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Year 4 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Childhood vaccinations at age 8 weeks / 2 months

A

Diphtheria/tetanus/pertussis/Haemophilus influenza type B(HiB)/ Hep B (6 in 1 vaccine)
Men B
Rotavirus (oral)

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2
Q

Childhood vaccinations at age 12 weeks / 3 months

A

Diphtheria/tetanus/pertussis/Haemophilus influenza type B/ Hep B (6 in 1 vaccine)
Pneumococcal conjugate vaccine (PCV)
Rotavirus

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3
Q

Childhood vaccinations at age 16 weeks / 4 months

A

Diphtheria/tetanus/pertussis/Haemophilus influenza type B/ Hep B (6 in 1 vaccine)
Men B

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4
Q

Childhood vaccinations at age 12-13 months

A

Hib B/Men C
PCV
MMR
Men B

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5
Q

Childhood vaccinations at age 3 yrs 4 months

A

Diphtheria, tetanus, pertussis, polio

MMR

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6
Q

Childhood vaccinations at age 12-13 yrs

A

HPV types 6,11,16,18 (both boys and girls)

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7
Q

Childhood vaccinations at age 14 yrs

A

Men ACWY

Tetanus/diphtheria/polio

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8
Q

Developmental milestone: sits without support

A

7 months (>9 months = red flag)

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9
Q

Developmental milestone: stands independently

A

12 months (>12 months = red flag)

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10
Q

Developmental milestone: Walks unsupported

A

13 - 15 months (>18 months = red flag)

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11
Q

Developmental milestone: Pincer grip

A

10 months (>12 months = red flag)

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12
Q

Developmental milestone: Drawing

A

2 1/2 yrs

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13
Q

Developmental milestone: 2-3 words / understands name

A

1 year

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14
Q

Developmental milestone: 6-10 words

A

15 - 18 months

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15
Q

Developmental milestone: startling at loud noise & follows face

A

2 months (>3 months = red flag)

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16
Q

Developmental milestone: smiling

A

6 weeks (>8 weeks = red flag)

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17
Q

Developmental milestone: plays near others but not with them

A

2 yrs

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18
Q

Developmental milestone: joining two words

A

2 yrs (>2 yrs = red flag)

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19
Q

Developmental milestone: stranger fear

A

7 months (>10 months = red flag)

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20
Q

Paeds BLS compression to breath ratio

A

15:2

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21
Q

First step of paeds BLS

A

5 rescue breaths before commencing CPR

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22
Q

Peads foreign body airway obstruction (FBAO)

A 
5 back blows 
5 thrusts (abdo if >1yr & chest if <1yr)
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23
Q

Neonatal life support Step 1

A

dry & stimulate baby

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24
Q

Neonatal life support Step 2

A

5x inflation breaths if still gasping/not breathing with open airway

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25
Q

Neonatal life support Step 3

A

CPR if not breathing/ HR < 60

ratio 3:1 (compression : ventilation)

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26
Q

APGAR score groups

A 
0-3 = bad
4-6 = moderate
7-10 = good
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27
Q

Risk factors for Sudden Infant Death Syndrome (SIDS)

A 
prone sleeping
parental smoking
prematurity
bed sharing
male sex
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28
Q

Protective factors for SIDS

A

breast feeding

supine sleeping

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29
Q

Most common genetic cause fo trisomy 21

A

meiotic non-disjunction of chromes 21 (known as full trisomy 21), has 3 full chromosome 21

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30
Q

Risk factors for trisomy 21

A

↑maternal age, previous child with down syndrome

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31
Q

Physical features of trisomy 21

A 
hypotonia
epicanthal folds
brushfield spots on iris
flat nasal bridge 
single palmar crease
small low set ears
short stature
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32
Q

Trisomy 21 investigations to confirm diagnosis

A

chromosomal karyotype

fluorescent in situ hybridisation (FISH)

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33
Q

Congenital heart defects associated with trisomy 21

A

atrioventricular septal defect (AVSD) most common

ASD, VSD, tetralogy of fallot

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34
Q

Screening of congenital heart defects in trisomy 21

A

all neonates require an echo

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35
Q

Congenital GI defects in trisomy 21

A

duodenal / oesophageal atresia

imperforate anus

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36
Q

How frequent is trisomy 21 related hearing loss

A

90% of pts have some extend of hearing loss

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37
Q

Hearing screen for trisomy 21

A

Screen hearing at birth, 6 months, 12 months and annually there after

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38
Q

Trisomy 21 related visual problem at birth

A

congenital cataracts (absent red reflex - leukocoria)

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39
Q

Thyroids screening for trisomy 21

A

annual TFTs

↑ risk of hypothyroidism

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40
Q

Trisomy 21 related cancer

A

↑ risk of acute lymphoid leukaemia & acute myeloid leukaemia

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41
Q

Most common trisomy 21 related sleep problem

A

Obstructive sleep apnoea (60% of children)

sleep study recommended age 3-4 yrs

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42
Q

Orthopaedics disorders associated with trisomy 21

A

atlanto-axial instability

scoliosis

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43
Q

Monitoring tests for Trisomy 21 pts

A

hearing screen: at birth, 6 months, 12 months and then annually
TFTs: at birth, 6 months, annually
Eye screening: at birth, 6 months, then yearly till age 5
Sleep study: age 3-4
echo: at birth
coeliac disease screen

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44
Q

leading cause of death in trisomy 21 pts after age 40

A

dementia

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45
Q

Trisomy 13 (patau syndrome) presentation

A

microcephaly
polydactyly
small eyes
midline facial defects

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46
Q

Trisomy 13 (patau syndrome) prognosis

A

very poor, usually stillborn/spontaneously aborted

if born alive usually dead in a week

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47
Q

which is more common Trisomy 18 (edward syndrome) vs Trisomy 13 (patau syndrome)

A 
Trisomy 18 (edward syndrome) is 2nd most common autosomal trisomy 
Trisomy 13 (patau syndrome) is 3rd most common autosomal trisomy
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48
Q

Most common management of Trisomy 21/18/13 if detected prenatally

A

abortion of the foetus

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49
Q

Trisomy 18 (edward syndrome) presentation

A 
low birth weight
microcephaly
micrognathia
prominent occiput
small facial features (microstomia/micropthalmia) 
overlapping fingers 
rocker bottom feet
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50
Q

Trisomy 18 (edward syndrome) prognosis

A

often stillbirth/death in labour

<10% survive to age 1 year

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51
Q

Fragile X inheritance pattern

A

X linked dominant inheritance

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52
Q

Fragile X presentation

A 
intellectual disability
macrocephaly
long face
large ears 
macro-orchidist 
hyperflexibility
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53
Q

Fragile X genetic cause

A

expansion of CGG triplet repetition on the FMR1 gene

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54
Q

Noonan syndrome

A

Autosomal dominate

Features: webbed neck, pectus excavatum, short stature, low set ears

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55
Q

Pierre-Robin syndrome

A

Features: micrognathia, posterior displaced tongue (can cause airway obstruction)

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56
Q

Prader-Willi syndrome

A

Features: hypotonia, hypogonadism, obesity, T2DM

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57
Q

Williams syndrome

A

Features: elfin face, learning difficulties, friendly/extroverted personality, Supravalvular aortic stenosis

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58
Q

Cri du Chat syndrome

A

Features: characteristic cat like cry, feeding difficulties, poor weight gain

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59
Q

DiGeorge syndrome

A

Features: CHD, abnormal facies, cleft palate, developmental delay

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60
Q

Turner syndrome genetic cause

A

complete or partial absence of second X chromosome in females, 45XO/45X

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61
Q

Turner syndrome features

A 
poor growth
short stature 
lymphoedema of hands and feet
webbed neck
shielded chest 
wide spaced nipples 
wide carrying angle 
absent pubertal development 
infertility
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62
Q

Turner syndrome associated cardiac abnormalities

A

bicuspid aortic valve

coarctation of the aorta

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63
Q

Hormone levels in turner syndrome

A

LH & FHS ↑ Antimullerian hormone↓

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64
Q

Klinefelter’s syndrome genetic cause

A

males with extra X chromosome (47XXY)

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65
Q

Klinefelter’s syndrome features

A 
tall & slender physique 
wide hips 
small firm testes 
impotence
↓ facial & pubic hair 
gynaecomastia
learning disability
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66
Q

Hormone levels in Klinefelter’s syndrome

A

↓ testosterone, LH & FHS ↑

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67
Q

Klinefelter’s syndrome associated cardiac abnormalities

A

↑ risk of mitral valve prolapse

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68
Q

cancer associated with Klinefelter’s syndrome

A

↑ risk of male breast cancer & germ cell tumours

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69
Q

Klinefelter’s syndrome management

A 
testosterone replacement (as pt enter puberty) 
intracytoplasmic sperm injection if they are trying to conceive
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70
Q

Neurofibromatosis (NF) types

A

NF-1:
chromosome 17 gene mutation

NF-2:
chromosome 22 gene mutations

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71
Q

Neurofibromatosis type 1 presentation

A

cafe au lait spots
axillary & inguinal freckles
neurofibromas
Iris hamartomas

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72
Q

Neurofibromatosis type 2 presentation

A 
bilateral acoustic neuromas/vestibular schwanomas
cafe au lait spots 
juvenile cataracts
meningiomas
intracranial schwanomas (multiple)
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73
Q

Investigating Neurofibromatosis (NF)

A

MRI/CT scan

genetic testing

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74
Q

Differentiating Neurofibromatosis (NF) types 1 and 2

A

NF-1 : more common in children, usually >6 cafe au lait spots

NF-2 : more common in adults, usually <6 cafe au lait spots

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75
Q

Neurofibromatosis (NF) differential diagnosis

A

tuberous sclerosis

which is differentiated by presence of ash-leaf spots (seen under UV light), retinal hamartomas, epilepsy

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76
Q

Cystic fibrosis (CF) genetics

A

abnormalities in salt and water transport across epithelial surfaces due to mutations in CF transmembrane conductance regulator (CFTR) gene on chromes 7
most common mutation in caucasians = DF508 (delta F508)

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77
Q

Ethnic group is at ↑ risk of cystic fibrosis

A

white population

↓ incidence in africans/hispanic/asian

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78
Q

Pathophysiology of cystic fibrosis

A

impaired salt & water transport by epithelial cells leads to thick sticky excretions, which can affect the pancreas/GI tract/Bilairy tree/resp system/sweat

