Paediatrics Flashcards
1
Q
Name 3 screening tools for autism spectrum disorder? (ASD)
A
ADOS (Autism Diagnostic Observation Schedule) - gold standard
ASQ-E2 ( Ages & Stages Questionnaires®: Social-Emotional, Second Edition)
M-Chart
2
Q
About ___ % of children with Type 1 diabetes present in DKA.
Classical symptoms include ____, ____, and weight loss (usually a result of dehydration).
Other less typical presenting symptoms include _____ and recurrent _____.
A
25-50%
Polyuria
Polydipsia (excessive thirst)
Weight loss
Secondary enuresis (previously dry at night) Recurrent infection
3
Q
Episodes of severe hypoglycaemia where there is an impairment of consciousness. seizures or coma can be treated with _____?
A
IV dextrose (10%)
and
IM Glucagon
4
Q
Other causes of hypoglycaemia to think about include:
A
Hypothyroidism
Glycogen storage disorders
Fatty acid oxidation defects
Liver cirrhosis
Alcohol
Growth Hormone Deficiency
5
Q
Long term complications of Hyperglycaemia (poorly controlled diabetes) include:
A
Macrovascular:
Coronary Artery Disease (CAD)
Stroke
Hypertension
Peripheral Ischaemia (poor healing - ulcers - diabetic foot)
Microvascular:
Peripheral Neuropathy
Retinopathy
Nephropathy (particularly glomerulosclerosis)
Infection related complications:
Pneumonia
UTI’s
Skin and soft tissue infections (particulalry in the feet)
Fungal infections (Candidiasis)
6
Q
Name the different classes of insulin regimes, their duration of action, and examples of each.
A
Rapid-acting: 4hrs
- Novorapid
- FIASP (starts working within 2 mins)
- Humalog
- Apidra
*FAHN*
Short-acting : 8hrs
- Humulin-S
- Insuman RAPID
HI
Intermediate-acting: 16hrs
- Insuman BASAL
- Insulatard
- Humulin - I
HII
Long Acting: 24+ hrs
- Levemir (24hrs)
- Toujeo (36hrs)
- Tresiba (>42 hrs)
LTT
7
Q
Delayed puberty is classed as no pubertal development by the age of ___ in boys and ___ in girls.
A
15
14
8
Q
What are the causes of delayed puberty?
A
Constitutional delay:
The most common cause of delayed puberty is constitutional delay of growth and puberty, in which children are ‘late bloomers’ and enter normal puberty later than their peers. They will eventually reach full normal height and development. Constitutional delay is confirmed with a hand-wrist X-ray to confirm bone age, which is delayed in constitutional bone delay because the epiphyseal plates are late to fuse.
Low gonadotrophin secretion induces pituitary disorders:
- Craniopharyngiomas
- Kallmann syndrome
- Panhypopituitarism
- Isolated gonadotrophin deficiency)
- Hypothyroidism
- Systemic disease (e.g. cystic fibrosis or Crohn’s).
High gonadotrophin secretion causes include:
- Chromosomal disorders (Turner’s XO, Klinefelter’s XXY)
- Congenital adrenal hyperplasia
- Acquired hypogonadism (e.g. after chemotherapy)
9
Q
Reasons for admission in bronchiolitis?
A
Aged under 3 months
Prematurity / Down Syndrome / Cystic Fibrosis
50-75% less of their normal milk intake
Clinical Dehydration
Resp Rate > 70
Oxygen sats < 92%
Signs of respiratory distress
Apnoeas
Parents not confident about managing at home or difficulty accessing medical help from home
10
Q
Signs of respiratory distress in the infant?
A
Raised respiratory rate
Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis (due to low oxygen saturation)
Abnormal airway noises:
- Wheezing is a whistling sound caused by narrowed airways, typically heard during expiration
- Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
- Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup
11
Q
Bronchiolitis is caused by which microorganism?
A
Respiratory Syncytial Virus (RSV)
12
Q
Management of Bronchiolits?
A
Supportive management. This involves:
- Ensuring adequate intake. This could be orally, via NG tube or IV fluids depending on the severity. It is important to avoid overfeeding as a full stomach will restrict breathing. Start with small frequent feeds and gradually increase them as tolerated.
- Saline nasal drops and nasal suctioning can help clear nasal secretions, particularly prior to feeding
- Supplementary oxygen if the oxygen saturations remain below 92%
- Ventilatory support if required such as
- High flow humidified oxygen (Airvo or Optiflow - Increase postive end-expiratory pressure PEEP to prevent air way collapsing).
