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Revision > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Organism that causes acute epiglottitis

A

Haemophilia influenza B

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2
Q

Features of acute epiglottitis

A

High temperature
Generally unwell, toxic child
Stridor
Drooling

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3
Q

X-ray sign of acute epiglottitis

A

Thumb sign

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4
Q

Management of acute epiglottitis

A

Intubate - call anaesthetist

Secure airways

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5
Q

Common organism that causes croup

A

Parainfluenza virus

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6
Q

Features of croup

A

Barking cough - worse at night
Stridor
Cold symptoms

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7
Q

Croup on X-ray

A

Steeple sign

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8
Q

severe croup

Features

A

Inspiratory stridor at rest
Sternal wall retractions
distress/agitation - sign of hypoxemia
Tachycardia

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9
Q

Management of croup

A

0.15 mg/kg of ORAL DEXA - regardless of severity
If not available give prednisolone

Severe cases = give oxygen (high flow) and nebulised adrenaline

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10
Q

Prognosis of croup

A

Natural resolution - complete recovery

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11
Q

Define enuresis

A

Involuntary discharge of urine - day or night or both
+ child >= 5 years old
+ with no congenital or acquired defects

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12
Q

Primary vs secondary enuresis

A

Primary - never achieved continence before

Secondary - dry for at least 6 months

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13
Q

Management of primary daytime enuresis over the age of 2

A

Refer to secondary care or enuresis clinic

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14
Q

Management of primary enuresis w/o daytime symptoms

- < 5 yrs

A

reassure

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15
Q

Management of primary enuresis w/o daytime symptoms

> 5 yrs

A

If < 2x/week = reassure

If > 2x/week =
-short term = desmopressin ( camp or child >7)
- long term = enuresis alarm + reward system
(Enuresis alarm first line for children <7)

** if 2 complete courses of treatment dont work = Refer to secondary care

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16
Q

Management of secondary enuresis

A

Refer to paediatrician

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17
Q

Common causes of secondary enuresis (4)

A

Emotional upset (?abuse)
UTI
DM
Constipation

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18
Q

How should the reward system work in enuresis management

A

Reward for agreed behaviour rather than dry nights

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19
Q

What happens in reflex nephropathy?

A

Urine goes back from bladder to ureters and kidneys - vesico-ureteric reflux

= dilated pelvicalyceal system -
=Repeated UTIs
= progressive renal failure

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20
Q

Cause of reflux nephropathy

A

Occurs mainly in children

Congenital abnormality at insertion of ureters into bladder

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21
Q

Diagnosis of reflux nephropathy

  • Initial
  • Gold standard
  • For parenchymal damage
A

Initial = Renal US +urinalysis + C&S
Gold* = MCUG (micturating cystourethrogram)
Damage (cortical scars) - DMSA

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22
Q

Treatment of reflux nephropathy

A

1 - low dose antibiotics = Trimethoprim daily

If it fails or there’s parenchymal damage = Surgery (ureter reimplantation)

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23
Q

4 cm lateral neck mass not translucent

Dx?

A

Branchial cyst

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24
Q

5 cm translucent lateral neck mass

Dx?

A

Lymphangioma

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25
Q

Ddx for lateral neck mass

Lateral = along or near strenocleidomastoid

A

Branchial cyst
Lymphangioma

Differentiate by translucency

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26
Q

3cm midline lump
Painless , Mobile
Moves with tongue protrusion

A

Thyroglossal cyst

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27
Q

severe croup

Features

A

Inspiratory stridor at rest
Sternal wall retractions
distress/agitation - sign of hypoxemia
Tachycardia

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28
Q

Management of croup

A

0.15 mg/kg of ORAL DEXA - regardless of severity
If not available give prednisolone

Severe cases = give oxygen (high flow) and nebulised adrenaline

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29
Q

Prognosis of croup

A

Natural resolution - complete recovery

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30
Q

Define enuresis

A

Involuntary discharge of urine - day or night or both
+ child >= 5 years old
+ with no congenital or acquired defects