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79
Q

Presentation of cystic fibrosis in neonates

A

meconium ileus/delayed passage of meconium

prolonged jaundice

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80
Q

Presentation of cystic fibrosis in older children

A 
recurrent chest infections/chronic pulmonary disease
wet sounding cough
purulent sputum
wheezes 
nasal polyps
failure to thrive 
steatorrhoea
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81
Q

Investigating cystic fibrosis

A

found on heelprick test (day 5-7 after birth)
Sweat test (↑ Cl- concentration >60mmol/L)
genetic testing
CXR
Lung function test (FEV1/FVC ↓)
stool elastase (for pancreatic dysfunction)

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82
Q

Common pathogens in cystic fibrosis pts

A 
staph aureus
H influenzas
pseudomonas aeroginosa
aspergillus 
Burkholderia cepacia
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83
Q

Managing respiratory problems in cystic fibrosis pts

A

chest physio & mucous clearance techniques
ABx
mucolytics e.g. dornase alfa

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84
Q

Management of pancreatic insufficiency in cystic fibrosis

A

confirm via stool elastase test

pancreatic enzyme therapy

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85
Q

Recommended diet for cystic fibrosis pts

A

high fat, high protein, high calorie diet

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86
Q

Fertility problems related to cystic fibrosis

A

almost all males suffer from azoospermia so should be counselled on IVF for conception

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87
Q

Biological treatments of cystic fibrosis

A

lumacaftor & Ivacaftor

to treat homozygous pts for DF508, help increase CFTR protein numbers

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88
Q

Presentation of meconium ileus

A

24-48h post birth with failure to pass meconium, abdo distension and bilious vomiting
NB seen in ~20% of CF pts

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89
Q

Management of meconium ileus

A

surgical decompression

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90
Q

Genetic cause of sickle cell disease

A

autosomal recessive gene defect of the 17th nucleotide of the beta chain leading to the substitution of valine instead of glutamic acid

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91
Q

screening for sickle cell disease

A

part of the routine heel prick test screening on day 5-7 after birth

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92
Q

timeline of presentation for sickle cell disease

A

symptomatic presentation between age 3-6 months as HbF levels fall

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93
Q

presentation of sickle cell disease

A 
jaundice
pallor
anaemia
growth restriction 
failure to thrive 
lethargy
systolic flow murmur
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94
Q

The spleen in sickle cell disease

A

↑ risk of infection by encapsulated organisms e.g. pneumococcus
highest risk of overwhelming infection in <3y/o
recurrent infections lead to autosplenectomy

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95
Q

Vaso-occlusive crisis in sickle cell

A

most common type of crisis

obstruction of micro circulation by sickle cells leading to ischaemia

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96
Q

precipitating factors of vaso-occlusive crisis in sickle cell

A

cold, infection, dehydration, exertion

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97
Q

presentation of vaso-occlusive crisis in sickle cell

A

swollen joints
pain
tachypnoea
priapism

if major vessels may present as thrombotic stroke/acute sickle chest syndrome

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98
Q

aplastic crisis in sickle cell

A

temporary cessation of erythropoiesis leading to severe anaemia

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99
Q

trigger of aplastic crisis in sickle cell

A

parvovirus B19 infection

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100
Q

presentation of aplastic crisis in sickle cell

A

generally rapid drop in Hb over 1 week with spontaneous recovery

may have high output congestive HF

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101
Q

sequestration crisis in sickle cell

A

sudden enlargement of spleen leading to ↓ Hb & circulatory collapse which causes hypovolaemic shock

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102
Q

at risk groups for sequestration crisis in sickle cell

A

young children snd babies

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103
Q

presentation of sequestration crisis in sickle cell

A

↓ Hb, ↑reticulocytes, splenomegaly

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104
Q

management of recurrent sequestration crisis in sickle cell

A

splenectomy

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105
Q

differentiating sequestration crisis in sickle cell & aplastic crisis in sickle cell

A

aplastic = ↓ Hb but no ↑reticulocytes

sequestration ↓ Hb, ↑reticulocytes, splenomegaly

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106
Q

Acute chest crisis in sickle cell

A

vaso-occlusive crisis of the lungs

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107
Q

diagnostic criteria for Acute chest crisis in sickle cell

A

new pulmonary infiltrates on CXR + ≥ 1 of

  • cough
  • fever
  • sputum production
  • tachypnoea
  • dyspnoea
  • hypoxia
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108
Q

investigating sickle cell disease

A 
FBC (↓ Hb, ↑reticulocytes)
blood film (sickle cells)
haemoglobin electrophoresis (to confirm diagnosis, absence of HbA, but presence of HbS)
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109
Q

general management of sickle cell disease

A

Patient & parental education
folic acid/zinc/Vit D supplementation
unconjugated pneumococcal vaccine (from age 2)
oral penicillin prophylaxis
hydroxycarbamide (,2y/o to ↓ frequency of crisis by stimulation HbF)
blood transfusion

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110
Q

treatment of sickle cell disease in pregnancy

A

prophylactic LMWH due ↑ risk of prematurity/neonatal death/low birth weight
low dose aspirin 75mg from 12 weeks

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111
Q

Duchenne muscular dystrophy (DMD) inheritance

A

X-linked recessive

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112
Q

Duchenne muscular dystrophy (DMD) pathophysiology

A

mutation leads to absence of dystrophin protein leading to muscle degeneration/necrosis with muscle being replaced by adipose tissue

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113
Q

Presentation of Duchenne muscular dystrophy (DMD)

A 
delayed motor milestones 
calf hypertrophy 
waddling gait/inability to run 
Gower's sign (climbing up legs when standing up)
heel contractures
lordosis
↓ tendon reflexes
↓muscle tone
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114
Q

Investigating Duchenne muscular dystrophy (DMD)

A 
Creatine kinase (↑10-100x normal levels)
genetic testing
muscle biopsy (check for dystrophin protein)
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115
Q

Normal test result excluding Duchenne muscular dystrophy (DMD)

A

normal creatine kinase excludes diagnosis of DMD

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116
Q

Managing Duchenne muscular dystrophy (DMD) early stages

A

Physiotherapy
knee-foot-ankle orthosis
corticosteroids e.g. prednisolone (prolongs ambulation)

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117
Q

Managing Duchenne muscular dystrophy (DMD) late stages

A

mobility aids
respite care
NIV
regular cardiology reviews (6 monthly)

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118
Q

Spinal muscular atrophy (SMA)

A

slow progressive atrophy & weakness of limb muscles due to SMN1 gene mutation, leading to lower motor neurone weakness
generally autosomal recessive

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119
Q

Features of Spinal muscular atrophy (SMA)

A 
muscle weakness & wasting
preserved intellect 
flaccid weakness
hypotonia
↓ tendon reflexes
fasciculation's
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120
Q

most common type of Spinal muscular atrophy (SMA)

A

SMA type II most common (chronic infantile SMA)

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121
Q

Investigating Spinal muscular atrophy (SMA)

A 
creatine kinase (normal)
genetic testing
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122
Q

Charcot-Marie-Tooth disease

A

heterogenous group of peripheral neuropathies which is the most common inherited neuromuscular disorder
usually autosomal dominant inheritance

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123
Q

Presentation of Charcot-Marie-Tooth disease

A

slowly progressive (CMT1 most common onset by age 10)
muscle weakness & wasting (starting in intrinsic foot muscles)
muscle weakness spreads to lower legs & thigh
sensory loss following same pattern as muscle weakness (especially ↓vibration & light touch)
generalised tendon areflexia

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124
Q

Necrotising enterocolitis (NEC)

A

ischaemic inflammatory bowel necrosis

most common GI emergency in neonates

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125
Q

Risk factors for necrotising enterocolitis (NEC)

A

prematurity
↓ birth weight
PDA

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126
Q

presentation of Necrotising enterocolitis (NEC)

A 
classically in preterm infants within first 2 weeks of life
abdo distension
altered stool pattern
bloody mucoid stool
bilious vomiting 
↓ bowel sounds
lethargy
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127
Q

investigating necrotising enterocolitis (NEC)

A

FBC
ABG/VBG
baseline biochem
AXR (dilated bowel loops, intramural gas, Ringler sign)

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128
Q

AXR findings in necrotising enterocolitis (NEC)

A

dilated bowel loops
bowel wall oedema
intramural gas (pneumatosis intestinalis)
portal venous gas
Rigler sign
Football sign (air outlining falciform ligament)

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129
Q

managing necrotising enterocolitis (NEC)

A 
Nil by mouth
NG tube to decompress bowel
IV fluids/parenteral nutrition
IV ABx (cefotaxime +metronidazole/clindamycin)
surgery
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130
Q

Exomphalos (omphalocele)

A

abdo contents herniated into umbilical cord via umbilical ring, viscera covered by a membrane

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131
Q

Gastroschisis

A

abdominal contents herniating into amniotic sac without covering membrane
usually to right side of umbilicus

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132
Q

Investigating gastroschisis & exomphalos

A 
maternal AFP (↑) 
USS
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133
Q

Managing exomphalos

A

surgical repair fo defect, abdominal contents returned to abdomen

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134
Q

Managing gastroschisis

A

surgical repair

requires more pre-op care than exomplhalos with IV fluids, radiant heaters etc

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135
Q

congenital diaphragmatic hernia

A

incomplete fusion of diaphragm leading to herniation of abdo contents into thorax which causes pulmonary hypoplasia

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136
Q

common side of congenital diaphragmatic hernia

A

left side

liver plugs space on right

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137
Q

congenital diaphragmatic hernia prenatal presentation

A

often prenatal diagnosis (polyhydraminos & via routine USS)

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138
Q

congenital diaphragmatic hernia presentation

A 
presents soon after birth 
cyanosis
tachypnoea
chest wall asymmetry 
absent breath sounds on affected side
bowel sounds audible on chest wall
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139
Q

Managing congenital diaphragmatic hernia

A 
intubate & venitalte at minimal pressures
orogastric tube (to locate stomach on X-ray)
surgery to fix diaphragm
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140
Q

Hirschsprung’s disease

A

congenital condition characterised by partial/complete colonic functional obstruction associated with absence of parasympathetic ganglion cells = tonically constricted lamina = functional obstruction

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141
Q

Disease associated with Hirschsprung’s disease

A

Down’s syndrome

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142
Q

Hirschsprung’s disease initial presentation

A

failure to pass meconium in first 48h of life
repeated bilious vomiting
abdo distension
explosive passage of liquid & foul smelling stools (especially post PR exam)
failure to thrive