- CPAP
- Intubation
There is little evidence for treatments such as nebulised saline, bronchodilators, steroids and antibiotics.
13
Q
______ is a monoclonal antibody that targets the respiratory syncytial virus. An injection is given ____ as prevention against bronchiolitis caused by RSV. It is given to high risk babies, such as ____ and those with ____.
A
Palivizumab
Monthly
Ex-Premature
Congenital Heart Disease.
14
Q
Management of ADHD?
A
Conservative:
- Parental and child education
- Diet and Exercise (food diary can be helpful to keep track of certain foods that trigger symptoms such as food colourings etc).
Medication: (CNS stimulants)
- Methylphenidate (Ritalin)
- Dexamfetamine
- Atomoxetine
15
Q
Slapped Cheek Syndrome or “fifth disease” “Erythema infectiosum” is a self-resolving condition that is caused by which microorganism?
A
Parvovirus B19
16
Q
Hand dominance normally develops by ___ years and children with a preference before 18 months may indicate _____ or _____
A
2 yrs
18 months
Cerebral palsy or Spastic hemiplegia
17
Q
Major complicaiton of slapped cheek syndrome or parvovirus B19 infection?
A
Aplastic Anaemia
18
Q
_____ is the most common cardiac defect in infants of diabetic mothers. This applies to mothers with type 1 and 2 diabetes, rather than gestational diabetes.
A
Transposition of the great arteries
19
Q
The 2nd most common cardiac defect associated with people with trisomy 21 or Down’s syndrome is an ______ , which will have a ____ murmur.
A
Atrio-ventricular septal defect (AVSD)
Pan-systolic
*Pan systolic due to the ventricular septal defect (VSD).
20
Q
HSP presents with purpura or petechiae on the lower limbs and ____ pain, _____ , and ____ (haematuria +/- proteinuria), due to immunoglobulin deposition in the gut, joints and kidneys respectively.
A
Abdominal
Arthralgia
Nephritis
21
Q
The most common congenital heart defect in a patient with Turner’s syndrome is ___
5% of babies with Turner syndrome are born with _____.
Frequent bouts of ____ are also more common in children with Turner’s syndrome
A
Bicuspid aortic valve
coarctation of the aorta
otitis media (i.e glue ear if recurrent)
22
Q
Tet spells can be managed with analgesia and supplemental oxygen. A last line medication is a ____ agent (e.g. ____ ).
A
Vasoconstrictive
Phenylephrine
23
Q
Duodenal atresia is diagnosed with a characteristic finding of a ‘____’ on abdominal x-ray
A
double bubble
24
Q
Ewing’s sarcoma typically presented with the ____ (____) periosteal reaction which is visible on x-ray. MRI typically shows a large mass with evidence of necrosis and on histology small ____ cells are visible with clear cytoplasms on haematoxylin and eosin staining.
A
lamellated
onion skinning
blue round
25
An episode of a generalised tonic-clonic seizure after head trauma with rapid recovery and no post-ictal confusion is consistent with a ___ seizure. This is caused by overactivity of the ___ nerve, causing vasodilation and a collapse from a temporary reduction in cerebral perfusion.
reflex anoxic
vagus
26
\_\_\_\_ is the most common cause of nephrotic syndrome in children and typically presents with ____ in the ages \_\_\_.
Minimal change disease
Facial swelling
1-8 yrs old
27
\_\_\_\_\_ is diagnosed by a MCUG (micturating cystourethrogram) scan. MCUG is a diagnostic test to visualise the radioactive dye refluxing up into the ureters and/or kidneys.
Scarring of the kidneys is investigated using a ____ test.
Vesicouretric reflux
DMSA (radionuclide scan)
28
\_\_\_\_\_ is a common disease in children characterised by an initial high fever followed by a maculopapular rash. It is caused by human herpes virus 6. _____ occur in up to 15% of children with the disease.
Roseola infantum
Febrile Convulsions
29
Perianal/vulval itching in a child worse at night with no abnormalities on examination is characteristic of ____ . First line treatment is with oral ____ and hygiene measures for all members of the household.
Threadworm (type of parasitic worm)
Mebendazole
Mebendazole is in a class of medications called anthelmintics.
30
The underlying trigger for the inflammation of the synovial membrane in transient synovitis is a ____ .