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31
Q

Primary vs secondary enuresis

A

Primary - never achieved continence before

Secondary - dry for at least 6 months

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32
Q

Management of primary daytime enuresis over the age of 2

A

Refer to secondary care or enuresis clinic

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33
Q

Management of primary enuresis w/o daytime symptoms

- < 5 yrs

A

reassure

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34
Q

Management of primary enuresis w/o daytime symptoms

> 5 yrs

A

If < 2x/week = reassure

If > 2x/week =
-short term = desmopressin ( camp or child >7)
- long term = enuresis alarm + reward system
(Enuresis alarm first line for children <7)

** if 2 complete courses of treatment dont work = Refer to secondary care

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35
Q

Management of secondary enuresis

A

Refer to paediatrician

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36
Q

Common causes of secondary enuresis (4)

A

Emotional upset (?abuse)
UTI
DM
Constipation

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37
Q

How should the reward system work in enuresis management

A

Reward for agreed behaviour rather than dry nights

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38
Q

What happens in reflex nephropathy?

A

Urine goes back from bladder to ureters and kidneys - vesico-ureteric reflux

= dilated pelvicalyceal system -
=Repeated UTIs
= progressive renal failure

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39
Q

Cause of reflux nephropathy

A

Occurs mainly in children

Congenital abnormality at insertion of ureters into bladder

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40
Q

Diagnosis of reflux nephropathy

  • Initial
  • Gold standard
  • For parenchymal damage
A

Initial = Renal US +urinalysis + C&S
Gold* = MCUG (micturating cystourethrogram)
Damage (cortical scars) - DMSA

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41
Q

Treatment of reflux nephropathy

A

1 - low dose antibiotics = Trimethoprim daily

If it fails or there’s parenchymal damage = Surgery (ureter reimplantation)

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42
Q

4 cm lateral neck mass not translucent

Dx?

A

Branchial cyst

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43
Q

5 cm translucent lateral neck mass

Dx?

A

Lymphangioma

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44
Q

Ddx for lateral neck mass

Lateral = along or near strenocleidomastoid

A

Branchial cyst
Lymphangioma

Differentiate by translucency

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45
Q

3cm midline lump
Painless , Mobile
Moves with tongue protrusion

A

Thyroglossal cyst

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46
Q

Fluctuant lump, transilluminates in the neck ?

A

Cystic hygroma

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47
Q

Management of suspected non accidental injury

A

Relieve pain + treat underlying medical conditions
** Skeletal survey
Inform local safeguarding
Refer to social services

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48
Q

Features of HSP

A

PAAN
Non blanching purpura+- arthralgia, abdominal pain, nephropathy= hematuria, proteinuria

Purpura - on buttocks and lower limb

Precipitated by URTI

All bloods - normal except raised ESR,IgA,creatinine

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49
Q

Osteogenesis imperfecta

  • inheritance pattern
  • features
  • treatment
A

Autosomal dominant
- collagen metabolism disorder - brittle bone disease

Blue sclera , dental abnormalities , brittle bones
Multiple/explained fractures
Hearing loss 2ry to otosclerosis

Bisphosphonate

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50
Q

Management of acute asthma exacerbation children

A

Oxygen
Salbutamol
Ipratropium bromide
Corticosteroids -Oral pred or IV Hydrocortisone
If still exacerbating consider
- salbutamol IV, IV aminophylline, IV MgSo4

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51
Q

Laryngomalacia

A

Congenital abnormality larynx

Presents @ 4 weeks of age - stridor

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52
Q 
Watery diarrhoea + weight loss + abdominal pain 
Foul smelling flatulence, bloating 
Dx?
First line investigation 
Another investigation

Treatment

A

Giardiasis
1- stool microscopy for ova and parasite
2- stool ELISA/PCR

Metronidazole and hygiene

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53
Q

Diarrhoea followed by RUQ pain

A

Amoeba

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54
Q

Breath holding spells vs reflex anoxic seizures

A

BHS - turns blue and stops breathing
Mainly 6mo-2yrs , rapid recovery

Reflex anoxic - child stops breathing and turns pale
Upward eye deviation + jerky movements
NO tongue biting

Management is the same for both - reassurance , put child in recovery position
Treat iron deficiency and ferritin if present

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55
Q

5 week old baby
Prolonged jaundice with pale stool dark urine liver enlargement and low weight for age
Dx?
Investigation

A

Biliary atresia
- direct conjugated bilirubin

= surgery

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56
Q

8 week baby +prolonged jaundice, yellow stool, pale rune, liver enlargement
Low weight, difficult feeding and vomiting
Dx?