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143
Q

later presentation of Hirschsprung’s disease

A

chronic constipation resistant to treatment

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144
Q

investigating Hirschsprung’s disease

A

AXR
contrast enema (contracted distal bowel & dilated proximal bowel)
rectal biopsy

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145
Q

Hirschsprung’s disease treatment

A

Surgery

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146
Q

Hirschsprung’s disease prognosis

A

most pts acquire normal fecal continence & normal bowel habits

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147
Q

Meckel’s diverticulum

A

true diverticulum due to failure of the vitelline duct to obliterate
most common congenital abnormality of the small bowel

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148
Q

Location of Meckel’s diverticulum

A

in distal ileum close to ileocaecal valve

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149
Q

Meckel’s diverticulum rule of 2’s

A

occurs in 2% of population
within 2 feet from ileocaecal valve
2 inches long

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150
Q

Meckel’s diverticulum presentation

A

generally asymptomatic
painless Gi bleeding = haematochezia
intractable constipation

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151
Q

Meckel’s diverticulum investigations

A

AXR (for bowel obstruction)
Meckel’s scan
CT abdo

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152
Q

Intussusception epidemiology

A

usually seen age 3-12 months

peak age 9 months

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153
Q

commonest part of bowel affected by Intussusception

A

ileocaecal region

lead point is often an enlarged lymph node (peters patch) in terminal ileum

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154
Q

Intussusception presentation

A 
paroxysmal colicky abdo pain
drawing knees up to chest
crying
early vomiting
blood PR (red current jelly stools)
child normal between bouts of pain
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155
Q

Investigating Intussusception

A

Abdo USS (target sign/doughnut sign)
AXR
diagnostic enema

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156
Q

Mangement of Intussusception

A

drip & suck (IV fluids & NG tube)
radiological reduction via air enema
surgical reduction

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157
Q

Umbilical hernia

A

herniation of peritoneal sac covered with skin

generally spontaneously resolves in most children

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158
Q

Umbilical hernia presentation

A

bulge at umbilicus with overlying skin

easily reducible

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159
Q

Umbilical hernia management

A

generally observed till age 4-5 yrs if small

surgical closure if large (if asymptomatic then by age 2-3 yrs)

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160
Q

Inguinal hernia

A

due to patent processus vaginalis allowing abdominal contents to herniate into inguinal canal, presenting as bulge lateral to pubic tubercle

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161
Q

Inguinal hernia management

A

urgent surgical management indicated due to ↑ risk of strangulation

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162
Q

pyloric stenosis

A

infantile hypertrophic pyloric stenosis due to hypertrophy of the pyloric sphincter narrowing the pyloric canal

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163
Q

risk factors for pyloric stenosis

A

first born
male
family history
exposure to erythromycin in first 2 weeks of life

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164
Q

time of presentation of pyloric stenosis

A

between 2-8 weeks of age

rare after 12 weeks of age

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165
Q

Presentation of pyloric stenosis

A

non bilious vomiting within 30-60 minute of feeding projectile vomit
upper abdominal mass (olive)
baby remains hungry after feed
frequency/intensity of vomiting ↑ over several days

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166
Q

investigating pyloric stenosis

A

ABG/VBG (hypochloraemic, hypokalaemic metabolic alkalosis)

Abdo USS

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167
Q

classic blood gas finding for pyloric stenosis

A

hypochloraemic, hypokalaemic metabolic alkalosis

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168
Q

Management of pyloric stenosis

A

Ramstedt’s pyloromyotomy

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169
Q

Biliary atresia

A

progressive idiopathic necroinflammatory process involving the extra hepatic biliary tree leading to fibrosis

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170
Q

time of presentation of biliary atresia

A

usually between 2-8 weeks after birth

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171
Q

presentation of biliary atresia

A 
usually seen in term infant with normal birth weight
persistent jaundice
play stools/dark urine
failure to thrive
hepatosplenomegaly
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172
Q

Investigations for biliary atresia

A

total & conjugated bilirubin (↑ conjugated bilirubin)
LFTs (generally ↑, disproportionate ↑ GGT)
Liver histology (gold standard)

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173
Q

management biliary atresia

A 
surgery (portoenterostomy), best outcome if surgery before 8 weeks of age
ursodeoxycholic acid (to encourage bile flow)
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174
Q

oesophageal atresia

A

blind ending oesophagus presenting with frothing at mouth, feeding difficulties, chocking, respiratory distress

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175
Q

oesophageal atresia investigation

A 
antenatal USS (polyhydraminos, smaller/no stomach bubble)
antenatal MRI (small stomach, oesophageal pouch)
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176
Q

oesophageal atresia management

A

surgery

suctioning oesophageal pouch till surgery

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177
Q

Risk factors of duodenal/oesophageal atresia

A

related to trisomy 21/13/18
twins
NB duodenal atresia is particularly related to trisomy 21

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178
Q

duodenal atresia presentation

A

abdo distension
bilious/non-bilious vomiting
presents in first days of life

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179
Q

Investigations for duodenal atresia

A

AXR (double bubble sign)

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180
Q

Volvulus/midgut rotation

A

a spectrum of rotation & fixation disturbances of the intestines occurring during embryonic development,
volvulus is complete twisting of a loop of intestines

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181
Q

Presentation of volvulus

A 
rapid onset bilious/non bilious vomiting 
lactataemia
metabolic acidosis
oligouria
hypotension
feeding intolerance
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182
Q

Volvulus/midgut rotation investigations

A 
Volvulus = clinical diagnosis 
AXR (double bubble sign, air fluid levels)
contrast studies (duodenojejunal junction displaced in malrotation)
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183
Q

Managing Volvulus/midgut rotation

A 
surgical treatment (even of asymptomatic malrotation due to risk fo volvulus)
Ladd's procedure = treatment of choice
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184
Q

hydrocele

A

collection of serous fluid between the layers of tunica vaginalis around testicles/along spermatic cord
usually disappears age 1-2 yrs

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185
Q

most common hydrocele in children

A

communicating hydrocele i.e. patent processus vaginalis allowing fluid to drain into scrotum from peritoneum

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186
Q

presentation of hydrocele

A

scrotal enlargement (non tender, smooth cystic swelling, below/anterior to testicle)
transluminates with pen torch
swelling confined to scrotum i.e. able to get above it

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187
Q

managing hydrocele

A

clinical diagnosis
usually self limiting, so observe
repair if not resolves after 2 yrs of age

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188
Q

cryptorchidism

A

unilateral/bilaterally undescended testes, i.e. not present within the dependent portion of the scrotal sac

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189
Q

when to refer cryptorchidism

A

specialist referral age 6 months (corrected) if still undescended with surgical correction in next year

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190
Q

presentation of cryptorchidism

A

testes may be palpable in upper portion of scrotum/inguinal canal or may be absent (indicates intra-abdominal location)

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191
Q

Management of cryptorchidism

A

if still undescended by age 3 months =pathological
referral to specialist before 6 months
surgical repair by 12-18 months of age

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192
Q

cryptorchidism complications

A

risk of infertility if delayed diagnosis (especially >2y/o)
↑ risk of testicular torsion
↑ of testicular cancer

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193
Q

Hypospadias

A

congenital abnormality of penis where urethral opening is somewhere along ventral aspect of penis

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194
Q

Hypospadias common location

A

90% have meatus on/near glans = distal hypospadias

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195
Q

Hypospadias associated condition

A

if associated with cryptorchidism then may suggest disorder of sexual differentiation

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196
Q

Posterior urethral valves

A

cause obstruction of urethra

most common cause if UTI in male infants

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197
Q

Posterior urethral valves presentation

A

poor, intermittent dribbling urine stream

±frequent UTIs

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198
Q

Posterior urethral valves complications

A

can cause high pressure & detrusor hypertrophy leading to vesicoureteric reflux causing hydronephrosis

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199
Q

Posterior urethral valves diagnostics

A 
voiding cystourethrography (VCUG) = gold standard postnatally
NB most prenatal diagnosis
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200
Q

Posterior urethral valves treatment

A

endoscopic ablation = gold standard

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201
Q

meconium aspiration syndrome (MAS)

A

respiratory distress in the newborn due to presence of meconium in the trachea usually secondary to foetal hypoxia

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202
Q

meconium aspiration syndrome (MAS) risk factors

A 
post term infants (>42 weeks)
fetal distress
oligohydramnios
chorioamnionitis 
NB rare in <34 weeks gestation
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203
Q

meconium aspiration syndrome (MAS) presentation

A 
meconium/green stained amniotic fluid
green/blueish staining of skin at birth
floppy baby 
↓ APGAR score
rapid/laboured/absent breathing 
bradycardia
signs of post maturity (skin peeling, long stained nails)
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204
Q

managing meconium aspiration syndrome (MAS)

A

suctioning
O2/ventilatory support
surfactant (if severe)

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205
Q

infant respiratory distress syndrome (IRDS)

A

know as surfactant deficient lung disease or hyaline membrane disease
usually seen in preterm infants due to surfactant deficiency

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206
Q

Risk factors for infant respiratory distress syndrome (IRDS)

A

prematurity
male infant
c-section delivery without maternal labour
maternal diabetes

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207
Q

Presentation of infant respiratory distress syndrome (IRDS)

A 
tachypnoea
nasal flaring
grunting
intercostal/subcostal recession
cyanosis
↓ air entry on auscultation
208
Q

infant respiratory distress syndrome (IRDS) investigations

A

ABG (↓ PaO2, ↑PaCO2, metabolic/respiratory acidosis)
CXR (air bronchograms, reticular granular pattern)
echo (to rule out congenital heart disease)

209
Q

Prevention of infant respiratory distress syndrome (IRDS)

A 
maternal corticosteroids (dexamethasone)
tocolytics (to delay premature delivery by ~48h while giving steroids) e.g. nifedipine
210
Q

infant respiratory distress syndrome (IRSD) management

A

surfactant replacement therapy (via ET tube)

O2/assisted ventilation

211
Q

Transient tachypnoea of the newborn (TTN)

A

delayed absorption of fluid in the lungs leading to ineffective gas exchange
commonest cause of respiratory distress in newborn period

212
Q

Presentation of Transient tachypnoea of the newborn (TTN)

A 
tachypnoea (DUHH ITS in the fucking name)
respiratory distress (nasal flaring/grunting/subcostal/intercostal recession, crackles)
213
Q

Transient tachypnoea of the newborn (TTN) investigations

A

ABG (↓ PaO2, ↑PaCO2)