Preceding viral infection.
31
Mesenteric adenitis often presents with a history of pain in the \_\_\_\_., usually following an ______ . It does not give a septic picture.
right iliac fossa (not similarity to appendicitis)
acute viral illness (usually upper respiratory tract infection)
32
\_\_\_\_\_ is a collection of fluid that collects due to pressure on the head during vaginal delivery.
Caput succedaneum
(C)aput (s)uccedaneum (c)rosses (s)uture lines. This will usually spontaneously resolve within days.
33
\_\_\_\_\_ is a condition caused by sustained and severely elevated levels of _____ bilirubin within the central nervous system.
Acute bilirubin encephalopathy
Unconjugated (lipid soluble and so in high doses can cross BBB and cause neurotoxicity)
Conjugated bilirubin is water soluble and thus cannot cross BBB and induce neurotoxicity.
34
Risk Factors for Sepsis in Paeds:
* **Age** (\<1 year)
* **Impaired immune function** (e.g. diabetes, splenectomy, immunosuppressant medication, cancer treatment)
* **Recent surgery** in the last **six** weeks
* **Breach of skin integrity** (burns/cuts/skin infections)
* An **indwelling catheter or line**.
35
A child with \> 5 days of fever, conjunctivitis, truncal rash, adenopathy, oedema and desquamation of the hands most likely has a diagnosis of ____ .
This is treated with ____ and ______ within 10 days of symptom onset. It is important to start treatment promptly to optimise patient outcomes.
Kawasaki disease
High dose aspirin
Intravenous Immunoglobulin
36
Perthes disease is the idiopathic _____ . It typically presents in boys aged ____ years. There is atraumatic hip pain and a limp. Treatment depends on the degree of joint destruction, and ranges from symptom control and bracing to surgical correction.
Avascular necrosis of the femoral epiphysis
5-6
37
\_\_\_\_ is a rare but dangerous condition that is similar to viral croup but the child has a high fever and has rapidly progressive airway obstruction with copious thick airway secretions.
It is caused by \_\_\_\_\_\_.
It will not respond to steroid and supportive treatment like croup. Treatment is thus with ____ . In some cases intubation may also be required.
Bacterial tracheitis
Staphylococcus aureus
IV antibiotics
38
Gold standard for a definitive diagnosis of coeliac disease is ____ .
Small bowel biopsy
| (not Anti-TTG although helpful)
39
Hand, foot and mouth disease presents with ___ on the hands and feet and ____ on the tongue, as well as a fever
blisters
ulcerations
40
\_\_\_\_ is the most common finding at paediatric cardiac arrests. ____ is the second most common
Asystole
Pulseless electrical activity
41
Diagnosis of neonatal respiratory distress syndrome is through clinical evaluation and a ____ appearance on chest x-ray.
'ground glass'
42
Paroxysmal cough to the point of vomiting is a red flag suggestive of \_\_\_\_. It is caused by _____ infection, and is diagnosed with a pernasal swab.
Whooping cough
Bordetella pertussis
43
The three core signs of Acute Lymphocytic Leukaemia are:
* **neutropaenia** (recurrent infections)
* **anaemia (**pallor, fatigue)
* **thrombocytopaenia** (purpuric rash)
44
The diagnosis of measles is confirmed by checking for ____ either from a **blood or \_\_\_** sample.
measles **IgM** antibodies
## Footnote
**saliva**
45
\_\_\_\_ is a poorly understood condition that results from ____ treatment of viral infections in children.
Reye's syndrome
aspirin
46
Reye's syndrome presents with:
* **Hepatitis/Hepatomegaly** - Abnormal LFTs
* Vomiting
* **Encephalopathy** (slurred speech, lethargy, coma and potentially death).
Can cause hepatomegaly and liver failure (liver swelling)
Primarily occurs in children (although can occur at any age) **taking aspirin in response to a viral infection** such as chickenpox (VZV)
47
\_\_\_\_ is not used in children, with the exception of treatment of Kawasaki disease.
Aspirin
48
The ___ Guidelines are used to assess whether patients below the age of ___ are competent to consent to contraceptive medication.
Fraser
16
49
What is the most likely causative organism in croup?
Parainfluenza Virus
50
An **obese** adolescent with a painful hip after a minor fall with a **widened growth plate** on X-ray most likely has a diagnosis of ____ .
The most significant risk factor is being overweight; 80% of affected adolescents are overweight
slipped capital femoral epiphysis (SCFE).
