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Phase 3a - SBA resit key points > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Boggy superficial scalp swelling that crosses the suture line

A

Caput Succedaneum

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2
Q

What is a cephalohematoma?

A

A subperiosteal haemorrhage - key = does NOT cross the suture lines

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3
Q

What % of term babies get jaundice

A

60%

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4
Q

What % of preterm babies get jaundice

A

80%

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5
Q

When are the age brackets for jaundice in babies and what do they mean

A

<24 hours = always abnormal

2-14 days = normal

> 2 weeks = can be normal or abnormal

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6
Q

Causes of jaundice in babies under 24 hours old

A

1) Rhesus haemolytic disease
2) ABO incompatibility
3) TORCH infections
4) Genetic conditions G6PD deficiency and hereditary spherocytosis)

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7
Q

Causes of jaundice in babies from 2 - 14 days old

A

1) Physiological
2) Breast milk
3) Bruising and polycythaemia
4) Infection

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8
Q

Causes of jaundice in babies over 2 weeks old

A

1) Breast milk
2) Congenital hypothyroidism
3) Biliary atresia
4) Cystic fibrosis

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9
Q

Symptoms of neonatal jaundice

A

Visible jaundice (discolouration)

Signs of kernicterus

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10
Q

What is kernicterus

A

Acute bilirubin encephalopathy

Deposition of unconjugated bilirubin in the basal ganglia and brainstem

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11
Q

Diagnosis and Ix. of jaundice

A

1) Transcutaneous bilirubin levels

2) Blood tests
- Direct coomb’s
- Kleihauer
- U&Es
- Conjugated and unconjugated bilirubin
- FBC + blood film
- Blood culture
- TFTs

3) USS if biliary atresia suspected

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12
Q

Tx of neonatal jaundice

A

1st line = UV phototherapy

2nd line = exchange transfusion

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13
Q

What is the most common GI malformation

A

Oesophageal atresia +/- tracheo-oesophageal fistula

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14
Q

Sx of Oesophageal atresia +/- tracheo-oesophageal fistula

A

Prenatal = polyhydramnios

Postnatal = blowing bubbles, salivation and drooling, cyanotic episodes on feeding, respiratory distress and aspiration.

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15
Q

Diagnosis and Ix for Oesophageal atresia +/- tracheo-oesophageal fistula

A

Pass an NG tube down and take x ray

= x ray should show NG tube coiled in the oesophagus.

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16
Q

What are the 3 main causes of paediatric small bowel obstruction

A

1) duodenal atresia
2) malrotation + volvulus
3) meconium ileus in CF

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17
Q

What is duodenal atresia and what are the key points to remember

A

Issue in the formation of the bile ducts

  • occurs in 1/3rd of patients with Down syndrome
  • Sx = small bowel obstruction symptoms +/- biliary vomiting
  • DOUBLE BUBLE SIGN on x ray
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18
Q

What is the most important cause of paediatric large bowel obstruction

A

Hirschsprung’s disease

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19
Q

Key features of Hirschsprung’s disease

A

Congenital absence of colonic ganglia

presentation =

  • failure to pass meconium within 48 hours
  • Abdo distention and late bilious vomiting

PR exam = contracted distal segment followed by rush of liquid stool

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20
Q

What is cryptorchidism more commonly known as

A

Undescended testes

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21
Q

Tx for undescended tests

A

Orchidopexy at 1 year if still undescended

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22
Q

What is the cause of neonatal inguinal hernias

A

Due to patent processus vaginalis

supposed to close and become tunica vaginalis

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23
Q

What is the Tx for neonatal inguinal hernias and what time frame should they be done on

A

ALL require surgery

if >6 weeks = 2 days
if <6 months = 2 weeks
if <6 years = 2 months

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24
Q

What is meant by hypospadias

A

The urethra opening is on the ventral (underneath) aspect of the penile shaft

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25
Q

What is the cause for hypospadias

A

Lack of testosterone

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26
Q

Clinical presentation of hypospadias

A

1) meatus on ventral surface
2) Hooded foreskin
3) Spraying on urination

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27
Q

Tx of hypospadias

A

Surgery not necessary BUT must not perform circumcision if want surgery.

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28
Q

What is testicular torsion

A

The twisting of the spermatic cord cutting off blood supply to the testicle

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29
Q

Aetiology of testicular torision

A

More common at times of high testosterone = neonates and pubertal teenagers.

