Paediatrics Flashcards
Which age has the greatest childhood mortality?
<1 year
Hepatomegaly is associated heavily with which disease state?
Heart failure
Congenital heart disease
What is the number one cause of splenomegaly?
Malaria
What is Pectus excavatum?
A hollow in the anterior chest wall
What is ‘Pigeon chest’?
Pectus carinatum i.e. bulging of the sternum
What is ‘diaphragmatic tug’?
Indrawing of the chest wall
causes Harrison sulcus (google it - seen in ricket’s)
What is sternal recession and when is it seen?
An indent in chest wall. Seen in acute cases e.g. Respiratory distress syndrome (RDS).
What can a sweat test be used to test for?
Cystic Fibrosis. Will be positive in Cystic Fibrosis.
What is the commonest cause of clubbing?
Cystic Fibrosis
Give x3 causes of clubbing
Cystic Fibrosis (If positive sweat test)
Primary Ciliary Dyskinesia (If negative sweat test)
Crohn’s Disease (If GI symptoms accompany)
What does the phrase ‘stony dullness’ specifically signify?
Pleural effusion.
Name 3 classic signs of pneumonia.
Fever
Dull to percussion
Inspiratory crepitations
What is the normal milestone by which a baby’s squint should disappear?
12 weeks.
What is exanthema?
a group of diseases where a rash presents as the main symptom. e.g. measles, scarlet fever, rubella
In which diagnosis can we find Koplik spots?
Measles
Measles is what type of virus?
RNA paramyxovirus
Name two notifiable diseases
Measles
Which rash characteristically starts behind the ears?
Measles
What is the most common complication of measles?
Otitis media
What is the most common cause of death in measles?
Pneumonia
What is the incubation period for chickenpox?
10-21 days.
What do we give to pregnant women who have never had chickenpox before?
VZIG - Varicella zoster immunoglobulins.
If a pregnant woman develops chickenpox, what is the first treatment we manage them with?
Acyclovir
Which virus most commonly causes hand, foot and mouth disease?
Cocksackie virus.
Give 3 characteristics of Rubella (German measles).
- Caused by rotavirus
- Maculopapular rash starts on face and spreads to the rest of the body (cephalocaudal rash)
- Lymphadenopathy
‘rash starting behind the ears’ - should make one think of what?
Measles.
What is the most common cause of a nappy rash?
Contact dermatitis
‘sandpaper rough rash and sore throat’ think what?
Scarlet fever; the rough rash is a big indicator
How do we treat Scarlet fever?
Penicillin: One of the few viruses whereby we use antibiotics - rest are conservative management.
What is strawberry naevus and how do we treat it?
Hemangaemioma which we treat with propranolol if really needed (treatment not necessarily required often)
What is one large red flag for rashes? What must we be on the lookout for?
Non-blanching. Should be on the lookout for meningococcal septicaemia.
What age baby is classified as premature?
<37 weeks.
What type of virus is ‘slapped cheek virus’ caused by?
Parvovirus aka. 5th disease
Which are the two main differentials in a patient with a ‘strawberry tongue’?
Scarlet fever (more accompanied with rough rash) Kawasaki's disease
What is scarlet fever caused by?
Group A Haemolytic streptococci
Name 5 features of Kawasaki’s disease.
Vasculitis = has systemic features
Clinical criteria = strawberry rash, conjunctivitis, ‘cracked lips’, swelling.
Treat with aspirin and IV immunoglobulin.
What is a key complication of Kawasaki’s disease and so which test must we use as a result?
Aneurysms; kawasaki’s is a vasculitis. This means we have to do an echocardiogram.
How do we treat Kawasaki’s disease?
Aspirin and iV immunoglobulin.
Give x3 key pieces of advice for eczema management.
Avoid irritants
Simple emollients
Topical steroids
What is roseola?
A rash caused by Herpes virus-6 infection aka 6th disease. ‘rose-pink macules with surrounding pale halos’.
Which rash?
Rose-pink macule with surrounding pale halos.
Roseola.
What is a fontanelle?
The SPACE where the bones have not fused as the brain is still growing.
There are two fontanelles: anterior and posterior.
List the most common GI diseases affecting nutrition
Coeliac
IBD - Crohn’s, ulcerative colitis
Food allergies
Lactose intolerance
Describe the advantages of breastfeeding over the life course.
Natural product, natural antibodies
Requires all nutrients for development
Proper temperature
Infant-mother bonding
What is the single contraindication to breastfeeding?
HIV infection.
How do we give parenteral nutrition?
Through a vein (intravenously
Give x3 sources of iron.
Eggs, red meat, fortified cereals, wholemeal bread.
What is a fontanelle?
Where the bones have not fused as the brain is still growing.
There are two fontanelles: anterior and posterior.
Give two causes of increased fontanelle sizes.
Hydrocephalus
Bleeding
Give a formula to measure height velocity.
Height change/ age change (cm/year)
Describe the growth hormone axis
GnRH from the hypothalamus stimulates GH release from the anterior pituitary gland which stimulates IGF-1 release from the liver.
Which is the most rapid phase of growth?
Antenatal (before birth i.e. during pregnancy)
Define antenatal
During pregnancy.
Centiles define normal ranges. True or false.
False; you can be taller or shorter than centile lines and still be completely normal and healthy.
Give 3 causes of short stature.
- Genetic
- Endocrine disorders (hypothyroidism, GH deficiency)
- Puberty/ growth delay
- Psychosocial deprivation
Which questions will you ask in a history assessing causes of short stature?