51
\_\_\_\_ is a common cause of respiratory tract infections in a patient with cystic fibrosis. Other common pathogens include Staphylococcus aureus and Haemophilus influenzae.
Pseudomonas aeruginosa
52
Developmental Dysplasia of the Hip gives a subsequent leg length discrepancy. ____ test is used to indicate whether the shortening is femoral or tibial.
Galleazi's
53
The total maintenance fluid requirements for children over 24-hours are calculated as follows:
* **100**ml/kg for the **first 10 kg**
* **50**ml/kg for the **second 10 kg**
* **20**ml/kg for **each kilogram over 20 kg.**
54
Features of innocent murmurs include:
\_\_\_\_\_ illnesses can accentuate innocent murmurs, and once the infection has resolved it is important to review the child to see if the murmur persists.
* **Localised with no radiation**
* **May vary with posture**
* **Soft systolic murmur with no diastolic component**
* **No heaves or thrills**
* **Asymptomatic**
* **No added sounds**
**Febrile**
55
Prader-Willi syndrome is a genetic condition that is inherited by ___ . It presents with ____ and poor feeding in infancy, developmental delay in early childhood, and learning disabilities, \_\_\_\_, hyperphagia and obesity in older childhood. Parents commonly report children will eat anything and everything and be hungry all the time, to the extent that they have to lock everything in the house and the child will even eat bars of soap if left unsupervised.
genomic imprinting
hypotonia
short stature
56
\_\_\_\_ describes a patient that has to use their hands and arms to 'walk' up their own body in order to stand up from a supine position. This is classically seen in Duchenne muscular dystrophy (DMD) due to ____ weakness. All boys that are not walking by the age of 1 1/2 years should have ____ measured, to rule out DMD.
Gowers' sign
proximal muscle
creatinine levels
57
Criteria for diagnosis of Kawasaki disease include fever for \>5 days, and 4/5 of the 'CREAM' features:
**Conjunctivitis**
**Rash**
**Edema/Erythema of hands and feet**
**Adenopathy** (cervical, commonly unilateral)
**Mucosal involvement** (strawberry tongue, oral fissures etc)
58
The rash is a malar rash with eyelid involvement, characteristic of _____ . ~50% of patients are positive for auto-antibodies but they are myositis specific ones. Even with the the antibody profile, ESR is still most likely to be raised in an untreated patient.
Juvenile dermatomyositis (JDM)
59
Ventricular septal defects (VSD) classically cause a ____ murmur loudest at the left lower sternal border; the louder the murmur the smaller the defect.
harsh pansystolic
60
The classical triad of Nephrotic syndrome is:
* **Oedema** (_usually periorbital)_
* **Proteinuria**
* **Hypoalbuminaemia**
Nephrotic syndrome can also cause _hyperlipidaemia_
61
Congenital hypothyroidism presents with:
* An **enlarged tongue** (macroglossia)
* **Constipation**
* **Hypotonia**
* **Jaundice**
* **Poor feeding**
* **Poor brain development**
62
Impetigo classically presents as a ___ rash with discrete patches that have a golden crusting. It is caused by ___ and \_\_\_\_\_. Impetigo is managed with ____ .
Pruritic
Staph and Strep bacteria
Topical Fusidic Acid
Oral flucloxacillin may also help.
It is highly infectious. Patients should not share towels and should not attend school or work until they have completed 48 hours of antibiotic treatment
63
Duct dependent congenital heart disease is managed with prostaglandins such as \_\_\_\_
Alprostadil
64
A teenager with learning difficulties and epilepsy, social anxiety, poor eye contact, echolalia (repeating your speech), mitral valve prolapse and prominent ears and jaw with a long thin face most likely has a diagnosis of _____ . The underlying genetic defect in fragile X syndrome is a ____ in the FMR1 (familial mental retardation 1) gene.
fragile X syndrome
trinucleotide repeat
Fragile X syndrome is the most common inherited cause of learning disabilities.