CXR (hyperinflation, fluid in horizontal fissure, prominent perihilar vascular markings)

214
Q

Transient tachypnoea of the newborn (TTN) management

A

supplementary O2

usually self limiting on 1-2 days

215
Q

Persistent pulmonary hypertension of the newborn (PPHN)

A

defined as failure of the normal circulatory transition that occurs after birth, i.e. ≥ 1 of the fetal shuts fail to close leading to persistently elevated pulmonary pressures

216
Q

Risk factors for Persistent pulmonary hypertension of the newborn (PPHN)

A

male gender
C-section
large for gestational age babies
asthma

217
Q

Persistent pulmonary hypertension of the newborn (PPHN) presentation

A 
tachypnoea
respiratory distress (nasal flaring/grunting/subcostal/intercostal recession, crackles)
loud S2
right ventricular heave
cyanosis
218
Q

Persistent pulmonary hypertension of the newborn (PPHN) investigations

A

echocardiogram = definitive diagnostic test (↑ pulmonary artery pressure, tricuspid regard, altered RV size/function)

219
Q

Retinopathy of prematurity (ROP)

A

proliferative disorder of immature retinal vasculature, due to vasculature of retina only reaching periphery at age of 1 month and being susceptible to oxidative damage
most common cause of preventable childhood visual impairment

220
Q

Risk factors for Retinopathy of prematurity (ROP)

A

prematurity (especially , <32 weeks)
low birth weight (especially ≤1250g)
O2 therapy
respiratory distress

221
Q

Management of Retinopathy of prematurity (ROP)

A

laser photocoagulation (treatment of choice)

222
Q

screening for Retinopathy of prematurity (ROP)

A

all infants born <32 weeks/ <1501g get weekly/fortnightly screening

223
Q

hypoxic ischaemic encephalopathy (HIE)

A

the neurological sequelae of perinatal asphyxia

224
Q

Diagnostic criteria of hypoxic ischaemic encephalopathy (HIE)

A

Metabolic acidosis with pH <7
Base deficit -12
APGAR score = 5 at 10 min & continued need for resuscitation
presence of multi organ failure
evidence of encephalopathy (hypotonia, abnormal oculomotor/pupillary movements, weak/absent suck reflex, seizures)

225
Q

hypoxic ischaemic encephalopathy (HIE) causes

A

maternal haemodynamic compromise
uterine conditions e.g. uterine rupture
placental/umbilical cord conditions e.g. abruption
infection

226
Q

Management of hypoxic ischaemic encephalopathy (HIE)

A

therapeutic cooling (to minimise secondary brain injury), within 6 h of birth

227
Q

Periventricular/intraventricular haemorrhage

A

haemorrhage related to perinatal stress affecting the highly vascularised subependymal germinal matrix
commonest intracranial haemorrhage in newborns

228
Q

Risk factors for periventricular/intraventricular haemorrhage

A 
prematurity
lowe birth weight 
IRDS
hypoxia
sepsis
229
Q

Presentation of Periventricular/intraventricular haemorrhage

A 
diminished/absent mono reflex
hypotonia
lethargy
apnoea
poor/absent suck
shrill cry
convulsions
bulging/tense fontanelle
posturing
↓GCS
230
Q

Periventricular/intraventricular haemorrhage investigations

A

transfontanelle USS = investigation of choice

231
Q

Periventricular/intraventricular haemorrhage management

A

mainly supportive

232
Q

Neonatal hypoglycaemia

A

hypoglycaemia is commonly seen in first 24h post birth

233
Q

Neonatal hypoglycaemia threshold

A

<2.6mmol/L

severe <1.4mmol/L

234
Q

causes of persistent/severe neonatal hypoglycaemia

A 
preterm 
large for gestational age
hypothermia
neonatal sepsis
gestational diabetes
235
Q

neonatal hypoglycaemia presentation

A 
often asymptomatic 
jittery
seizures
tachypnoea
weak cry
drowsy
hypotonia
poor feeding
236
Q

Management of neonatal hypoglycaemia

A

If asymptomatic:
encourage feeding & monitor blood glucose

If symptomatic:
buccal glucagon
IV glucose (10%) generally slow infusion but may require bolus if LOC/seizures

237
Q

define neonatal sepsis

A

serious bacterial/viral infection in the blood of babies within 28 days of birth

238
Q

time frame of neonatal sepsis

A 
early onset (EOS): within 72h of birth
late onset (LOS): 7-28 days after birth
239
Q

Causative organisms for neonatal sepsis

A

Group B strep (75% of EOS)

E.coli

240
Q

Risk factors for neonatal sepsis

A

mother with previous Group B Strep infection
prematurity
low birth weight
maternal chorioamnionitis

241
Q

Presentation of neonatal sepsis

A 
subacute onset of respiratory distress
tachycardia
apnoea
jaundice
seizures
↓ feeding 
lethargy
fever (often fluctuates)
242
Q

Investigating neonatal sepsis

A

Blood cultures
CRP (↑, helps guide management & monitor progress)
urine MC&S
LP

243
Q

Management of neonatal sepsis

A

IV benzylpenicilin & gentamicin (usually 10 days)

guided by CRP & culture results (if both negative stop ABx after 48h)

244
Q

physiological neonatal jaundice

A 
due to RBC breakdown & immature liver function
usually presents 2-3 days post birth & resolves by day 10
very common (up to 40% of neonates)
245
Q

early neonatal jaundice

A

presents within 24h of birth
ALWAYS PATHOLOGICAL
causes include haematological disease (e.g. ABO incompatibility), congenital infection

246
Q

prolonged neonatal jaundice

A

jaundice that persists >14 days in term/ >21 days in premature infants
causes: hypothyroidism, breast milk jaundice, Gi problems (e.g. biliary atresia)

247
Q

causes of conjugated hyperbilirubinaemia in the newborn

A

biliary atresia
cystic fibrosis
neonatal hepatitis

248
Q

Risk factors for significant neonatal jaundice

A 
male gender
gestational diabetes
low birth weight
jaundice in first 24h of life
previous sibling requiring phototherapy 
preterm
249
Q

presentation of neonatal jaundice

A

jaundice (usually first visible in face & forehead) drowsiness
neurological signs (muscle tone changes, seizures, altered cry)
NB neurological signs are Red flags and must be treated to prevent kernicterus

250
Q

kernicterus

A

chronic bilirubin encephalopathy with deposition of unconjugated bilirubin in the basal ganglia and/or brain stem nuclei
leads to cerebral paresis, movement disorders, intellectual impairment

251
Q

Investigating neonatal jaundice

A 
bilirubin levels (serum bilirubin or transcutaneous bilirubinmeter)
LFTs
infection screen
Haemolysis screen 
TFTs
252
Q

Managing neonatal jaundice

A 
phototherapy (as per treatment threshold on bilirubin charts) 
exchange transfusion (as per bilirubin chart threshold)
253
Q

haemolytic disease of the newborn

A

due to transplacental passage of maternal antibodies causing immune haemolytic of the fetal/neonatal RBCs
may be due to naturally occurring antibodies e.g. ABO or sensitising events e.g. Rhesus alloimmunisation

254
Q

presentation of haemolytic disease of the newborn

A

hydrops fetalis/polyhydramnios
jaundice
pallor
hepatosplenomegaly

255
Q

investigating haemolytic disease of the newborn

A

indirect coombs test (+ve for antibodies)
foetal blood sampling (Rh typing)
FBC (↓Hb, ↑reticulocytes)

256
Q

Neural tube defects (NTDs)

A

abnormal closure of the neural plates results in NTDs

257
Q

risk factors for Neural tube defects (NTDs)

A

family history
folate deficiency
anti-epileptic drugs (sodium valproate, carbamazepine)

258
Q

investigating Neural tube defects (NTDs)

A

MRI = gold standard
USS (antenatal screening)
AFP ↑ (antenatal screening at 16-18 weeks)

259
Q

Prevention of Neural tube defects (NTDs)

A

folic acid supplementation (400 mcg/day for everyone until 12 weeks of gestation, 5mg if high risk)

260
Q

risk factors for congenital heart defects

A 
family history
consanguineous unions 
intrauterine infection e.g. rubella
drugs/toxins e.g. lithium or alcohol
lack of folic acid
gestational diabetes
261
Q

most common congenital heart defect

A

Ventricular petal defect (VSD)

262
Q

Ventricular petal defect (VSD) presentation

A

if small = asymptomatic

if larger = presents around 5-6 weeks post birth
exercise intolerance
feeding intolerance
harsh systolic murmur loudest at sternal edge (pan systolic)

263
Q

Investigations for congenital heart defects

A

CXR
ECG
Echocardiogram

264
Q

Atrial septal defect (ASD) presentation

A

generally missed in children and diagnosed in adults

soft systolic ejection murmur at left sternal edge and fixed S2 splitting

265
Q

Atrioventricular septal defect (AVSD) presentation

A 
similar to ASD &VSD
dyspnoea
cyanosis
signs of HF in newborn
pan systolic murmur
266
Q

Complication of Atrioventricular septal defect (AVSD)

A

life long follow up needed due to development of AV valve regurgitation and left ventricular outflow obstruction

267
Q

Patent ductus arteriosus (PDA) presentation

A 
failure to thrive
difficulty feeding
poor growth
continuous machinery murmur loudest in left infraclavicular area/upper left sternal edge
hyperactive precordium
systolic thrill at left sternal edge
268
Q

Patent ductus arteriosus (PDA) management in preterms

A

indomethacin used to stop prostaglandin production & causing duct to close

269
Q

General management of congenital heart defects

A

Surgical closure especially if symptomatic

270
Q

Coarctation of the aorta presentation

A 
poor feeding
lethargy
tachypnoea
congestive HF
shock
BP in upper limbs > lower limbs
systolic murmur in left infraclavicular area
271
Q

coarctation of the aorta management in neonates

A

Prostaglandin E1 to maintain ductus arteriosus

surgery/balloon angioplasty to repair defect

272
Q

tetralogy of fallot (TOF)

A

right ventricular hypertrophy
ventricular septal defect
right ventricular outflow tract obstruction
overriding aorta

273
Q

tetralogy of fallot (TOF) presentation

A

poor feeding
breathlessnes
agitation
dyspnoea on exertion
squatting to rest while exercising (characteristic for R→L shunt)
Tet spells (intense crying, cyanosis, ↓intensity of murmur)
ejection systolic murmur