A

Galactosemia

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57
Q

Causes of prolonged jaundice (6)

A 
Biliary atresia
Congenital hypothyroidism 
Breast milk jaundice
Galactosemia
UTI
Congenital infections - CMV toxoplasmosis
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58
Q

Congenital hypothyroidism
Features
Treatment

A

Jaundice, constipation, cold mottled dry skin , floppy,

Oral levothyroxine

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59
Q

Features biliary atresia

A

Biliary atresia - obstructive jaundice

= pale urine, dark stool , FTT , hepatomegaly

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60
Q

4-8 YO starts walking late
Waddling gait
Raised CK

A

DMD

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61
Q

Initial test for DMD

A

CK

Then
Muscle biopsy - if + —> genetic testing

Mutated dystrophin in striated muscle

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62
Q

Double bubble seen in

A

Duodenal atresia

Volvulus and malrotation

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63
Q 
Sudden onset green bilious vomiting in neonate 
\+ blood per rectum 
\+ double bubble sign on Xray. 
Dx?
Treatment
A

Malrotation and volvulus
ABCDE , NG decompression
Refer to paediatrics surgery for laparotomy and resection

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64
Q

Projectile non bilious vomiting approx 30 mins after feed in 3-8 week neonate
Palpable almond sized mass

A

Pyloric stenosis

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65
Q

Dx of pyloric stenosis

A

Abdominal ultrasound - thickened pylorus

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66
Q

Imbalance in pyloric stenosis

A

Metabolic alkalosis

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67
Q

Urgent step in pyloric stenosis

A

Serum potassium K+

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68
Q

Treatment pyloric stenosis

A

Correct dehydration and electrolytes
NGT
Ramstedt pyloromyotomy

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69
Q

Infant (6-18 mo) + crying + paroxysmal abdominal colic pain
+ bloodstained stool = red currant jelly (late sign)
+- sausage shaped mass RUQ
Dx?

A

Intussusception

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70
Q

Finding on abdominal US for intussusception

A

Target sign / doughnut sign

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71
Q

Treatment of intussusception

A

Mechanical reduction
1st line - air enema insufflation
2nd - reduction by barium enema

If failed - surgical reduction (laparotomy)

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72
Q 
Painless bleeding per rectum in a male child
2-3 YO
Dx?
Investigations:
Initial , definitive
A

Meckels diverticulum

Initial - radioisotope scan
Definitive - laparotomy

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73
Q

Treatment of meckels diverticulum

A

Surgical resection

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74
Q

Meckels rule of 2

A

2-3 YO
Mainly male
2 inches long
2 feet from ileocecal valve

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75
Q

Measles

Features

A 
Fever, irritability 
Rash - face/neck —> body 
Koplik spots on buccal mucosa 
URTI
NO cervical lymphadenopathy

*measles = rubeola

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76
Q

Management of measles

A

Supportive
Notifiable disease
Reassurance

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77
Q

Features of rubella

A

Low grade fever
Rash - maculopapular (face —> body) ; fades by 3-5th day
lymphadenopathy - suboccipital postauricular
Froschheimer’s spots - soft palate

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78
Q

Measles vs Rubella

A

Measles:
No lymphadenopathy
Spots on BUCCAL mucosa

Rubella:
Lymphadenopathy
Spots on soft palate

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79
Q

Roseola

Features

A

Sudden high temp

Non itchy rash chest or legs —> body

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80
Q

Erythema infectiousum
Features
Organism

A

Slapped cheek appearance

Parvovirus B19

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81
Q

Hand foot and mouth disease
Organism
Features
Management

A

Coxsackie virus
Painful ulcers on tongue + grey blisters on hand and feet

Mgmt

= supportive + reassurance

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82
Q

Test for suspected UTI in infants and children >3 months

A

Urine dipstick
If nitrite + leukocyte - negative - no further management
If + = start ABx, and send urine sample for culture