65
Fragile X syndrome presents with features including:
**A long face**
**Extra large testicles**
**Jaw and ears**
**Social anxiety**
**Autistic spectrum features**
66
Patients with fragile X syndrome are at an increased risk of ____ and epilepsy
mitral valve prolapse
67
Henoch-Schonlein Purpura (HSP) is the most common ___ vessel vasculitis in children. It most commonly affects children aged \_\_\_
HSP is commonly preceded by a ___ infection.
small
3-5
viral upper respiratory tract
68
Common presentations of ____ include stealing, bullying, lying, fighting, fire-setting and cruelty to animals. Temper tantrums which are not age-appropriate can also be seen.
conduct disorder
69
Hyper-inflated lungs and a fluid level in a newborn is the characteristic presentation of ____ , especially in ____ deliveries.
transient tachypnoea in the newborn
caesarean section
Transient tachypnea of the newborn (TTN) is a parenchymal lung disorder characterised by **pulmonary oedema** resulting from **delayed resorption and clearance of foetal alveolar fluid**
It is the **commonest cause of respiratory distress** in the **term** baby.
Treatment is with **oxygen**. TTN should resolve in a couple of days with resorption of lung fluid.
70
\_\_\_\_ micrograms of 1:1000 IM adrenaline is the correct dose for children under age 6.
\_\_\_\_ micrograms of 1:1000 IM adrenaline is the correct dose for children 6-12
\_\_\_\_ micrograms of 1:1000 IM adrenaline is the correct dose for children aged over 12 to adults.
150
300
500
71
Which finding from the echocardiogram is most important in determining the severity of cyanosis in a newborn with TOF?
The degree to which the outflow from the right ventricle is reduced.
72
Five stages of chronic kidney disease:
Stage 1 with normal or high GFR (GFR \> ___ mL/min) + evidence of renal damage
Stage 2 Mild CKD (GFR = ___ mL/min)
Stage 3A Moderate CKD (GFR = ___ mL/min)
Stage 3B Moderate CKD (GFR = ___ mL/min)
Stage 4 Severe CKD (GFR = ___ mL/min) - pre-dialysis
Stage 5 End Stage CKD (GFR
Five stages of chronic kidney disease
**Stage 1** with normal or high GFR (GFR **\> 90** mL/min) + evidence of renal damage
**Stage 2** Mild CKD (GFR = **60-89** mL/min)
**Stage 3A** Moderate CKD (GFR = **45-59** mL/min)
**Stage 3B** Moderate CKD (GFR = **30-44** mL/min)
**Stage 4** Severe CKD (GFR = **15-29** mL/min)
**Stage 5** End Stage CKD (GFR **\<15** mL/min)
73
The only drug of its class (SSRI) licensed for use in patients under 18 years of age is \_\_\_\_.
Fluoxetine
74
A baby with a _collapsing pulse_, _continuous machine-like murmur_ and _apnoeic episodes with bradycardia_ most likely has a \_\_\_\_\_.
If symptomatic, this can be managed medically with a prostaglandin synthesis inhibitor (NSAID) like \_\_\_\_\_, causing vasoconstriction to close the duct.
Persistent ductus arteriosus
Indomethacin
75
If coeliac disease is not properly managed with a gluten-free diet long-term, there is an increased risk of ____ and _____ cancers.
**Lymphomas** (such as EATL - enteropathy associated T-cell lymphoma)
**Small bowel** adenocarcinomas
76
A ________ is used to diagnose Meckels' diverticulum and will highlight ectopic gastric mucosa in a symptomatic patient. This is the **commonest cause of per rectal bleeding in a child.**
**Technetium scan (**radioactive metastable technetium-99)
77
ASD is also common in trisomy 21 and causes an ____ murmur at the _____ . The first heart sound is normal but there is wide fixed splitting of the second heart sound.
**ejection systolic**
**upper left sternal edge**
78
What are the characteristic skin changes seen in dermatomyositis?
* **Heliotrope rash**: a purple rash on the eyelids
* **Gottron's papules**: red papules on the dorsal aspect of the finger joints.
* **Shawl rash**: erythema across the upper back and shoulders
* **Nailfold erythema**
79
The diagnostic investigation for dermato myositis is \_\_\_\_. Which antibodies can help suspect a diagnosis?
**A muscle biopsy**
**Anti-Jo-1** antibodies: polymyositis (but often present in dermatomyositis)
**Anti-Mi-2** antibodies: dermatomyositis.
**Anti-nuclear** antibodies: dermatomyositis.
80
5-15% of cases of poly/dermatomyositis are secondary to ____ and should be looked for, especially in dermatomyositis as the association is much stronger than for polymyositis.
