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Paediatrics Flashcards

1
Q

By what age should a child be able to momentarily hold their head up?

A

6 weeks

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2
Q

By what age should a child be able to full-hand grasp?

A

3-6 months

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3
Q

When can a child support their head?

A

3 months

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4
Q

By what age should a child start to sit unsupported?

A

6 months

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5
Q

By what age should a child crawl/shuffle?

A

9 months

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6
Q

By which age should a child walk?

A

12-18 months, after 18 definite delay

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7
Q

By what age should a child start to pincer grip?

A

9-12 months

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8
Q

By what age should a child be able to draw a circle?

A

3 years

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9
Q

By what age should a child be able to draw a cross/square

A

4 years

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10
Q

What language skills would you expect a child to have at 12 months?

A

One to two words

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11
Q

What language skills would you expect a child to have at 2 years?

A

The ability to join 2-3 words

Vocabulary of 20-50 words

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12
Q

By what age would you expect a child to be able to make basic sentences?

A

3 years

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13
Q

By what age would you expect a child to drink from a cup?

A

1 year

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14
Q

By what age would you expect a child to eat with a spoon?

A

2 years

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15
Q

What social behaviour would you expect from a 3 year old?

A

Dress self with help and undress self
Mostly toilet trained in the day
Eat with a fork and spoon

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16
Q

What are the risk factors for Croup?

A

Age 6m-6 years

Autumn months

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17
Q

What virus is responsible for croup?

A

Parainfluenza virus

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18
Q

What are the symptoms of croup?

A

Dry, barking cough
Stridor, hoarse voice
Symptoms worse at night
Tachypnoea, fever, fatigue

Signs of hypoxia and exhaustion in severe disease

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19
Q

How is croup managed?

A

Oral dexamethasone= definitive treatment, can be given in GP

Admit to hospital if <12m, signs of exhaustion/respiratory compromise
Humidified oxygen
Nebulised adrenaline in severe cases

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20
Q

What are the risk factors for bronchiolitis?

A

Age <2
Winter months
Smoke exposure, asthma, other lung problems
Premature
Congenital heart disease, immunosuppression

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21
Q

What virus is responsible for bronchiolitis?

A

Respiratory Syncytial Virus

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22
Q

What are the symptoms of bronchiolitis?

A 
Cough- can be dry or wet
Wheeze and crackles OA
Tachypnoea, fever, fatigue
Respiratory effort: grunting, nostril flaring, retractions
Irritability and poor feeding
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23
Q

How is bronchiolitis managed?

A

Supportive treatment
If well enough to be at home: lots of fluids, calpol for fever
If admitted (need for respiratory support, poor feeding, poor urine output etc) then respiratory support is given- supplemental oxygen -> nasal high flow -> CPAP -> I&V + fluid support

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24
Q

What are symptoms of GORD in a baby?

A

Usually <18 months
Vomiting and distress after feeding, reluctance to feed
Respiratory difficulty/stridor after feeding
Irritability
Excessive burping, BACK ARCHING after feeds

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25
Q

How is GORD managed in children?

A

Sit up to feed and place in a head 30degree prone position for 30 mins after
Feed thickeners
Baby gaviscon - can cause constipation
Omeprazole

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26
Q

What are the differentials for stridor in a child?

A 
Croup
GORD
Epiglottitis
Bacterial tracheitis
Inhaled foreign object
Anaphylaxis
Acute asthma
Laryngomalacia
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27
Q

What is the causative organism of epiglottitis?

A

Haemophilus influenzae B (HiB)

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28
Q

What is given for prophylaxis in contacts of epiglottitis?

A

Rifampicin

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29
Q

What is the management of acute epiglottitis?

A

Airway management- urgent ICU admission
IV antibiotics: cefuroxime
IV steroids for inflammation
Supplementary oxygenation, fluid resuscitation

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30
Q

What organisms are usually causative of bacterial tracheitis?

A

Staphylococcus aureus

Group A B-haemolytic streptococci

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31
Q

How is bacterial tracheitis managed?

A

Airway management- ICU involvement
IV antibiotics: rifampicin and cefuroxime
Supplementary oxygenation and fluid resuscitation

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32
Q

What features would make you think epiglottitis over croup?

A

Rapid onset and progression
High fever
Drooling and unable to close mouth, inability to swallow
Muffled voice

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33
Q

What are the triad of symptoms associated with anaphylaxis?