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30
Q

Clinical presentation of testicular torsion

A
  • Acute swollen, tender testicle
  • Testicle displaced higher
  • Vomiting due to pain
  • Negative Prehn’s sign (pain not relieved on lifting)
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31
Q

Tx of testicular torision

A

Surgical emergency!

If done within 6 hours = 90% chance of testicular survival

After 24 hours = 10% chance of testicular survival

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32
Q

What is intussusception

A

When one section of bowel telescopes into the other - usually the ileum into the caecum

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33
Q

Aetiology of intussusception

A

Incidence = 3 months - 2 years

  • Classically preceded by viral infection
  • CF
  • Lymphoma
  • Meckel’s diverticulum
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34
Q

Sx of intussusception

A
  • Episodes of colicky abdo pain
  • Legs draw up to chest
  • Sausage shaped mass in abdo

Late sign = red current jelly stool

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35
Q

Diagnosis and Tx of intussusception

A

USS = target sign

abdo x ray = dilated proximal bower loops.

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36
Q

Tx of intussusception

A
  • Rectal air insufflation

- Surgical correction

37
Q

What is pyloric stenosis

A

Hypertrophy of the pylorus muscles leading to gastric outlet obstruction

38
Q

Clinical presentation of pyloric stenosis

A
  • Projectile vomiting shortly after feeds
  • non bilious vomit
  • hungry after vomit
    dehydration
  • Weight loss if left
39
Q

Diagnosis and Ix of pyloric stenosis

A

Test feed - feel for an olive sized mass in RUQ

USS - thickened pyloris

Blood gas = hypochloraemic hypokaelaemic metabolic alkalosis

40
Q

Tx for pyloric stenosis

A

Non urgent outpatient pyloromyotomy

41
Q

Common causes of necrotising enterocolitis (NEC)

A
  • Premature babies (RDS and hypoxia are RFs)

- Indomethacinn (given for PDA)

42
Q

Clinical features of necrotising enterocolitis (NEC)

A
  • Feed intolerance
  • Vomiting +/- bile staining
  • PR = fresh blood + mucus
  • Abdo distention
  • Taught shiny skin
43
Q

Diagnosis and Ix for necrotising enterocolitis (NEC)

A
  • FBC (platelets)
  • Blood cultures
  • Clotting screen
  • Abdo x ray (intramural air is pathognomonic) and dilated bowel loops)
44
Q

Tx of necrotising enterocolitis (NEC)

A

1) Stop oral feeds
2) Antibiotics - cefotaxime and vancomycin
3) Laparotomy if rapid distention and sign of perforation

45
Q

What is the most common cause of vomiting in infants

A

GORD

46
Q

Aetiology of GORD

A

Immaturity of LOS
Mostly liquid diet
Mostly horizontal position

47
Q

Clinical features of GORD

A

Persistent regurgitation and vomiting WITHOUT bile

48
Q

Diagnosis and Ix for GORD

A
  • Mostly clinical
  • ?red flags = refer to paeds
  • if severe Sx. do 24hr pH monitoring
49
Q

Tx of GORD if minor/mild

A

Reassurance - smaller more frequent feeds and sitting upright straight after feeds

Thickening agents in bottles - e.g. carobel

50
Q

Tx of GORD if severe

A

PPI like omeprazole

51
Q

Tx of GORD if very severe

A

If unresponsive to treatment and >1 year old = Nissen fundoplication.

52
Q

What do you do if you suspect IgE mediated cows milk protein allergy

A

Skin prick weal - 4mm is positive

53
Q

What do you do if you suspect non IgE mediated cows milk protein allergy

A

Temporary removal from diet then gradual re-introduction using milk ladder

54
Q

Tx of cows milk protein allergy

A

If breastfed = mum removes milk from her diet

If bottle-fed = extensively hydrolysed formula

55
Q

Tx of constipation

A
  • Reassurance
  • Ensure good hydration
  • Ensure good toilet habits
  • Osmotic laxative (Movicol)

Then add stimulant laxative (Senna)

56
Q

What is bronchiolitis and what is it caused by

A

A viral lower resp infection leading to inflammation of the bronchioles

80% is caused by respiratory syncytial virus

57
Q

Clinical features of bronchiolitis

A
  • Coryzal symptoms preceding a dry wheezy cough
  • Fever
  • Poor feeding
  • Tachypnoea
  • Signs of increased work of breathing (recessions, grunting, flaring)
58
Q