**An underlying malignancy** - This makes them **paraneoplastic syndromes**
The cancers that are most commonly associated with PM/DM include:
**Lung**
**Oesophagus**
**Breast**
**Colon**
**Ovary**
81
Elevated serum enzymes in DermatoMyositis and PolyMyositis can be remembered by the mnemonic
DM and PM turn your muscles into CLAAA (clay):
**C**reatine kinase
**L**actate dehydrogenase
**A**ldolase
**A**LT
**A**ST
\*Creatine kinase is always raised in inflammatory myopathic disorders like polymyositis and dermatomyositis. It is **not unusual for it to be up to 50 times the upper limit of normal** in active disease)
82
\_\_\_\_ is the 1st line treatment for both dermato and polymyositis.
Corticosteroids (ex. prednisolone)
83
The excessive production of a single type of WBC in the bone marrow in leukemia can lead to suppression of the other cell lines known as \_\_\_\_\_. This causes:
**Pancytopaenia**
1. Low RBCs (Anaemia)
2. Low WBCs (Leukopenia)
3. Low platelets (thrombocytopaenia)
84
\_\_\_\_\_\_ are giant B cells seen in patients with Hodgkin's lymphoma. They are typically multinucleated and contain inclusions.
Reed- Sternberg cells
85
Definitive diagnosis of Hirschsprung's disease is established histologically by taking a biopsy at least 1.5 cm above the pectinate line, to demonstrate acetylcholinesterase positive nerve excess and the absence of ganglion cells.
86
Which electrolyte abnormality is a complication of bronchiolitis?
**Hyponatraemia** is commonly seen as a complication in bronchiolitis caused by respiratory syncytial virus (RSV).
87
1st line treatment of impetgio is \_\_\_\_
Topical fusidic acid
88
The most common form of congenital heart defect in infants of diabetic mothers is \_\_\_\_\_.
transposition of the great vessels
89
Precipitants of transient proteinuria (benign) in children include \_\_\_\_, strong ____ , pregnancy and heavy exercise.
Seizures
Infections
90
Management of croup can be remembered with an acronym.
The management can be remembered with the acronym **ODA**:
**Oxygen** (humidified)
**Dexamethasone** PO 0.15g/kg or **budesonide neb** 2mg
**Adrenaline nebulised** (5ml 1:5000)
91
Potter's syndrome describes the typical physical appearance caused by pressure in utero due to ____ , classically due to \_\_\_\_\_
**oligohydramnios**
**bilateral renal agenesis**
92
As a neonate, cystic fibrosis may present acutely with \_\_\_\_\_.
**Meconium Ileus**
This is due to viscous meconium (from thick mucus) that causes a delay in passing meconium and even gastrointestinal obstruction. Meconium ileus is diagnosed and treated with a gastrograffin enema. May also require surgical intervention.
93
Wilm's tumour is the most common abdominal tumour in children. It is also known as nephroblastoma and is most common in children under ___ . It presents with a palpable abdominal mass, distension and \_\_\_
**5** (peak incidence 3-4) - remember bald patient screaming on ward and throwing ball.
**haematuria**
Wilm's tumours typically do not cross the midline but in up to 5% of cases they may be bilateral.
94
If a neonate has a ‘clunk’ on examination of the hips with the ____ test (dislocation on pushing perpendicular femur down into the bed) and ____ test (relocation on abduction of the hips) this is suggestive of ______ . This needs to be investigated further with a _____ .
Barlow
Ortolani
developmental dysphasia of the hip
hip ultrasound
95
Aspirin should not be given to children under ___ years old because of its association with \_\_\_\_.
12
Reye's syndrome
96
Reye's syndrome causes ___ and _____ which occurs in children under 12 who are given aspirin during the acute phase of a \_\_\_\_\_. Liver biopsies show microvesicular steatosis and venous collapse. Treatment is supportive, and often requires ITU admission. _____ can be used to lower ammonia levels.
**Acute liver failure**
**Non-inflammatory hepatic encephalopathy**
**Viral infection**
**Lactulose**
97
An obstructive picture on asthma gives a FEV1/FVC of \_\_\_\_\_. A bronchodiltor reversibilty (BDR) test should increase this by at least ___ for a diagnosis of asthma. If there is no reversibilty then you can perfrom a ____ test.
\< 70%
12%
FeNO
98
All children with Asthma should be offered the _____ vaccine in winter. This can be given via ___ or ____ routes.
Children with asthma should have a review at least every \_\_\_\_\_. At this review the most important thing they need to have is an \_\_\_\_.