A

Allergic symptoms- hives, urticaria, angioedema
Bronchoconstriction
Hypotension

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34
Q

How is anaphylaxis managed in a child?

A

Airway management + oxygenation

IM adrenaline 1:1000:
150micro-g <6
300micro-g 6-12
500micro-g >12

IV hydrocortisone
Antihistamines
IV fluids resuscitation

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35
Q

By what age would you expect laryngomalacia to resolve spontaneously?

A

2 years old

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36
Q

How would you manage a choking child?

A

If conscious and effective cough (loud and can take a breath before) then encourage to cough

If ineffective cough + conscious: 5 back blows -> 5 thrusts
If ineffective cough + unconscious: CPR: open airway, 5 breaths, 15:2

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37
Q

What are the symptoms of heart failure in a neonate?

A

Dyspnoea/cyanosis/grunting - especially on feeding, crying, exertion
Sweating on the above also
Reduced feeding and failure to thrive
Lethargic, recurrent chest infection

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38
Q

What are signs of neonatal heart failure?

A 
Tachypnoea and increased WOB, tachycardia
Cyanosis and hypoxia
Murmurs on auscultation
Cardiomegaly, hepatomegaly
Weak pulses and cold peripheries
Prolonged CRT
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39
Q

How would you investigate suspected HF in a neonate?

A 
Cardiovascular examination
SO2 + other obs
ECG
Echo
CXR
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40
Q

What are the managements for HF in neonates?

A 
Diuretics: furosemide, spironolactone
ACE-I: enalapril 
Oxygen unless oxygen-dependent lesion
Inotropes: dopamine, dobutamine
Surgery
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41
Q

What are the acyanotic congenital heart defects?

A

Atrial Septal defects
Ventricular Septal defects
Patent Ductus arteriosus
Coarctation of the aorta

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42
Q

What are the cyanotic congenital heart defects?

A

Tetralogy of fallot
Transposition of the great arteries
Truncus arteriosus
Tricuspid valve deformity

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43
Q

What is the most common congenital heart defect?

A

Ventricular septal defect

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44
Q

What murmur is associated with VSD?

A

Pansystolic murmur + may also have a thrill

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45
Q

What murmur is associated with ASD?

A

Ejection systolic murmur, split second heart sound

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46
Q

What murmur is associated with PDA?

A

Continuous machinery murmur heard under the L clavicle

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47
Q

How is PDA managed?

A

Preterm: ibuprofen/indomethacin to encourage closure
Term: surgical ligation

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48
Q

What are the signs of coarctation of the aorta in a neonate?

A 
Murmur between the scapulae
LVH/cardiomegaly
Cold extremities
Weak femoral pulses
High systolic BP
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49
Q

How is coarctation of the aorta managed?

A

IV prostaglandins to maintain patency of ductus arteriosus
dopamine/dobutamine to improve contractility
Surgical repair
Supportive rx

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50
Q

What four characteristics make up tetralogy of fallot?

A

PROV

Pulmonary stenosis
RVH
Overlying aorta
VSD

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51
Q

What is the definitive treatment for tetralogy of fallot?

A

Blalock-Taussig shunt

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52
Q

Which congenital heart problem is associated with Down’s syndrome?

A

VSD

ASD and AVSD also increased prevalence in this population

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53
Q

What congenital heart defects are associated with Turner’s syndrome?

A

Coarctation of the aorta

Aortic stenosis

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54
Q

What is the treatment algorithm for paediatric stable asthma?

A
  1. SABA
  2. SABA + ICS (initially BD, then OD once well controlled)
  3. SABA + ICS + trial of leukotriene receptor antagonist (montelukast)
  4. Stop montelukast and trial LABA + ICS + SABA breakthrough
  5. Consider trial of ipratropium
  6. Oral prednisolone in severe, refractory asthma
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55
Q

What advice should be given regarding managing an asthma attack?

A

Use salbutamol inhaler- one puff every 30-60 seconds with 5 tidal breaths in between
If no relief after 10 puffs, seek help

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56
Q

Following management of acute asthma, how should patients be stabilised?

A

PRN bronchodilator nebs- can be discharged once down to 4 hourly
Oral steroids 3-7 days
Review of medication and inhaler technique at discharge
Follow-up arranged at discharge

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57
Q

What is first-line management of suspected pneumonia in children?

A

Amoxicillin

Or if associated with flu- co-amoxiclav

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58
Q

How is bronchiectasis diagnosed?