274
Q

tetralogy of fallot (TOF) management

A

Prostaglandin E1 to maintain patent ductus arteriosus if unwell
asap surgical repair if unwell
surgical repair age 3-6 months if not unwell

275
Q

transposition of the great arteries (TGA)

A

not compatible with life if no communication between the 2 circuits e.g. VSD/ASD/PDA

276
Q

transposition of the great arteries (TGA) presentation

A 
cyanosis soon after birth
tachypnoea
respiratory distress
congestive HF (if large VSD)
single loud S2, no murmur
277
Q

Truncus arteriosus

A

single outflow tract

presents as congestive HF & cyanosis

278
Q

Phimosis

A

non retractile foreskin associated with infection & scarring

279
Q

presentation of phimosis

A 
ballooning during micturition
non retractile foreskin
recurrent balanophosthitis
painful micturition
recurrent UTI's
swelling/erythema/tenderness of prepuce
280
Q

Management of phimosis

A

expectant management if <2yrs old

plastic surgery/circumcision if persistent >2y/o

281
Q

paraphimosis

A

foreskin retracted & left behind glans leading to vascular engorgement & oedema of the distal glans

medical emergency, may need circumcision

282
Q

Balnatitis/balanophosthitis

A

inflammation of the glans or glans & prepuce usually due to poor personal hygiene in uncircumcised males

283
Q

Cleft lip/palate

A

relatively common congenital abnormality with a complex aetiology but it is associated with chromosomal/teratogenic syndromes
~30% have associated syndromes

284
Q

cleft lip/palate presentation

A

obvious gap in newborn lip (usually upper lip)
gap in palate on palpation of roof of mouth
difficulty feeding (especially from bottle)
poor weight gain

285
Q

Cleft lip/palate mangement

A

surgical repair in a stepwise fashion
lip closure at 3 months
palate closure at 6-12 months

286
Q

anorectal malformations (ARMs)

A

range of conditions
generally diagnosed in early neonatal period
relatively common congenital abnormality

287
Q

presentation of anorectal malformations (ARMs)

A

absence/abnormal location of anus
look for anal pit in males
looks for 3 classic peritoneal openings in females

288
Q

anorectal malformations (ARMs) management

A

early surgical management crucial

289
Q

Cerebral palsy

A

umbrella term for non progressive disease of the brain originating during the antenatal/neonatal/early postnatal period when brain neuronal connections are still evolving

290
Q

Classifications of cerebral palsy

A

Spastic : intermittently ↑ tone, pathological reflexes

Athetoid/dyskinetic: hyperkinesia (storm movements), dsytonia, chorea, athetosis

ataxic: loss of orderly muscular coordination = abnormal force/rhythm/accuracy of movements

mixed type: a combination of the above

291
Q

cerebral palsy presentation

A 
↓ APGAR score
delayed developmental milestones (especially motor & speech)
retention of primitive reflexes
spasticity/clonus
contractures
toe walking
muscle tone abrnomalities
292
Q

cerebral palsy associated conditons

A

learning disability ~50%
communication difficulty ~50%
epilepsy ~30%

293
Q

Management of cerebral palsy

A 
MDT approach 
psychological support is key
oral baclofen/diazepam for spasticity 
botulin toxin for focal spasticity 
mobility aids & orthotics
294
Q

chickenpox infection

A

caused by varicella zoster virus, highly infectious but generally only mild to moderate disease which is self limiting

295
Q

presentation of chickenpox

A

pyrexia
itchy vesicular rash (generally starts centrally, like dew drops on rose pedals)
generally crops of lesions that eventually crust over
headache
malaise

296
Q

chickenpox school exclusion

A

school exclusion & avoidance of pregnant woman until all lesions are crusted over

297
Q

Measles

A

highly infectious disease caused by measles virus which has been becoming more frequent due to ↓ uptake of MMR vaccine

298
Q

Measles presentation

A

prodrome of fever/irritability/conjunctivitis/coryza/cough
koplik spots (white spots on oral mucosa)
maculopapular rash (spreading from behind ears/head down to trunk)
high fever

299
Q

Measles school exclusion

A

5 days from onset of rash

300
Q

measles complications

A

pneumonia
otitis media
encephalitis
subacute sclerosing panencephalitis

301
Q

chickenpox complications

A

varicella pneumonia

encephalitits

302
Q

Mumps

A

acute systemic infectious disease caused by an RNA paramyxovirus which spreads via respiratory droplets
usually seen in school aged children

303
Q

Mumps presentation

A

non specific symptoms e.g. mails, fever, headache, myalgia
unilateral/bilateral parotitis
orchitis (swollen oedematous scrotum)

304
Q

Mumps school exclusion

A

5 days of school exclusions from onset of parotitis

305
Q

Complications of mumps

A

epididymo-orchitis (sub fertility/infertility)
defaness (not permanent)
pancreatitis

306
Q

Rubella presentation

A

prodrome (low grade fever, headache, mild conjunctivitis)
maculopapular rash (starts on face then spreads, fades after 3-5 days)
cervical/suboccipital/postauricular lymphadenopathy *

307
Q

erythema infectiosum other names

A

fifth disease, slapped cheek syndrome

308
Q

cause of slapped cheek syndrome (erythema infectiosum)

A

parvovirus B19

309
Q

presentation of erythema infectiosum

A

prodrome (fever, malaise, headache, rhinitis, sore throat)
bright red macular erythema of bilateral cheeks sparing the nasal bridge/perioral areas
arthralgia/arthritis

310
Q

complications of parvovirus B19 infection

A

transient aplastic crisis due to ↑RBC turnover e.g. in sickle cell pts, thalassaemia etc

311
Q

Scarlet fever

A

exotoxin mediated disease secondary to bacterial function by an erythrogenic toxin producing strain of strep pyogenes

312
Q

normal age of presentation of scarlet fever

A

peak at 4y/o

usually seen between 2-6 y/o

313
Q

scarlet fever presentation

A

sudden onset fever lasting 24-48h
rash (appears on second day of illness, starting on neck/chest, coarse ‘sandpaper’ texture with fine punctuate erythema i.e. pinhead)
strawberry tongue

314
Q

Management of scarlet fever

A

Notifiable disease

10 days of penicillin V (azithromycin if penicillin allergic)

315
Q

school exclusion for scarlet fever

A

return 24h after initiating Abx

316
Q

hand-foot-mouth disease

A

viral illness of childhood caused by cocksackie virus A16

usually seen in children <10y/o

317
Q

presentation of hand-foot-mouth disease

A 
prodrome (low fever, cough, abdo pain, malaise, loss of appetite)
oral lesions (begin as macule that develop into vesicles and then erode)
skin lesions (on palms/soles & in between fingers/toes, starts as macule progressing to vesicles)
318
Q

school exclusion for hand-foot-mouth disease

A

not necessary

319
Q

molluscum contagiosum presentation

A

rash (pearly papule with central umbilication, firm & smooth, usually found in clusters on trunk/extremities)
NB >50 lesions/facial lesions imply immunocompromise

320
Q

Roseola infantum (sixth disease)

A

common febrile illness of childhood caused by Human herpes virus 6 (HHV 6)
usually seen in children between 6 months and 2 years of age

321
Q

Presentation of roseola infantum

A

3-5 days of high fever (40°C), peaks in early evening
exanthema presents after fever resolves (2-5mm pink-red macules/papules)
maybe be associated with febrile seizures

322
Q

pertussis (whooping cough)

A

URTI caused by bordetella pertussis which is characterised by a severe cough
NOTIFIABLE DISEASE even when suspected only on clinical grounds

323
Q

Presentation of pertussis

A

prodrome: 2-3 days of coryza
dry hacking cough (usually worse at night, may cause vomiting)
inspiratory whoop (caused by forced inspiration against closed glottis after coughing fit)

324
Q

Management of pertussis

A

macrolide Abx e.g. clarithromycin

325
Q

School exclusion for pertussis

A

21 days from onset of symptoms or 48h after Abx started

326
Q

croup (laryngotracheobronchitis)

A

URTI seen in infants & toddlers usually between 6 months and 3 years of age
caused by parainfluenza virus

327
Q

Croup presentation

A

general non specific URTI
cough (seal like/barking = characteristic)
stridor
respiratory distress (nasal flaring, inter/subcostal recession/tracheal tug/tachypnoea)
lasts 3-7 days

328
Q

croup scoring system

A

westley score

329
Q

croup mangement

A

single dose oral dexamethasone (0.15mg/kg)
avoid agitating child (i.e. do not examine throat)
admit if moderate/severe croup

330
Q

Bronchiolitis

A

Lower respiratory tract infection caused by respiratory syncytial virus (RSV)
generally seen in infants under the age of 2 with peak incidence between 3-6 months of age

331
Q

Risk factors for severe bronchiolitis

A 
prematurity
low birth weight 
age <12 weeks
congenital heart disease
chronic lung disease
332
Q

Croup presentation

A

prodrome: 1-3 day history of coryza symptoms
persistent cough (seal like/barking = characteristic)
stridor
respiratory distress (nasal flaring, inter/subcostal recession/tracheal tug/tachypnoea)
wheeze/crackles
poor feeding
rhinitis
fever (<39°C)

333
Q

croup management

A

single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity

supportive therapy (O2, feeding support)
self limiting, lasting 3-7days
334
Q

Epiglottitis

A

a cellulitis of the supra glottis with the potential to cause airway compromise caused by haemophilia influenzas type B (HiB)
rare but serious infection

335
Q

epiglottitis presentation

A 
sore throat
odynophagia
fever
inability to swallow secretions = drooling 
muffled voice
tripod positioning
336
Q

epiglottitis investigations

A

fibre-optic laryngoscopy = gold standard

lateral neck X-ray (thumb sign)

337
Q

Management of epiglottis

A

oral/IV ABx (usually IV)

may require intubation/tracheostomy

338
Q

Impetigo

A

common superficial skin infection cause by strep pyogenes or staph aureus

339
Q

Bullus impetigo presentation

A

thin roofed bullae, tend to rupture spontaneously

often painful

340
Q

Non bullous impetigo presentation

A

tiny pustules/vesicles which rapidly erode into a honey coloured crusted plaque
especially on face, around the mouth & nose

341
Q

Management of impetigo

A

hydrogen peroxide 1% cream
topical Abs (fusidic acid)
Oral flucloxacillin if systemically unwell (erythromycin if penicillin allergy)

342
Q

impetigo school exclusion

A

until all lesions crusted over & healed

or 48h after commencing ABx

343
Q

Laryngomalacia

A

congenital abnormality of the larynx that predisposes to supraglottic collapse during the inspiratory phase
commonest cause of stridor in infants
often associated with GORD