**Influenza** (may be certain scenarios where patient also needs pneumococcal vaccine)
**IM**
**Nebulised** (note that this version should be *_avoided in immunocompromised patients_* as it is a live attenuated vaccine)
**12 months**
**asthma action plan**
99
Components of the APGAR score
There are 5 components to the APGAR score: \_\_\_\_\_, \_\_\_\_\_, \_\_\_\_\_, _____ and \_\_\_\_.
The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born.
**_Appearance_**
Appearance relates to the colour of the child. A score of 2 is for a pink baby, 1 if the baby is blue peripherally but pink centrally, and 0 if the baby is blue all over.
**_Pulse_**
Pulse: a heart rate of \>100 beats per minute scores 2, \<100 scores 1, and a non-detectable heart rate scores 0.
**_Grimace_**
Grimace relates to the response to stimulation: crying on stimulation scores 2, a grimace scores 1, and no response scores 0.
**_Activity_**
Activity: Flexed limbs that resists extension score 2, some flexion scores 1, and a floppy baby scores 0.
**_Respiration_**
Respiration: a strong cry scores 2, a weak cry scores 1, and no respiratory effort scores 0.
100
Scores for each component of the APGAR are added up to an overall score out of \_\_\_\_
A score of ____ is reassuring
A score of ____ requires stimulation
A score of ____ requires resuscitation
Newborns are assessed at \_\_\_,\_\_\_ and ___ minutes.
**10**
**\>7** - reassuring
**4-6** - requires stimulation
**\< 4** - resuscitation
**1, 5 and 10 minutes**
101
Patients are infectious up to ____ days before lesions appear and up until the last lesion dries (i.e crusts over) . The incubation period for chicken pox is up to \_\_\_\_
3 days
3 weeks
102
One of the physically demonstrable symptoms of meningitis is ______ sign. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.
**Brudzinski's**
103
Why is 5 rescue breaths administered before chest compressions in paediatrics?
Respiratory causes of arrest more likely (i.e hypoxia) than cardiac as in adults.
104
What is the metabolic abnormality associated with pyloric stenosis?
Hypocholoric metabolic alkalosis
105
\_\_\_\_\_ is a commonly seen metabolic complication in bronchiolitis caused by respiratory syncytial virus (RSV).
Hyponatraemia
106
Whilst bronchiolitis obliterans (aka \_\_\_\_) is a relatively rare complication of bronchiolitis it is most commonly associated with _____ infection.
popcorn lung
adenovirus
Bronchiolitis obliterans (BO), also known as obliterative bronchiolitis, constrictive bronchiolitis and popcorn lung, is a disease that results in obstruction of the smallest airways of the lungs (bronchioles) due to inflammation
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The MHRA advises that codeine should be contrainidcated in ____ and also children who have undergone adeno/tonsillectomy surgery who have Obstructive Sleep Apnoea.
This is because a % of the child population (6% of caucasians) are rapid metabolisers of codeine due to an increased activity of the ____ enzyme.
**Children under 12 years**
CYP2D6
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Pharmacokinetics in children (ADME)
**Absorption**
Most paediatric drugs are oral • Developmental changes in gut pH, gastric emptying, intestinal drug -metabolising enzymes, can all affect drug absorption.
• In general absorption is ____ in the very young. For example _higher gastric pH_ in children results in a slower absorption of phenytoin and thus requires a **IV loading dose** and higher **oral maintenance doses.**
Consider other routes – e.g. Topical or inhaled corticosteroids (this can be faster - i.e higher serum concentration reached)
**Distribution**
Children have ____ extracellular and total body water compartments.
The permeability of the BBB is also different and so is the level of ____ protein
**Metabolism**
_Phase I_ • Oxidation, reduction, hydrolysis or hydration •Predominantly catalysed by cytochrome P450 enzymes (e.g. CYP3A4, CYP1A2, CYP2D6)
_Phase II_ • Conjugation to form polar compounds (so that they can be excreted) • Usually **glucuronidation** (e.g. by **_UGT_**2B7) or **sulphation**
**Excretion**
Renal clearance different in children.
Aminoglycosides (i.e Gentamicin) eliminated primarily by glomerular filtration.
* Aminoglycosides are also _nephrotoxic_
* Dosing Adjustments may be needed _(i.e Longer dosing intervals_ and _lower initial dose_ in infants (especially preterm) to avoid accumulation)
Slower
Larger body water %
Circulating plasma proteins (albumin)