NICE - clean catch urine sample

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83
Q

11 referrals

- developmental milestones assessment

A
  1. No smile by 8 weeks
  2. No eye contact by 3 months
  3. Can’t hold object by 5 months
  4. Can’t reach for objects by 6 months
  5. cant transfer objects between hands by 9 mo
  6. cant sit unsupported by 12 months
  7. Cant walk by 18 months
  8. No single meaningful words by 18 months
  9. Only dada and mama by 24 months
  10. 2-3 word sentences by 2.5 years
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84
Q

At any point of time if a parent is concerned about their speech

A

Refer for hearing test

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85
Q

Tower of 3 age

A

18 months

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86
Q

Tower of 6 age

A

2 years

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87
Q

Tower of 8 with four bricks

A

2.5 years

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88
Q

Draw a line age

A

2 years

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89
Q

Draw circle age

A

3 years

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90
Q

Draws cross @ age

A

3.5

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91
Q

Draw square @

A

4 years

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92
Q

Draw triangle at

A

5 years

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93
Q

Most common organism affecting chest in cystic fibrosis

A

Staph aureus

2. Pseudomonas

94
Q

Inguinal hernia vs femoral hernia

A

Inguinal - above + medial to pubic tubercle

Femoral - below + lateral to pubic tubercle

95
Q

Risk factors of inguinal hernia

A 
Male 
Heavy lifting 
Old age 
Chronic cough
Previous abdominal surgery
96
Q

Treatment of hernia
< 10
>10

A

<10 - herniotomy

>10 - herniorrhaphy

97
Q

Obstructive sleep apnoea in children
Next step
Investigation of choice

A

Refer to ENT surgeons

Polysomnography

98
Q

Rett’s syndrome

A

Normal development until 2-3 Y

Regression afterwards - motor social language coordinations

99
Q

Willis ekbom syndrome

Investigations

A

= restless leg syndrome

Check iron

  • low - give supplements
  • normal - give dopamine agonist
100
Q

Diagnosis of Kawasaki

A 
Fever + at least 4 of :
Conjunctival injection 
Bright red cracked lips
Strawberry tongue 
Painless cervical lymphadenopathy 
Red palms soles - later desquamation 
Polymorphous rash

Mnemonic RASH
Conjunctivitis, rash , adenopathy, strawberry tongue , hand foot erythema, burning high fever

101
Q

Complications of Kawasaki

A

Coronary artery aneurysm

102
Q

Management of Kawasaki

A

High dose aspirin

IVIG

103
Q

Initial screening test for coronary artery aneurysms

In Kawasaki

A

Echo

104
Q

Why should aspirin use be avoided in children

A

Reye’s syndrome

- encephalitis + liver damage

105
Q

Commonest organism causing scarlet fever

A

Group A strept pyogenes

106
Q

Features of scarlet fever

A 
Fever 
Sore throat - clincher
Rash  - sand paper like rash
= trunk —>body ; no palms or soles 
Strawberry tongue 
Cervical LNS 
Tonsils w/ palate exudates
107
Q

Management of scarlet fever

When can children return to school

A

Oral penicillin V 10 days
If allergic - azithromycin

24 hrs after start of ABX
Notifiable disease

108
Q

Complications of scarlet fever

A

otitis media - most common

Rheumatic fever - typically 20 days after infection

109
Q

Diagnostic imaging for malrotation and volvulus

A

Abdominal XR - double bubble

Barium enema

110
Q

Diagnostic imaging for pyloric stenosis

A

Abdominal US

111
Q

Diagnostic imaging for intussusception

A

Abdominal US

- target sign

112
Q

Peripartum exposure to varicella

Management

A

Peripartum = 7 days before or after delivery
Give VZIG + isolation

If 8 or more days - observation, advise mum to continue caring for baby

113
Q

Infectivity of chicken pox

A

4 days before rash appears

5 days after

114
Q

When should VZIG be given (3)