A

CXR
Spirometry- obstructive picture
High-resolution chest CT
Culture of sputum to rule out exacerbating infection

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59
Q

What are the differentials for cough in a child?

A 
Asthma
Respiratory tract infection / pneumonia
Croup
Bronchiolitis
Bronchiectasis
Pertussis 
Cystic fibrosis
Congenital heart abnormality
Choking
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60
Q

What are the symptoms of pertussis?

A

Dry cough with inspiratory whoop
Vomiting after episodes of coughing
Fever, sneezing, runny nose

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61
Q

How is pertussis managed?

A

First line = macrolide antibiotics

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62
Q

What is the mutation associated with cystic fibrosis?

A

Autosomal recessive mutation in CFTR gene on chromosome 7 (delta F508)

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63
Q

How is CF diagnosed?

A

Newborn heel prick test
Chloride sweat test
Genetic counselling and DNA testing

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64
Q

What are the features of CF?

A 
Chronic cough and sputum production
Recurrent respiratory infection
Malabsorption and malnutrition
Meconium ileus in newborns
Bronchiectasis
Diabetes
Salty sweat
Infertility
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65
Q

What are the symptoms of coeliac disease?

A 
Failure to thrive- buttock wasting, faltering growth
Abdominal distension
Diarrhoea
Irritability
Anaemia
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66
Q

Which conditions are associated with coeliac disease?

A

Type 1 diabetes
Autoimmune thyroid disease
First degree family history
Down’s syndrome

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67
Q

How is coeliac disease diagnosed?

A

Anti-TTG antibody testing
IgA testing- to rule out false negatives of the above
Duodenal biopsy- must still be eating gluten

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68
Q

What are the symptoms of shaken baby syndrome?

A 
Inconsistent history
Altered mental state
Hypotonia
Areflexia
Vomiting
Papilloedema/retinal haemorrhages
Suspicious bruising and fractures
Bulging fontanelle
Seizures
Apnoea
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69
Q

What are the criteria for IBS diagnosis?

A

ROME criteria:

  1. Improves with defecation
  2. Onset associated with change in stool frequency
  3. Onset associated with change in stool consistency
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70
Q

What electrolyte disturbances are associated with refeeding syndrome?

A

Low: phosphate, potassium, magnesium, thiamine
High serum glucose
ECG abnormality

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71
Q

How is refeeding syndrome managed?

A

Supplementation of thiamine, fat soluble vitamins and electrolytes
Careful fluid resuscitation
Gradual nutrition replacement

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72
Q

What fluid resuscitation should be prescribed in children?

A

Rapid IV bolus 0.9% NaCl <15 mins
20ml/kg

Second bolus if shock persists

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73
Q

How are maintenance fluids prescribed for children?

A

First 10kg: 100ml/kg

10-20kg: 50ml/kg

20+: 20ml/kg

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74
Q

What antibiotic can be given in campylobacter infection?

A

Erythromycin

75
Q

What antibiotics can be given in c-difficile?

A

Metronidazole and vancomycin

76
Q

What are complications of rotavirus?

A

Dehydration

Post-infective lactose intolerance

77
Q

What are the complications of E-coli 0157?

A

Haemolytic Uraemic Syndrome

Bloody diarrhoea

78
Q

What are the classic symptoms of intussusception?

A

Vomiting- often bilious
Abdominal pain, distension and tenderness- draw legs up
Episodes of colic where baby may go very pale
Red-current jelly like stool
Palpable sausage-shaped mass in the abdomen

79
Q

Where is the most common site of intussusception

80
Q

Where is the most common site of intussusception?

A

Ileum -> caecum

81
Q

How is intussusception diagnosed?

A

Gold std- USS showing target sign
AXR may also show target sign or small bowel obstruction
Contrast enema= most sensitive but most invasive

82
Q

How is intussusception managed?

A

Make NBM- IV fluids, pain relief
Contrast enema or gas reduction (if stable)
Surgical fixation

83
Q

What is a Meckel’s Diverticulum?

A

Congenital defect causing outpouching of the small bowel- can cause obstruction, bleeding, inflammation or perforation

84
Q

What are the symptoms of Meckel’s diverticulum?

A

Haematochezia- PR passage of bright red blood
Abdominal pain, bloating and distension
Vomiting- may be bilious
Small bowel obstruction

May present with intussusception

85
Q

How is Meckel’s diverticulum diagnosed?