Birth weight? Chromosomal abnormalities Psychosocial deprivation Endocrine illness Parent's height? Chronic illnesses?
What are some signs of respiratory distress in children?
Head bobbing nasal flaring intercostal/subcostal recessions tracheal tug 'tripoding' grunting
What can we check test wise to assess growth deficiency?
FBC, Iron, thyroid, coeliac screen, liver function, IGF-1, bone age.
What is croup?
URTI most commonly caused by parainfluenza virus
‘barking cough’
What is mesenteric adenitis?
Inflamed lymph nodes within the mesentery
What is the most common cause of anal itching in children?
Threadworms
What is the most common cause of ambiguous genitalia in children?
Congenital adrenal hyperplasia.
What are some signs of respiratory distress in children?
Head bobbing nasal flaring intercostal recessions tracheal tug 'tripoding'
What is bronchiolitis?
An LRTI mostly caused by RSV.
What is croup?
URTI most commonly caused by parainfluenza virus
What is whooping cough?
Which microorganism causes it?
Bacterial infection caused by Bordetella pertussis.
What do we often give in neonates to stimulate the respiratory centre?
Caffeine
How do you manage acute asthma in children?
OSHITME oxygen salbutamol hydrocortisone ipratropium bromide theophylline magnesium escalate
Why do we get worried in children who are having an asthma attack where CO2 levels are levelling?
Starting to get tired and retain CO2 rather than hyperventilating
How would you expect bronchiolitis to present?
Virus like symptoms
cough, wheezing, reduced feeding.
How would you manage a case of mild/ moderate croup?
Fluids
One off dose of dexamethasone.
What is the causative organism of epiglottis?
Hepatitis B.
Give three important initial questions to ask in history taking.
- Number of wet nappies (indicates hydration status)
- Waking up for feeds
- Maternal illness
Give 2 signs of cardiovascular compromie in a baby.
Cool peripheries
Mottled appearance
Give 3 ways of describing the anterior/ posterior fontanelles.
Soft (normal)
Sunken (dehydration)
Tense (raised intracranial pressure).
In a baby with infection, which are the three most appropriate initial investigations?
Bloods (FBC, U+Es, CRP, blood culture)
Urine sample
Lumbar puncture
NOT Stool culture.
In a newborn baby, what is the most likely pathogen for infection?
Group B Streptococcus.
Hypotonic, mottled and floppy baby point toward which diagnosis?
Sepsis.
Herpes simplex with CNS infection points toward which main diagnosis?
Encephalitis.
Name 3 signs of meningitis.
Non-blanching rash
neck stiffness
Fever
What is the most common causative microorganism of meningitis in neonates vs. babies >1month?
Neonates - Gp B Streptococcus, pneumococcus.
Babies >1 month - Meningococcus, pneumococcus.
What is the name of the virus that commonly causes bronchiolitis?
RSV - Respiratory syncytial virus.
How do children with cystic fibrosis typically present?
Failure to thrive
diarrhoea
respiratory symptoms
‘barking cough’ could be indicative of which respiratory diagnosis?
Croup.
Why would signs such as stridor and sternal recession point away from pneumonia?
They are signs of an upper airway problem.
How would pyelonephritis present?
Fever
Foul smelling, scanty urine
Tachycardia
If testicular torsion is confirmed in theatre, what is the next stage indicated?
Bilateral orchidopexy (fixation) as both sides are at risk.
Name one key risk factor for testicular torsion.
Undescended testis.
Is Molluscum contagiosum caused by bacteria or virus?
Virus. DNA pox virus.
What is the cause of epiglottitis in children?
Haemophilus influenza type B
Give 3 causes of developmental delay
Neglect, Cerebral palsy, iron deficiency
Which disorder typically describes poor social skills and repetitive behaviour?
Autism spectrum disorder
Describe 3 dysmorphism disorders
Down’s
Turner’s
Noonan’s
Give 2 causes of collapse in neonates
Sepsis
Congenital heart defect
Give 2 causes of jaundice in neonates
Physiological
Breast milk jaundice
Sepsis
Give 3 causes of rashes in children
Nappy rash
Mongolian blue spot (disappear by 3-5 years)
Give x1 main cause of a jittery baby
Hypoglycaemia
Give x3 differentials of breathing difficulty in a baby
Transient tachypnoea of newborn
Sepsis
Pneumonia
What causes ‘blue baby’?
Cyanotic CHD
Give x3 causes of a pre-term baby
Hypothermia Hypoglycaemia RDS Infection Anaemia
Give x3 causes of abdominal pain in a baby
Mesenteric adenitis
Appendicitis
Constipation
UTI
Give x2 differentials of limp/ joint pain.
Reactive arthritis
Trauma (NAI)
‘Purpura fulminans’ is due to which diagnosis?
Meningococcal meningitis
= skin necrosis and intravascular coagulation.
Give x3 eye problems in the infants
Otitis Media
Conjunctivitis
Pharyngitis
Give x3 causes of pallor in children
Iron deficiency anaemia
Beta Thalassaemia
SCA
Give x3 causes of short stature in children
Constitutional delay
Down’s syndrome
Hypothyroidism
Malnutrition
Which bacterium causes bronchiolitis?
RSV
Which bacteria cause UTIs?
E Coli, Klebisella, pseudomonas
Which viruses can cause a cold?
Rhinovirus, EBV.