A

Immunocompromised w/ exposure
Pregnant w/ exposure + no VZ antibodies
Newborns with peripartum exposure

115
Q

When shoul acyclovir be given in chicken pox (2)

A

Immunocompromised w/ chicken pox

Pregnant w/ CP

116
Q

Management of febrile seizure

A

<5 mins - antipyretics

>5 mins - benzodiazepine - buccal midazolam

117
Q

Type of hearing loss in otitis media

A

CHL

118
Q

Aminoglycoside ototoxicity hearing loss

A

SNHL

119
Q

Congenital infections cause what type of hearing loss

A

SNHL

CMV

120
Q

When should you worry about fever post vaccine

A

> 1 week of fever

121
Q

TCA overdose features

Immediate action , tx

A

Dilated pupil ,dry mouth , dry flushed skin , tachycardia
Drowsiness, Hypotension urine retention , wide QRS

ECG monitor
- wide QRS , broad complex tachy

IV NS 250ml + sodium bicarbonate 50 mmol IV slow infusion 8.4%

122
Q

Investigate what delayed milestones

A 
No smile 8 weeks
No eye contact 3 months 
No holding objects 5 months 
No reaching for object 6 months 
No transferring objects 9 months 
Not sitting unsupported 12 months 
No walking 18 months 
No meaningful s words 18 months 
Only mama dada @ 24 months 
No 2-3 word sentences 30  month/2.5 yrs
No running by 2.5 yrs
123
Q

Advice for SIDS

A

Avoid - prone sleeping , parental smoking, parental sedative use at child bedtime , soft bedding
No blanket higher than infants shoulder
No heavy wrapping of baby or head covering
Place baby with feet at foot of cot
Avoid bed sharing

124
Q

Imbalance in severe asthma

A

Respiratory acidosis

125
Q

Common organism causing bronchiolitis

A

RSV

126
Q

Features of bronchiolitis

A

Coryzal + dry cough
Wheezing + fine inspirations crackles
Feeding difficulty

Most common cause of serious LRTI in <1YO

127
Q

Peak incidence of bronchiolitis

A

3-6 months

128
Q

LN >/= 2 cm

Steps to be taken

A

FBC and blood film

US

129
Q

Causes of lymphadenopathy children

A

ALL, lymphoma

CMV, EBV, Kawasaki, TB

130
Q

Pathological jaundice causes

A

Jaundice in 1st 24 hrs

  • Rh or ABO incompatibility
  • hereditary spherocytosis
  • G6PD
131
Q

Prolonged jaundice screening

A

Conjugated and unconjugated bilirubin
Coombs test
TFTs
FBC , blood film , U&E, LFTs

132
Q

Child w/ UTI still feverish after start of ABx for 2 days

Next step

A

Urgent US or MCUG

If they respond well to ABx - US w/in 6 weeks

133
Q

Preterm baby + continuous machinery murmur

A

PDA

134
Q

Cyanosis baby with ejection systolic murmur

A

Tetralogy of Fallot

Ejection systolic murmur = pulmonary stenosis

135
Q

Tetralogy of Fallot

A

A

136
Q

Progressive severe cyanosis + poor feeding

Pan systolic murmur on LSB

A

Tricuspid atresia

137
Q

Acyanotic pan systolic murmur

A

VSD

138
Q

Cyanotic heart diseases

A 
Truncus arteriosus 
TGA
Tricuspid atresia
TOF
Total anomalous pulmonary venous return
139
Q

Acyanotic CHD

A

ASD VSD PDA CoA

140
Q

PDA common in

A

Preterm babies

May close spontaneously

141
Q

Diagnosis of PDA

A

Echo

142
Q

Treatment PDA

A

Indomethacin

- inhibits prostaglandin synthesis

143
Q

When to refer for hearing test

A 
Any parental concern 
Doctor concern 
Temporal bone fracture
Bacterial meningitis 
Severe unconjugated hyperbilirubinemia 
Delayed speech and language milestones
144
Q