A

Meckel’s scan- technetium 99m- technetate scan
AXR
CT

86
Q

What are the symptoms of pyloric stenosis?

A

Vomiting after feeds- becoming increasingly frequent and forceful (projectile)
Refusing to feed
Failure to thrive/dehydration
Palpable mass- olive-like

87
Q

How is pyloric stenosis diagnosed?

A

Abdominal USS

88
Q

How is pyloric stenosis managed?

A

Pyloromyotomy

Feed within 6 hours of procedure

89
Q

What are the potential complications of intestinal malrotation?

A

Volvulus
Bowel ischaemia and necrosis
Bowel obstruction
Failure to thrive

90
Q

What are the symptoms of intestinal malrotation?

A

Vomiting- often bilious
Abdominal pain, distension and tenderness
Bloody stool
Tachycardia, tachypnoea -> SIRS, acidosis and hypotension if ischaemia occurs

91
Q

How is malrotation best diagnosed?

A

Upper GI contrast series- showing odd course of the right-sided duodenum
May also show volvulus

92
Q

What is Hirschprung’s disease?

A

A lack of ganglion cells in the myenteric and submucosal plexi, affecting the rectum and some of the large bowel proximally (extent varies)

93
Q

How does Hirschprung’s present?

A

Delayed/failure to pass meconium
Abdominal distension, pain, tenderness
Bilious vomiting

Digitation of the rectum causes gush of stool and flatus
May present with Hirschprung’s enterocolitis

94
Q

How is Hirschprung’s diagnosed?

A

Rectal biopsy showing absence of ganglion cells

95
Q

What rash is characteristic of meningococcal disease?

A

Non-blanching purpuric/petechial rash

Associated with fever, malaise, meningism, bulging fontanelle

96
Q

What rash is characteristic of SJS?

A

Extensive haemorrhagic rash -> blistering and peeling of skin
Mucous membrane involvement
Usually starts on face and spreads distally
Associated with medication, infection, inflammation

97
Q

What rash is characteristic of Kawasaki disease?

A

Erythematous maculopapular rash- may be erythema-multiform like
Associated with 5 day fever, conjunctivitis, lymphadenopathy, strawberry tongue, induration of palms and soles

98
Q

What rash is characteristic of staphylococcal scalded skin?

A

Blistering and desquamation of skin
Often starts from small graze/rash that gets infected
Group A strep
Managed with IV flucloxacillin

99
Q

What rash is characteristic of eczema herpeticum?

A

HSV 1 infection of eczema
Painful blistering on face and neck
Rapid spread-> can cause blindness
Req acyclovir ASAP

100
Q

What rash is characteristic of measles?

A

Widespread maculopapular rash which starts to coalesce
Rash beginning on the head and spreading to the trunk and extremities over a few days.
Resolution of fever soon after rash appearance.
Fever, coryza, cough, conjunctivitis
Mucosal involvement- oral koplik spots

101
Q

What rash is characteristic of chicken pox?

A

Varicella zoster virus
Macules -> papules -> pustules -> crusted blisters
Associated with headache, URTI, itch and fever
Affects face and trunk then spreads to limbs

102
Q

What rash is characteristic of Scarlet fever?

A

Sandpaper rash affecting face, chest and upper arms
Caused by group A strep
Associated with sore throat, strawberry tongue 12-48 hours BEFORE rash

103
Q

What rash is characteristic of Rubella?

A

Pale pink/red spots starting on the face and spreading distally
Can affect mucosa
Rash + swollen glands + fever

RF: not had MMR vaccine

104
Q

What rash is characteristic of shingles?

A

Prodromal itching and burning pain
Vesicular rash in dermatomal distribution: erythematous maculopapular rash, which is followed by the appearance of clear vesicles.
DOES NOT CROSS THE MIDLINE

Need acyclovir

105
Q

What rash characterises parvovirus B19?

A

Slapped-cheek rash

Lace-like rash on the trunk

106
Q

What are differentials for purpuric rash in a child?

A 
Meningococcal
HUS
HSP
ITP
Leukaemia
NAI
107
Q

What is HSP?

A

IgA-mediated vasculitis
Usually presents following streptococcal infection- URTI or gastroenteritis
Tetrad: rash, abdominal pain, arthralgia, glomerulonephritis
Usually self-resolving, supportive rx

108
Q

What is ITP?

A

Idiopathic thrombocytopenic purpura
purpuric rash + low platelets with no clear cause
Associated with epistaxis
Usually presents following viral infection
Usually supportive rx

109
Q

What is HUS?