344
Q

Mesenteric adenitis

A

inflammation of mesenteric lymph nodes after viral illness

presents as fever, RLQ pain, nausea, vomiting

345
Q

Kallman’s syndrome

A

delayed puberty secondary to hypogonadotrophic hypogonadism
x-linked recessive trait
presents with anosmia, delayed puberty, cryptorchidism
↓ sex hormone levels, ↓/normal FSH/LH

346
Q

Kawasaki disease

A

idiopathic self limiting vasculitis
usually seen in children age 6 months to 5 years
more common in the asian population

347
Q

Kawasaki disease presentation

A 
Fever (≥39°C for ≥5days)
conjunctival injections
polymorphous rash
erythema/oedema of palms/soles ±desquamation 
cervical lympadenopathy
bright red cracked lips
strawberry tongue
348
Q

Kawasaki disease diagnosis

A

clinical

no diagnostic tests available

349
Q

Management of kawasaki disease

A 
Aspirin (high dose)
IV immunoglobulin (IVIG)
350
Q

complications of kawasaki

A

coronary artery aneurysm (screen with echo)

351
Q

Henoch-Schönlein Purpura (HSP)

A

IgA mediated mediated autoimmune hypersensitivity vasculitis of unknown aetiology
usually seen between the ages of 4-6 years
most common vasculitis of childhood

352
Q

Henoch-Schönlein Purpura (HSP) presentation

A 
often preceded by URTI or GI infection
arthralgia ± oedema 
abdo pain ± nausea & vomiting
palpable, non blanching purpuric rash over buttocks & extensors surfaces of arms and legs 
renal disease
353
Q

Management of Henoch-Schönlein Purpura (HSP)

A

NSAIDs for joint pain
consider corticosteroids if nephrotic range proteinuria
monitor renal function (BP & urinalysis at 6 & 12 months)

354
Q

Febrile seizures

A

a seizure occurring in a febrile child between the ages of 6 months and 5 years without other underlying causes

355
Q

Peak incidence of febrile seizures

A

18 months of age

356
Q

simple febrile seizure

A

generalised tonic clonic seizure lasting <15min and do not recur within 24h/the same febrile illness

357
Q

complex febrile seizure

A

≥1 of the following:

  • focal seizure/focal features
  • duration between 15-30min
  • recurrence within 24h/same febrile illness
358
Q

febrile status epilepticus

A

seizure >30 min duration

359
Q

Trigger for febrile seizures

A

rapidly rising temp (usually early in illness)

360
Q

presentation of febrile seizures

A

normal post ictal examination
generally tonic clonic seizures lasting <5min
quick recovery of consciousness
no sequelae

361
Q

Referring a febrile seizure pt

A 
if 1st febrile seizure
unable to exclude serious illness
complex seizure
<18 months old
status epilepticus
362
Q

Management of febrile seizures

A

mainly parental education
e.g. call 999 if seizure >5min
give PR diazepam/buccal midazolam if >5min & repeat at 10 min
consider IV phenytoin if still continuing

363
Q

Complications of febrile seizures

A

reoccurrence in 1/3 pts

↑ risk of developing epilepsy

364
Q

otitis media

A

infection of the middle ear space occurring often in childhood

365
Q

presentation of otitis media

A 
otalgia (tugging at ear in younger children)
irritability
sleep disturbance
fever
malaise
366
Q

Investigations for otitis media

A

otoscaopy (bulging tympanic membrane, red/yellow/cloudy tympanic membrane, air fluid level behind tympanic membrane, discharge in auditory canal if tympanic membrane perforation)

367
Q

Management of otitis media

A

admit if <3 months & temp > 38°C / acute complication e.g. meningitis suspected
antipyretics & analgesia
Abx ( amoxicillin 1 st line, or erythromycin if penicillin allergy)

368
Q

when to give ABx in otitis media

A

if ≥ 4 days duration & no improvement, systemically unwell, immunocompromised, perforation & discharge, <2y/o with bilateral AOM

369
Q

Meningococcal disease causative organism

A

Neisseria meningitidis (gram -ve, commensal in nasopharynx)

370
Q

Meningococcal disease

A

leading cause of infective deaths in early childhood
mostly seen in <5 y/o
peak age is in under 1 y/o

371
Q

Presentation of Meningococcal disease

A 
rapid onset of illness (febrile illness >24h unlikely to be meningococcal disease)
fever, irritability, leg pain, headache
stiff neck
photophobia
back rigidity 
bulging fontanelle
seizures
altered mental status
↓ level of consciousness
non blanching purpuric rash
hypotonia
372
Q

Investigating Meningococcal disease

A

clinical suspicion
Blood cultures
lumbar puncture

373
Q

Management of Meningococcal disease

A

< 3 months = cefotaxime/ceftriaxone +ampicillin/amoxcillin (to cover listeria)

> 3 months = cefotaxime/ceftriaxone
anticoagulation for DIC

374
Q

complications of Meningococcal disease

A

sensorineural hearing loss
Disseminated intravascular coagulation
↑ ICP
Waterhouse- Friedrich syndrome

375
Q

testicular torsion presentation

A 
sudden onset intense scrotal pain
pain associated with nausea & vomiting
pain preceded by sport/physical activity
absent cremaster reflex 
scrotal swelling/oedema/erythema
376
Q

testicular torsion investigations

A

DO NOT delay surgical exploration if clinical suspicion is high

377
Q

Management of testicular torsion

A 
scrotal exploration (emergency surgery)
bilateral orchioplexy
378
Q

Appendicitis in children <4 y/o

A

uncommon but often presents as perforation if it does occur

379
Q

Appendicitis presentation

A

abdo pain ( typically starting centrally then moving to RLQ/RIF, constant pain with intermittent cramps which is aggravated by movement)
anorexia
nausea & vomiting
Rovsing’s sign positive (palpation of LLQ = ↑ pain in RLQ as inflamed peritoneum is stretched)

380
Q

Investigations for appendicitis

A

abdo USS/ CT abdomen
FBC
CRP (↑)

381
Q

Managing appendicitis

A

appendectomy (laparoscopically)

382
Q

Risk factors for paediatric asthma

A 
atopy
family history
allergies
passive smoking
prematurity
low birthweight
383
Q

presentation of paediatric asthma

A

wheezing episodes/SOB/chest tightness/cough (symptoms often worse at night/early morning)

384
Q

Investigating paediatric asthma

A

spirometry (↓FEV1/FVC ratio)
response to bronchodilators on spirometry
peak expiratory flow (↓)
CXR (normal)

385
Q

managing paediatric asthma step 1

A

Inhaled short acting beta agonist (SABA) e.g. salbutamol

386
Q

managing paediatric asthma step 2

A

SABA + low dose inhaled corticosteroids

387
Q

managing paediatric asthma step 3

NB Step 2 = SABA + low dose inhaled corticosteroids

A

add leukotriene receptor antagonist (LTRA)

388
Q

managing paediatric asthma step 4

NB Step 3 = Trial of LTRA

A

stop LTRA if ineffective and add LABA

389
Q

Acute asthma in children management

A

Salbutamol via inhaler, or nebuliser with O2 if hypoxic
ipratropium bromide
oral/IV corticosteroids
nebuliser/IV magnesium sulphate

390
Q

sign of life threatening asthma

A 
SpO2 <92%, 
PEF < 33%
silent chest
cyanosis
poor respiratory effort
confusion
agitation
LOC
391
Q

sign of severe asthma

A 
SpO2 <92%
HR >125 if >5y/o or >140 if 2-5y/o
RR >30 if >5y/o or >40 if 2-5y/o
use of accessory muscles
inability to complete full sentences
392
Q

causative organism for septic arthritis in children

A

staph aureus

393
Q

Most commonly affected joint for septic arthritis in children

A

hip, knee, ankle

394
Q

presentation of septic arthritis in children

A

easy to miss as localised signs may be absent
hot/swollen/painful joint
restricted movement of affected joint
unwillingness to weight bear/move affected joint
fever

395
Q

investigating septic arthritis in children

A

joint aspirate for culture/MC&S (↑WCC)
FBC/CRP/blood cultures/U&Es/LFTs
USS/X-ray of joint

396
Q

managing septic arthritis in children

A

joint drainage & Abx (according to local guidelines but often flucloxacillin)

397
Q

Kocher diagnostic criteria for septic arthritis in children

A

fever >38.5 °C
non weight bearing
↑WCC
↑ESR/CRP

398
Q

Slipped upper femoral epiphysis (SUFE)/slipped capital femoral epiphysis (SCFE)

A

due to weakness in proximal femoral growth plate allowing displacement of the capital femoral epiphysis
most common hip disorder in adolescent age group

399
Q

SUFE epidemiology

A

more common in boys

peaks around age 13 for boys and age 11.5 for girls

400
Q

SUFE risk factors

A

OBESITY**
endocrine disorders (e.g. hypothyroidism)
puberty
male gender

401
Q

SUFE presentation

A 
hip/groin discomfort/pain
limp
abnormal gait
leg externally rotated 
loss of internal rotation of leg
↓ Range of movement 
may have knee pain
402
Q

SUFE investigations

A

bilateral AP X-ray (kleins line does not intersect femoral head)
lateral frog leg X-ray ( +ve Bloombergs sign)

403
Q

Management of SUFE

A

immobilise/non weight bearing
provide analgesia
surgical referral
single screw internal fixation

404
Q

Classical presentation of SUFE

A

overweight/obese teenage boy

405
Q

transient synovitis

A

self limiting inflammatory disorder common in young children often triggered by a viral infection e.g. URTI
Peak incidence age 5-6 yrs

406
Q

Presentation of transient synovitis

A 
discomfort/pain (less severe than septic arthritis, often still able to weight bear)
limp
abnormal gait
↓ Range of movement 
positive log roll
systemically well
407
Q

managing transient synovitis

A

analgesia
rest
usually self limiting

408
Q

Perthes disease

A

self limiting disease of the femoral head with necrosis, collapse, repair and remodelling , essentially avascular necrosis of the nucleus of the proximal femoral epiphysis

409
Q

Epidemiology of perthes disease

A

typically unilateral
5:1 male:female ratio
usually seen in boys aged 4-8 yrs

410
Q

presentation of perthes disease

A 
hip pain progressively worsening over several weeks
limp
stiffness
↓ Range of movement 
no history of trauma
411
Q

investigating perthes disease

A

bilateral hip X-ray (femoral collapse & fragmentation)
lateral frog leg X-ray (widening of joint space)
both X-rays show (flattening of femoral head, and ↓ femoral head size)