Hearing test in <6 mo

A

Otoacoustic emissions or

Audiological brainstem response

145
Q

6-18 mo hearing test

A

Distraction testing

146
Q

2-4 years hearing test

A

Speech discrimination pr

Conditioned response audiometry

147
Q

> 5 years hearing test

A

Pure tone audio gram

148
Q

Treatment of croup

A

Dexa - oral

If severe - o2+ neb adrenaline

149
Q

Treatment bronchiolitis

A

Supportive care

150
Q

Sudden high fever + rash on chest or below

No rash on head/neck

A

Roseola

151
Q

Child > 2 YO + bed wetting + daytime symptoms

A

Refer 2ry care or enuresis clinic

152
Q

Investigation of cushings

  • best initial test
  • localise lesion
A

Initial - overnight dexa suppression 1mg

Localise - high dose dexa suppression 8mg

153
Q

Interpreting dexa suppression test

A

Low dose:
Cortisol is low = normal
High/normal cortisol = cushings

High:
Low cortisol - Cushing disease —> pituitary MRI
High/normal cortisol + low ACTH - adrenal cushings —> adrenal CT
“” + high ACTH - ectopic ACTH —> CT chest abdomen

154
Q

Cushings

Syndrome vs disease

A

Both = increased cortisol

Syndrome - adrenal adenomas, ACTH prod e.g lung ca- small cell lung ca steroid meds

Disease - pituitary tumour - raised ACTH —> adrenal hyperplasia

155
Q

IV fluids for children that cant tolerate orally

A

Initial bolus - NS
Maintenance - NS + 5% dextrose

NS + kcl if associated hypokalemia

156
Q

Di George syndrome

A 
CATCH 22 
Cleft palate 
Abnormal face
Thymic aplasia 
Cardiac - TOF
Hypocalcemia, hypoparathyroidism 
22 - chromosomal abnormality on C22
157
Q

Hypchloraemic Hypokalemic alkalosis

A

Pyloric stenosis

158
Q

What is the risk in Ehler danlos syndrome

A

Subarachnoid hemorrhage

159
Q

Deletion of some genes on chromosome 15

A

Prader willi

160
Q

Most common congenital heart defect in Down’s syndrome

A

AVSD

161
Q

Management of 2ry enuresis

A

Refer to paeds

162
Q

Common cause of 2ry enuresis

A

Emotional upset

UTI , DM, constipation

163
Q

Wilson’s disease

  • inheritance pattern
  • presentation
A

Autosomal recessive
Cu deposition liver
Hepatosplenomegaly , deranged LFT , Cirrhosis
CNS - Ataxia, dysarthria, dystonia
Behaviour — personality changes , declining school performance

164
Q

Dx of Wilson’s

A

Initial - LFT + serum CU (very low <0.1)

165
Q

Treatment Wilson’s

A

Lifelong penicillinamine

If acute liver failure - liver transplant

166
Q

Alpha anti-trypsin deficiency

Presentation

A

Haemoptysis + cough + jaundice

167
Q

Hemoptysis + hematuria

A

Goodpastures

168
Q

Hematuria after bloody diarrhoea

A

HUS

169
Q

Hematuria + SNHL

A

Alport syndrome = x linked

170
Q

Macrophages with periodic acid-schiff granules

A

Whipples disease

171
Q

+ve anti glial in antibodies

A

Coeliac disease

172
Q

Peak incidence of nephrotic syndrome

A

2-5 years old

Minimal change 80%

173
Q

Features of minimal change disease

A 
Nephrotic syndrome 
Normal tension
Selective proteinuria - only albumin and transferrin leak through 
Renal biopsy - definitive test 
= fusion of podocytes
174
Q