A

Haemolytic Uraemia syndrome
Haemolytic anaemia + AKI + thrombocytopenia
Usually occurs post e-coli 0157 infection
Present with bloody diarrhoea, abdo pain, vomiting, rash
Supportive rx

110
Q

What are the most common causes of meningitis in neonates?

A

Group B strep
E-coli
Listeria

111
Q

What are the most common causes of meningitis in kids >3m?

A

Neisseria meningitides

Streptococcus pneumoniae

112
Q

How would you manage a child with suspected meningitis?

A

A-E assessment and observation
IV access + catheterise (measure urine output)
Give O2 (if indicated) and IV fluids
Bloods: FBC, CRP, U&E, LFT, cultures, blood gas
Urine culture
LP if stable enough
IV abx / acyclovir + steroids

113
Q

What antibiotics are usually indicated in meningitis?

A

IV ceftriaxone

Add amoxicillin in neonates to cover for listeria

114
Q

Why do you give steroids in meningitis?

A

Reduce meningeal inflammation

Reduces risk of deafness and neurological complications

115
Q

What LP results would you expect in BACTERIAL meningitis?

A

Raised opening pressure
Raised neutrophil count, low or normal lymphocytes
Elevated protein content
Low glucose

May have turbid appearance

116
Q

What LP results would you expect in VIRAL meningitis?

A

Raised opening pressure
High lymphocyte count, low neutrophils
Elevated protein
Normal glucose

Clear looking fluid

117
Q

What LP results would you expect in TB meningitis?

A 
Raised opening pressure
Straw-coloured fluid
Low neutrophils, raised lymphocytes
High protein
Very low glucose
118
Q

What are red flags for sepsis in kids?

A 
Low GCS
Parental concern
Weak/high-pitched/continuous cry
Grunting/apnoea
Low sats, severe tachypnoea, tachy/bradycardia
No wet nappy
Rash, mottled, cyanotic
hypo/hyperthermia
119
Q

What are the sepsis 6 steps in paeds?

A
  1. High-flow oxygen
  2. IV/IO access- blood cultures, gas, glucose, FBC, U&E
  3. IV antibiotics
  4. IV fluids
  5. Call in senior help
  6. Consider inotropes
120
Q

What is the most common type of leukaemia in children?

121
Q

Red flags for leukaemia in children:

A 
Unexplained bruising/petechiae 
Hepatosplenomegaly
Pallor/anaemia
Recurrent infection
Persistent fever and lymphadenopathy
Bone pain
Weight loss/failure to thrive
122
Q

How would you investigate suspected leukaemia?

A

FBC: high WBC or pancytopenia
Blood film: high proportion of blast cells
Clotting: deranged
LDH + uric acid elevated due to high cell turnover
Bone marrow aspirate = gold standard

123
Q

What is the most common type of brain tumour in children?

A

Medulloblastoma

124
Q

What is the characteristic sign of Ewing’s sarcoma?

A

Bone pain

Onion-like structure on imagine

125
Q

What is the most common type of bone cancer in children?

A

Osteosarcoma

126
Q

What is the characteristic sign of retinoblastoma?

A

Leukocoria - white instead of red reflex

May have family history

127
Q

What characterises an indirect hernia?

A

Emergence through the deep inguinal ring

Holding over deep ring and asking to cough with prevent emergence of the hernia

128
Q

How would you differentiate an inguinal hernia from a hydrocele?

A

Can’t get above a hernia on examination

Hernia will not transilluminate on examination, hydrocele will

129
Q

How are inguinal hernias managed?

A

Stable: taxis (compression with analgesia) and planned surgery
If incarcerated/irreducible: emergency surgery to avoid strangulation

130
Q

How are hydroceles managed?

A

Usually no management and resolve on their own

If not resolved by 2 years, surgery may be considered

131
Q

At what age should undescended testes be reassessed?

A

By 3 months - majority descend on their own by this stage

132
Q

What is the management for persistently undescended testes?

A

Orchidopexy performed by the age of 1 year

133
Q

Which congenital deformity increases the risk of testicular torsion?

A

Bell-Clapper deformity

134
Q

What is the management for testicular torsion?

A

Surgical fixation of BOTH testes

135
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change syndrome

Usually steroid-responsive

136
Q

What are the symptoms of nephrotic syndrome in children?