Diagnosis and Ix for bronchiolitis

A

Mainly clinical
Chest x ray to rule out pneumonia

Can do PCR to confirm RSV is cause (uncommon)

59
Q

What is the Tx for bronchiolitis

A

Supportive
Humidified O2

NO indication for Abx, steroids or bronchodilators

60
Q

Who are considered high risk in bronchiolitis and what is done to prevent them from catching it

A

High risk:

  • Congenital heart disease
  • CF
  • Prematurity

Prevention = IV palivizumab

61
Q

What is croup

A

A self-limiting upper respiratory tract infection

Caused by parainfluenza virus

62
Q

Clinical features of croup

A
  • Barking cough
  • Inspiratory stridor
  • Hoarse voice
  • Increased work of breathing.
63
Q

Treatment of croup

A

Reassurance
One dose of oral or nebulised steroids

If unresponsive to steroids =
hospital for nebulized adrenaline and monitoring

64
Q

Causes of epiglottitis

A

Haemophilus influenza most common cause (despite vaccine)

Others = S.pyogenes and S.pneumoniae

65
Q

Clinical features of epiglottitis

A
  • Drooling
  • Tripod position
  • Muffled “hot potato” voice
  • Inspiratory stridor
  • Fever
66
Q

Tx of epiglottitis

A

Immediate senior review

DO NOT ATTEMPT TO EXAMINE THE AIRWAYS

67
Q

What causes mumps

A

Paramyxovirus

68
Q

Clinical features of mumps

A

Coryzal symptoms followed by parotid swelling

Ear ache

69
Q

Name 3 common complications of mumps

A

1) Orchitis
2) Meningitis/encephalitis
3) Pancreatitis

70
Q

Tx of mumps

A
  • Rest
  • School exclusion for 7 days
  • Notify public health England
71
Q

What causes measles

A

Morbillivirus

72
Q

Clinical features of measles

A

2 stages:

Catarrhal stage - cough, cranky, coryza and conjunctivitis

Exanthematous stage - maculopapular rash with top to toe progression

73
Q

Name the most common complication of measles

A

Otitis media

74
Q

Diagnosis and Ix for measles

A
  • Clinical diagnosis

- Saliva swab for measles IgM

75
Q

Tx for measles

A
  • Rest
  • Isolation for 5 days post onset of rash
  • Notify public health England
76
Q

What causes rubella

A

Rubivirus

77
Q

What are the clinical features of rubella

A
  • Coryzal prodrome
  • Pink maculopapular rash
  • Lymphadenopathy (below eyes and behind ears particularly)
  • Arthralgia
78
Q

Diagnosis and Ix for rubella

A
  • Clinical

- Saliva swab for rubella IgM

79
Q

Tx for rubella

A
  • Rest
  • Isolation for 5 days post rash onset
  • Notify public health England
80
Q

Why is it important to consider rubella with pregnant women

A

At <13/40 transmission to foetus is 80% - defects likely

Once >16/40 this decreases to 25% but is unlikely to causes defects

81
Q

What makes up the rubella congenital defects

A
  • Sensorineural deafness
  • Cardiac abnormalities
  • Eye abnormalities including cataracts.
82
Q

What causes slapped cheek virus

A

Parvovirus B19

83
Q

Clinical features of parvovirus B19

A
  • Coryzal prodrome
  • Fever
  • Malar (butterfly) rash

Also common:

  • Glove and stocking erythema
  • Arthropathy in older kids
84
Q

What causes hand, foot and mouth disease

A

Coxsackie virus (A16)

85
Q

Tx of hand, foot and mouth disease

A

Supportive

No school exclusion needed

86
Q

What causes tonsilitis

A

Majority viral

Can be bacterial - S.pyogenes (group A beta haemolytic stre)

87
Q

What makes up the Fever PAIN score and what does this score mean in practise

A
  • Fever
  • Purulent tonsils
  • Attended rapidly (<3 days)
  • severely Inflamed tonsils
  • No cough or coryza

Scores:
2-3 = 40% chance of strep
5-6 = 60% chance of strep

88
Q

Tx for bacterial tonsilitis

A

1st line = phenoxymethylpenicillin for 7-10 days

clarithromycin if allergic

Phase 3a - SBA resit key points (1 decks)

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