Raised PTT + bleeding time

A

VWD

175
Q

Raised PT PTT bleeding time

A

DIC

176
Q

Normal PT

A

10-14 s

177
Q

Normal PTT

A

35-45 s

178
Q

Bleeding time

A

3-9 minutes

179
Q

Treatment hemophilia A

A

Desmopressin

If major bleeding - recombinant factor 8

180
Q

Treatment hemophilia B

A

Recombinant factor 9

181
Q

What should NOT be given in treatment of hemophilia

A

NSAIDs

IM injections

182
Q

Treatment congenital hypothyroidism

A

Oral levothyroxine until 2 years old

183
Q

ECG - delta waves + wide QRS

A

Wolff Parkinson white syndrome

184
Q

Bilateral ground glass appearance on neonate xray

A

RDS

185
Q

RDS vs meconium aspiration

A

RDS - preterm <32 weeks

MA - post term >42 weeks

186
Q

Increased risk of meconium aspiration in:

A 
Hx of mat HTN 
Preeclampsia
Chorioamnionitis 
Smoking 
Substance abuse
187
Q

1st line in VUR management

A

ABx - low dose trimethoprim daily

If fails or parenchymal damage
= surgery

188
Q

Dx of VUR
Imaging
Initial , gold std , parenchymal damage

A

Initial - Renal US + urinanalysis
Gold = MCUG
DMSA - cortical scars

189
Q

Salt wasting in infant male

A

CAH

190
Q

ITP treatment

A

IV immunoglobulins

191
Q

Treatment HUS

A

IV fluids +- transfusion +- dialysis
If very severe - plasma exchange

NEVER gibe ABx

192
Q

Echogenic bowel on pre-natal US

A

Cystic fibrosis

193
Q

Necrotising enterocolitis

  • main RF
  • features
A

Prematurity
Increased risk when empirical ABx given to infants beyond 5 days
Vomiting - feeding intolerance, hypoactive, distended abdomen , bloody stools

194
Q

Distended loops + air in bowel on XR

Dx?

A 
Pneumatosis intestinalis 
Necrotising enterocolitis (NEC)
195
Q

Treatment NEC

A

TPN + total gut rest
If perforated = laparotomy

Stop feeds + IV fluids + abdominal films +start systemic ABx

196
Q

VACTERL

A

Vertebral anal cardiac trachesophageal, renal, limb defects

197
Q

GORD presentation in children

A 
< 1 yo 
Non projectile vomiting after feeds
Gags, chokes after feeds
Crying, difficult to feed
FTT - severe GORD
198
Q

Treatment of GORD paediatrics

A

Assess breastfeeding, increased frequency and decreased amount
Gaviscon - try this 1st
Then PPI H2

199
Q

APGAR

A

Appearance
0 - blue/pale 1- acrocyanosis (blue extremities pink body) 2- pink all over
Pulse
0-absent 1- <100 2- >100
Grimace
0- no response 1- grimace on aggressive stimulation/suction 2- cry cough sneeze on stimulation
Activity
0- floppy 1- some limb flexion 2- active
Respiration
0- absent 1- weak irregular gasping 2- strong robust cry

0-3 = very low score
4-6 moderate low
7-10 = good state

200
Q

Breast milk jaundice
Features
Management

A

Starts in 2nd week of life
Increased Unconjugated bilirubin
Infants are well
Advise mother to continue breastfeeding - disappears in 6 weeks

201
Q

p-ANCA +ve + intermittent bloody diarrhoea + weight loss + abdominal pain

A

Ulcerative colitis

P anca - specific in Churg Strauss but can be + in UC

202
Q

Innocent Murmur

A

Children 3-8 YO
Due to turbulent blood flow at the outflow tract of the heart
More evident in fever and in supine position
Benign/ physiologic

203
Q

Cow milk allergy

  • acute
  • delayed
A

Acute - igE mediated
So assess cow milk protein allergy - skin prick test / blood test

Delayed -
Non igE mediated
Change to hypoallergenic formula

204
Q

Commonest cause of early-onset neonatal infection

A

Streptococcus agalactiae (GBS)