412
Q

managing perthes disease

A

physiotherapy

surgery if >6y/o

413
Q

Developmental dysplasia of the hip

A

spectrum of mild dysplasia with stable hip to established hip dysplasia with subluxation and instability
affects 1-3% of newborns

414
Q

Developmental dysplasia of the hip risk factors

A 
female gender (6:1 female:male ratio)
breech presentation
family history
oligohydramnios
macrosomia
415
Q

Developmental dysplasia of the hip presentation

A

often on NIPE examination/6 week baby check
positive ortolans’s and Barlow’s test (i.e. able to dislocated & relocate the hip joint)
limited hip abduction

416
Q

Screening for developmental dysplasia of the hip

A

USS screening for all pts with the following

  • first degree relative with history of hip problems in early life
  • breech presentation at/after 36 weeks gestation
  • multiple pregnancy

All babies are screened view Barlow/Ortolani test at NIPE/6week check

417
Q

Investigating developmental dysplasia of the hip

A

USS of hips

Hip X-ray if >6months of age

418
Q

developmental dysplasia of the hip management

A

stabilisation with Pavlik harness if <5months

if failed stabilisation/>6 months old =surgery

419
Q

juvenile idiopathic arthritis (JIA)

A

collection of chronic paediatric arthropathies characterised by onset <16 yrs and presence of objective arthritis for >6 weeks

420
Q

Presentation of juvenile idiopathic arthritis (JIA)

A 
> 6 week duration
joint pain
erythema
joint swelling
fever
morning stiffness
↓ ROM
pink salmon coloured rash
421
Q

managing juvenile idiopathic arthritis (JIA)

A

NSAIDs
steroids
methotrexate (1st line if >1 joint affected)

422
Q

Osgood-Schlatter disease

A

overuse syndrome of the paediatric population typically affecting young athletes during adolescent growth spurts
more common in boys
one of the most common causes of knee pin in active adolescents

423
Q

Osgood-Schlatter disease presentation

A

gradual pain/swelling below knee
pain worse on activity/better at rest
pain over tibial tuberosity

424
Q

Toddlers diarrhoea

A

commonest cause fo chronic diarrhoea in young children

characterised by undigested food in stool & systemically well child

425
Q

Cow’s milk protein intolerance

A

one of the commonest allergic disorders in young children, usually seen in 1st year of life (especially formula fed infants

426
Q

Cow’s milk protein intolerance presentation

A 
failure to thrive
↓ growth velocity
skin reaction (urticaria/angioedma)
Nausea & vomiting
diarrhoea
abdo pain
427
Q

gastroenteritis in children

A

frequently rotavirus

very common in <5y/o

428
Q

Managing gastroenteritis in children

A

encourage fluid intake & continue feeding
offer ORS if ↑ risk of dehydration
IV fluids if dehydrated

429
Q

IV fluids for dehydrated children

A

if shocked 100ml/kg

if not shocked 50ml/kg

430
Q

coeliac disease

A

systemic autoimmune disease triggered by dietary gluten peptides
HLA DQ2 & HLA DQ8 associated

431
Q

coeliac disease presentation

A 
failure to thrive
diarrhoea
abdo distension
faltering growth
persistent mouth ulcers
432
Q

investigating coeliacs disease

A

total IgA
IgA-tTG (tissue transglutaminase)
endomysial antibody
small bowel biopsy

433
Q

GORD in children

A

very common especially in <1y/o due to immature sphincters

NB smalll amounts of asymptomatic effortless regurgitation after feeding (possetting is normal)

434
Q

Presentation of GORD in infants

A 
stressful meal times
long feeds
inappropriate volume of feeds
regurgitation
vomiting
irritability at meal times
435
Q

managing GORD in infants

A

feeding position (30°, head up)
review feeding volume
trial of gaviscon

436
Q

constipation in children presentation

A 
difficult/painful defectation 
straining 
long interval between stools
faecal incontinence 
anal fissure
437
Q

Red flags for constipation

A 
symptoms from birth/in first weeks of life
overflow soiling
>48h to pass meconium
ribbon stools 
leg weakness
abdo distension + vomiting
abnormal appearance of anus
abnormal reflexes
438
Q

Managing constipation in children

A

1st line: paediatric movicol

2nd line: add stimulant laxative if no dissimpaction after 2 weeks e.g. senna or decussate

3rd line: if still not working substitute stimulant laxative for lactulose

439
Q

Reflex anoxic seizures

A

syncopal episodes secondary to emotional/painful stimuli
usually seen in children aged 6 months - 2yrs

30-60 sec on tonic jerking of limbs but no post ictal phase

no treatment needed

440
Q

Breath holding spells

A

vigorous crying followed by blocked respiration resulting in cyanosis, LOC, opisthotonic posturing

441
Q

Infantile spasms (west syndrome)

A

seen in babies aged 4-8months

Salaam attacks of head bobbing/torso flexion/arm flexion
usually spasm occur in clusters (ie repeated 50x), generally symmetrical & bilateral

CT (diffuse/localised brain disease) & EEG

Treatment = vigabatrin

poor prognosis

442
Q

absence seizures in childhood

A

onset usually age 3-10yrs

presenting with behavioural arrest/starring attacks lasting 5-10 secs, with no aura or post-octal phase

Management : 1st line = sodium valproate/ethosuximide/lamotrigine

443
Q

Tonic clonic seizures in childhood

A

contraction of limbs followed by extension & arching of back lasting 10-30 seconds
cyanosis & apnoea
post ictal phase up to 30 min
tongue biting common

Management: lamotrigine or levetiracetam

444
Q

Benign rolandic epilepsy/benign focal epilepsy

A

children aged 4-10yrs, more common in boys

nocturnal seizures especially on waking characterised by facial twitching & aphasia

most children outgrow these & no treatment required

445
Q

Status epilepticus in children

A

prolonged seizure >30min or recurrent seizures without full return to baseline between seizures

446
Q

managing status epilepticus in children

A

at 5 min = Buccal midazolam/rectal diazepam (0.5mg/kg)
repeat at 5-10 min after first dose

at ~25min = phenytoin IV (20mg/kg) over 20 min

if not terminated = RSI & intubation

447
Q

causative organisms for paediatric sepsis

A

neonates <72h after birth = group B strep

neonates 72h-28 days after birth = coagulase -ve staph

infants/young children = staph pneumoniae, neisseria meningitidis

448
Q

Abx for paediatric sepsis

A

cefotaxime/ceftriaxone + gentamicin is commonly used

449
Q

contraindications for Lumbar puncture

A 
coma 
suspected ↑ ICP
cardiovascular/respiratory compromise
suspected cerebral herniation
coagulopathy/thrombocytopenia
local infection
450
Q

Septic screen in children

A 
Blood cultures
urine MC&S
Lumbar puncture
ABG
CXR/AXR
FBC/CRP/U&Es/LFTs/Coagulation
451
Q

definition of neutropenic sepsis

A

neutrophil count <500 cells/microlitre (<0.5x10^9) in a patient having anticancer therapy + temp >38.5°C or other clinical features of sepsis

452
Q

Abx management of neutropenic sepsis

A

Tazocin (piperacillin + tazobactam)

453
Q

Pneumonia in children causative organism

A

strep pneumonia = most common causative organism

454
Q

first line Abx for penumonia in children

A

amoxicillin

455
Q

UTI in children causative organisms

A

E. coli most common

456
Q

UTI presentation in children

A 
Fever (>39°C)
lethargy
poor feeding
frequency
dysuria
abdo pain
457
Q

UTI investigation for children

A

clean catch urine for urinalysis (+ve nitrites, +ve leukocytes) & MC&S (↑WBC, diagnostic culture)

458
Q

management of UTI in children

A

<3 months old = refer to peads

> 3 months = cephalosporin/co-amoxiclav for 7-10 days

459
Q

recurrent UTIs in children

A

should raise question of child abuse

460
Q

Continence in children

A

majority of children achieve day & night time continence at age 3-4

461
Q

enuresis

A

involuntary discharge of urine day/night/both in a child ≥5 y/o in absence of congenital/acquired defects of the nervous system of the urinary tract

462
Q

primary vs secondary enuresis

A

primary = never previously acquired continence

secondary = in a child who has previously been dry for >6months

463
Q

Management of enuresis

A

1st line = advice on fluid intake & toileting behaviour

2nd line= reward system

3rd line = enuresis alarm

4th line = desmopressin (particularly in 7y/o for short term control e..g a sleep over/school trip)

464
Q

Haemophilia

A

X-linked recessive bleeding disorder

Haemophilia A = factor VII deficiency (more common)
Haemophilia B = factor IX deficiency

present with recurrent/severe bleeding, easy bruising, pronged bleeding episodes, recurrent nose bleeds

Investigations: aPTT (↑), plasma factor VIII/IX (↓/absent), PT (normal)

Management: Type A (prophylactic factor VIII)
                         Type B (recombinant factor IX)
465
Q

Neuroblastoma

A

solid tumour arising from the developing sympathetic nervous system

majority of pts diagnosed by age 5

location usually adrenal/paraspinal sites

presents with abdo distension, abdo mass, fatigue, bone pain, constipation, hepatomegaly, weakness paralysis

FBC ( pancytopenia), USS abdo (shows mass), CT/MRI
urinary catecholamines ( VMA/HVA ↑)
466
Q

Wilms tumour/nephroblastoma

A

most common renal malignancy of childhood presenting between age 2-5

presents as asymptomatic abdominal mass, flank pain, UTIs, haematuria, pallor

Urinalysis (↑RBC, ↑protein), abdo USS, CT/MRI

management: nephrectomy followed by chemo

467
Q

Osteosarcoma

A

most common primary bone malignancy in children, usually seen age 13-16

presents with worsening bone pain over weeks/months, which is worse at night, firm mass/swelling, limping

75% in knee/proximal humerus

X-ray (sunburst appearance of calcified soft tissue, conman triangle of subperiosteal bone), ALP (↑), LDH (↑)

management: surgery + chemo

468
Q

Ewings sarcoma

A

rare cancer, usually occurs in teenagers

presents as mass/swelling in long bones, pelvis or skull with pain, erythema, weight loss, malaise

X-ray (bone destruction and overlying onion skin layers of periosteal bone), biopsy

Management: chemo (VIDE)

