 0.15mg/kg
+/- nebulised adrenaline
Supportive treatment

66
Q

Causative agent of epiglottitis

A

H. influenzae type B

67
Q

What is the combined test for Down’s screening?

A

nuchal translucency measurement + serum beta HCG + PAPP-A

High HCG
Low PAPP-A
Thickened nuchal measurement

68
Q

Most common cardiac abnormalities in Down’s syndrome

A

ASD 40%

VSD 30%

69
Q

Patau syndrome

A

Trisomy 13

Features of microcephaly, small eyes, cleft palate, polydactyly

IUGR, neural tube defects

Median survival <3 days

70
Q

Edward’s syndrome

A

Trisomy 18

Features micrognathia, rockerbottom feet, overlapping of fingers, low set ears

71
Q

Turner syndrome

A 
45 XO
Widely spaced nipples, broad shield chest, webbed neck short statue, may be normal intellect, wide carrying angle 
Subfertility
Sexual developmental issues 
Coarctation of the aorta
72
Q

Fragile X syndrome

A

Most commonly inherited caused of intellectual disability in males
Macrocephaly, long face, large ears, macro-orchidism

73
Q

What is secondary nocturnal enuresis?

A

Involuntary discharge of urine in a child older than 4 when they have been dry for a period of at least 6 months previously

74
Q

Management of enuresis

A

Conservative- look for trigger, advise on fluid intake, diet and toileting behaviour, reward systems for dry nights/ using the toilet before bed

Medical- Enuresis alarm 1st line for children <7
Desmopressin 1st line for children >7, particularly if enuresis alarm has been ineffective or for short term control

ISCE prep (6 decks)

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