205
Q

Investigation of pyloric stenosis

A

Abdominal ultrasound

206
Q

Recommended dose for children above 1 YO

VIT D

A

400 IU = 10 mcg per DAY

207
Q

Bimodal age presentation Hodgkin’s lymphoma

A

<25 YO or >55 YO

208
Q

Organism causing HFMD

A

Coxsackie A16 and enterovirus 71

209
Q

Infantile spasm / west syndrome

Features

A

1st 4-8 months of life
M>F
Flexion of head trunks and arms —> extension of arms
Progressive mental handicap

210
Q

Investigation west syndrome

A

EEG - hypsarrythmia

CT - diffuse/localised brain disease e.g tuberous sclerosis

211
Q

Management of infantile spasms

A

1- vigabatrin
ACTH

Poor prognosis

212
Q

Imaging in child with UTI
<6mo
- responds to treatment
- atypical/recurrent UTI

A 
- responds to Tx = UD in 6 weeks
Atypical or recurrent 
= US in acute infection 
DMSA 4-6 mo after infection 
MCUG
213
Q

Imaging in child with UTI
>6mo - <3yrs
- responds to treatment
- atypical/recurrent UTI

A

RTT - nothing
Atypical - US now , DMSA after 4-6 months
Recurrent - US in 6 weeks, DMA “^”

214
Q

Imaging in child with UTI
>3 yrs
- responds to treatment
- atypical/recurrent UTI

A

RTT - no imaging
Atypical - only US now
Recurrent - US in 6 weeks, DMSA 4-6 months

215
Q

Diagnostic criteria - whooping cough

A

Acute cough <14 days w/o apparent cause + 1 or more :

  • paroxysmal cough
  • Inspiration whoop
  • Post tussive vomiting , central cyanosis
  • undiagnosed apnoea can attacks - young infants
216
Q

Dx of whooping cough

A

Nasal swab culture of bordetella pertussis

217
Q

Management whooping cough

A

< 6 months old - admit , notifiable disease
Oral macrolides - clarithromycin , azithromycin, erythromycin if onset of cough is within the last 21 days

Prophylaxis for household contacts
School - 48 hrs after starting ABx or 21 days from onset if no ABx given

218
Q

Complications of whooping cough

A

Subconjuctival hemorrhage
Pneumonia
Bronchiectasis
Seizures

219
Q

When is pertussis vaccine offered to pregnant women

A

20-32 weeks

Influenza + DPT vaccine

220
Q

Umbilical granuloma management

A

Signs of infection - fusiliers acid

No signs - table salt 1st line , silver nitrate 2nd line

221
Q

Subclassifications of osteomyelitis

A

Haematogenous
= bacteriuria - monomicrobial - children commonly
Most common = vertebral osteomyelitis

Non haematogenous
Spread from soft tissue to bone - poly microbial - adults -
RF- diabetic foot/pressure sores, PAD
Staph aureus except SCA = salmonella

222
Q

Investigations osteomyelitis

A

MRI

223
Q

Management osteomyelitis

A

Flucloxacillin 6 weeks

Clindamycin - penicillin allergic

224
Q

IV fluid resuscitation - paeds

A

Mod - severe dehydration = IV NS bolus over <10 mins

  • term neonate = 10-20 ml/kg
  • children + young people = 20 ml per kg
  • small vol of fluid in underlying cardiac and renal problems
225
Q

When does lymphadenopathy require urgent referral (paeds)

A

Firm and non tender
Hard
Progressively enlarging
>2cm

226
Q

2 types of flat head syndrome

A

Plagiocephaly - flattened on 1 side (asymmetrical)

Brachycephaly - back of head becomes flattened

227
Q

Dysgraphia

A

Deficiency in the ability to write

228
Q

What team do you refer a child with writing difficulty

A

Educational psychologist

229
Q

Management of ITP

A

Prednisolone
IV immunoglobulins
Admit to paediatric ward
Platelet transfusion if life threatening bleed

230
Q

Management ophthalmia neonatorum

A

Reassure or
Refer 2ry care if purulent discharge + swelling of lid or injected conjunctiva
Chlamydia - erythromycin orally
Gonorrhoea - ceftriaxone IV

231
Q

Important cause of seizure in afebrile child

A

Hypoglycemia

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