469
Q

brain tumours in children

A

brain = most common site of solid tumours in children, mainly infratentorial, astorcytomas & medulloblastomas are most common

presents with headache, vomiting, gait abnormalities, co-ordination problems, papiloedma
Headache (worse in morning, frequent, gradually working)

MRI/CT head

Management: surgery/chemo/radiotherapy

470
Q

Retinoblastoma

A

embryonal tumour of the retina usually seen in <5y/o with a peak at 18 months of age

presents with leukocoria (absent red reflex), strabismus, visual problems, pseudo-orbital cellulitis, ocular pain (indicates advanced disease)

fundoscopy and examination under GA, MRI

Management: enucleation & implant

471
Q

Leukaemia in childhood

A

most common diagnosed cancer in children, with peak incidence between 2-3 yrs of age
Acute lymphoblastic leukaemia (ALL) = 80% of childhood leukaemia
Acute myeloid leukaemia (AML) = 15% of childhood leukaemia, most common in infants

presents with anaemia, thrombocytopenia, hepatosplenomegaly, lymphadenopathy
often vague non specific symptoms

FBC/blood film (pancytopenia, ↑blast cells)
bone marrow aspirate/biopsy
CT/MRI

management: chemotherapy
allogenic bone marrow transplant

472
Q

Prognosis of childhood leukaemia

A

leading cause of death in childhood

ALL better prognosis than AML

473
Q

Childhood lymphoma

A

lymphoproliferative disorder, non-hodgkins type is more common in children

presents with painless, progressive lymphadenopathy (rubbery, asymmetrical), fatigue, fever, malaise, night sweats, ↓weight

FBC (thrombocytopenia, neutropenia), excisions node biopsy (diagnostic) CT/MRI chest/abdo/pelvis

Management: watchful waiting, chemotherapy, radiotherapy

474
Q

ADHD

A

a disorder of inattention, hyperactivity, impulsivity which affects ~5% of children
usually diagnosed at age 3-7
more common in boys

475
Q

Diagnostic criteria for ADHD

A

≥ 6 of the following symptoms which have persisted for ≥6months to a degree that is maladaptive & inconsistent with developmental level

symptoms present in ≥2 settings

Inattention:
Poor attention to details at work/school, Difficulty sustaining attention during tasks, Does not listen when spoken to directly, Inability to complete tasks/instructions at work/school, Struggles to organize tasks/activitie, Prefers to avoid tasks that require a high amount of mental effort, Loses things necessary to complete tasks, Easily distracted, Forgetful

Hyperactivity & impulsivity:
Fidgets or squirms in seat, Often leaves their seat during inappropriate situations, Restless, Unable to carry out tasks quietly, Talks excessively, Answers questions prematurely or for others, Difficulty waiting their turn, Interrupts other people

476
Q

management of ADHD in children

A

CAMHS referral
education & advice
regular exercise & healthy diet

pharmacological
Methylphenidate (monitor heigh & weight 6 monthly)
lisdexamfetamine or atomoxetine (2nd line)

477
Q

Monitoring children on pharmacological therapy for ADHD

A

Monitor height & weight

monitor BP & ECG (drugs potentially cardiotoxic)

478
Q

Autism spectrum disorder (ASD)

A

a disorder characterised by persistent impairments of social communication, restricted, repetitive and stereotyped patterns of behaviours/interests/activities
more common in males

479
Q

Presentations of autism spectrum disorder (ASD)

A

impaired social communication & interaction
language delay/regression
verbal & non-verbal communication impairment
repetitive, rigid, stereotyped interests/behaviours/activities
motor stereotypes (e.g. rocking, spinning)
feeding difficulties
sensory interests (e.g. examining objects closely)

480
Q

Investigations for autism spectrum disorder (ASD)

A

ASD screenign tools

481
Q

Management of autism spectrum disorder (ASD)

A

early educational & behavioural interventions
SALT
occupational therapy
family support and counselling

482
Q

Rickets

A

changes caused by deficient mineralisation of the growth plates of long bones

presents with slow growth rate, bone pain, bony deformities (bow legs, knock knees), late dentition

management: Calcium & Vit D supplementation, phosphate salts

483
Q

Assessing puberty stages

A

Tanner stages are used in boys and girls

484
Q

Normal onset of puberty

A

Males: 12-13 y/o

Females: usually round 11y/o

485
Q

First sign of puberty in boys

A

testicular enlargement

486
Q

First sign of puberty in girls

A

breast development

487
Q

Delayed puberty in boys

A

absence of testicular development i.e. testicular volume <4ml at age 14

488
Q

Delayed puberty in females

A

absence of breast development by age 13 or primary amenorrhoea with normal breast development by age 15

489
Q

average age of menarche

A

13 years

490
Q

Causes for delayed puberty

A

central
Constitutional delay of growth and puberty (CDGP), chronic disease, malnutrition, excessive physical exercise, hypothyroidism

Peripheral
Boys: testicular damage, Prader-willi/Noonas/Klinefelters
Girls: Turner, PCOS

491
Q

Precocious puberty in boys

A

in boys before age 9

492
Q

Precocious puberty in girls

A

in girls before age 8

NB 5-10x more common in women)

493
Q

Types of Precocious puberty

A

gonadotrophin dependent (central precocious puberty)
most common, premature HPG axis activation
↑FSH/LH
e.g. CNS tumours

gonadotrophin independent (precocious pseudo puberty)
les common, production of sex independent of HPG axis
↓FSH/LH
↑ testosterone/estradiol
e.g. congenital adrenal hyperplasia

494
Q

Investigating precocious puberty

A

FSH/LH levels
testosterone
oestrogen
USS pelvis

495
Q

paediatric fluid resuscitation

A

20ml/kg NaCl 0.9% over 10 minutes

if ≥40-60ml/kg required call PICU

496
Q

Paediatric maintenance fluids

A

100ml/kg/24h for first 10kg
50ml/kg/24h for second 10 kg (11-20kg)
20ml/kg/24h for every kg >20kg

to calculate rate
rate (ml/h) = total daily requirements/24

497
Q

Dehydration fluids in children

A

50ml/kg (~5%) deficit add 50ml/kg/24h as fluid replacement on top of maintenance

100ml/kg (~10%) deficit add 100ml/kg/24h as fluid replacement on top of maintenance

498
Q

Red flags for developmental milestones

A

developmental regression/loss of previously acquired skills/milestones
parental concerns
hand preference in infant <1y/o
marked hyper/hypotonia
lack of response to sound/visual stimuli
poor interaction with parent/other children

499
Q

Red flags for headaches

A 
headache waking them up at night/present at waking 
worse on coughing/bending over
persistent vomiting
fever/neck stiffness/photophobia
confusion
altered level of consciousness
change in gait/balance
seizures
focal neurology
school absences due to headache
500
Q

Non accidental injuries red flags

A

no history of trauma
unwitnessed trauma
injury incompatible with developmental stage
delayed presentation
changing history
fractures in child <1y/o
multiple fractures
presence of other injuries
fractures of different ages
injuries to sites not usually exposed to trauma
lack of concordance between given MOI and injury

501
Q

Fever red flags

A 
≥38°C in <3 months old
≥39°C in 3-6 month old
non blanching rash/mottled skin
child appears unwell to HCP
↓ fluid intake/ ↓ urine output
does not wake when roused/does not stay awake
signs of dehydration
bulging fontanelle 
seizures
persistent fever >5days
502
Q

Features of innocent murmurs

A

systolic
musical/vibratory quality
does not radiate
Vary with respiration & positioning

503
Q

Migraine in children

A

very common (~10%), most common cause of primary headache in children

504
Q

Presentation of migraine in children

A

headache lasting 4-72h usually unilateral, usually frontal/temporal with a pulsating/throbbing character
may be associated with nausea & vomiting, photophobia or photophobia

505
Q

Managing migraine in children

A

NSAIDs (ibuprofen)

NB Ibuprofen is more effective than paracetamol

506
Q

Tension headache in children

A

2nd most common cause of headache in children, can be episodic or chronic

507
Q

Triggers for tension headaches

A

stress (physiological, social, emotional)
disturbed sleep pattern
mental tension

508
Q

Presentation of tension headaches

A

generalised bilateral headache, usually less severe than migraine, pressure like non-throbbing pain, often occipital/frontal
described as tight band around head

509
Q

Managing tension headaches in children

A

advice on triggers
simple analgesia
TCAs (for recurrent/chronic TTH)

510
Q

Fetal alcohol syndrome presentation

A

failure of growth (↓ head circumference, ↓ weight, ↓ length), irreversible (i.e. stunted for life)

craniofacial abnormalities (microcephaly, flat philtre, micro/retrognathia, microphtalmia, cleft lip/palate)

presence of congenital abnormalities (e.g. congenital heart defects)

neurodevelopment abnormalities ( e..g developmental delay, learning difficulties, mental health problems, behavioural problems)

511
Q

Diamond blackfan syndrome

A

congenital hypoplastic anaemia that usually presents in infancy

presents with severe/life threatening in first few months of life as severe hypo plastic microcytic anaemia

treated with ciclosporin A + prednisolone

512
Q

Caput succedaneum

A

poorly defined subcutaneous collection of serosanguinous fluid,soft puffy swelling, spreads over suture lines and midline
soft puffy swelling

due to prolonged labour or use of venous delivery

513
Q

Cephalohaematoma

A

subperiosteal haematoma that develops shortly after birth, usually in parietal region, does not spread across suture lines

may cause jaundice as haematoma resolves

514
Q

Erbs Palsy

A

injury to upper trunk of the brachial plexus (C5/C6)

causes loss of motion of shoulder with limp arm that is adducted & internally rotated
absent bicep reflex, intact grasp reflex

due to excessive lateral traction on neck during labour

515
Q

Klumpke’s palsy

A

injury to lower trunk of brachial plexus (C7/C8/T1)

causes paralysis & weakness of hand, loss of grasp reflex, may cause Horner’s

due to excessive traction on arm during delivery

516
Q

Juvenile idiopathic arthritis (JIA)

A

arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks. Systemic onset JIA is a type of JIA which is also known as Still’s disease

presentation includes pyrexia, salmon-pink rash, lymphadenopathy, arthritis, uveitis, anorexia and weight loss

ANA may be positive (especially in oligoarticular JIA)
rheumatoid factor is usually negative

NBP pauciarticular JIA refers to cases where 4 or less joints are affected. It accounts for around 60% of cases of JIA

Year 4 (12 decks)

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