A

Peri-orbital oedema- esp on waking
Breathlessness
Ascites
Infections (due to loss of immunoglobulins in the urine)

137
Q

How do you manage nephrotic syndrome?

A

8 week tapering course of prednisolone + prophylactic antibiotics

138
Q

At what age are UTIs more common in boys?

139
Q

How should upper UTIs be managed?

A

Co-amoxiclav or cefalexin

140
Q

When should UTIs be investigated more thoroughly?

A

Recurrent infection
Atypical bacteria
<6m old

141
Q

What is the gold standard investigation for vesicoureteric reflux?

A

Micturating cystogram

142
Q

How should nocturnal enuresis be investigated?

A

Urine dip- to rule out infection
Urine osmolality: assessment of ability to concentrate urine
USS renal tract to rule out anatomical causes

143
Q

What is the management algorithm for nocturnal enuresis?

A
  1. Behavioural changes: no drinking before bed, avoid caffeinated drinks, ensure adequate fluid intake in the daytime, manage constipation, correct voiding posture
  2. Positive reinforcement of behaviour
  3. Enuresis alarms
  4. Desmopressin (increases water reabsorption)
  5. Psychological therapies
144
Q

How does ADPKD usually present in children?

A

Abdominal pain/mass

Incidental finding of hypertension

145
Q

What infection causes Lyme disease?

A

Borrelia Burgdorferi - from Tics

146
Q

What are the symptoms of Lyme disease?

A

Erythema migrans: target rash appearing at the site of the tic bite + non-specific flu symptoms

Several weeks later: aseptic meningitis, facial palsy, arthritis, carditis

Months-years later: neuropsychiatric manifestations

147
Q

What is the management of Lyme disease?

A 
Prophylactic doxycycline within 72 hours of the bite
Amoxicillin treatment (doxycycline if >12 due to tooth staining)
148
Q

What are the symptoms of Kawasaki disease?

A 
Fever > 5 days
Conjunctivitis
Strawberry tongue
Arthralgia 
Induration on hands and feet
Erythematous rash
Cervical lymphadenopathy
149
Q

How would you investigate Kawasaki disease?

A

Echo= gold standard to rule out aneurysms
ECG
Bloods: raised ESR and CRP, normocytic anaemia, high WBC and platelets

150
Q

What is the treatment for Kawasaki disease?

A

Aspirin
IVIG within 10 days
Echo at 6 weeks
May need long term anticoagulation

151
Q

What score is used to guide treatment for Kawasaki disease?

A

Z score

How much larger coronary artery diameter is compared to average

152
Q

What features suggest a simple febrile seizure?

A 
< 15min duration
Self-terminating
No recurrence in 24 hours
Occurring during a febrile episode
No acute neurological disease
153
Q

When is admission necessary for a febrile seizure?

A

Complex seizure
< 18m
Recurrence in 24 hours
Not during a febrile episode

154
Q

What features suggest a complex febrile seizure?

A

Lasting over 15 minutes / anticonvulsants used to terminate before this point
Recurring within 24 hours
Post-ictal neurological abnormalities (Todd’s palsy)

155
Q

What is the most important condition to rule out in a child presenting with febrile seizures?

A

Meningitis - should do LP

156
Q

What parental advice should be given re. febrile seizures?

A
  1. Clear mouth and loosen anything around neck
  2. Protect head but do not restrain
  3. Call ambulance if persisting >5min or if rescue meds ineffective >5min
  4. May receive buccal midazolam/rectal diazepam rescue packs for use at 5 mins
  5. Record seizure if possible
157
Q

What are differentials for seizures in a child?

A 
Febrile seizure
Inborn error of metabolism
Epilepsy
Meningitis
Head trauma
Ingestion of toxin
Iatrogenic- medication
158
Q

What is first line management for generalised tonic-clonic seizures in children?

A

Lamotrigine- esp for girls

Valproate can be considered in boys

159
Q

What is first line management for absence seizures in children?

A

Ethosuxamide in girls

Valproate appropriate for boys

160
Q

What is first line management for myoclonic seizures in children?

A

Leviteracetam- esp in girls

Valproate can be considered in boys

161
Q

What doses should be used in the management of paediatric status epilepticus?

A
  1. IV lorazepam 0.1mg/kg

2. buccal/rectal preparations 0.5mg/kg

162
Q

What are the risk factors for developing cerebral palsy?

A

Antenatal: prematurity, SGA, IU infection, multiple gestation, maternal smoking/drinking/drug usage, anything causing inflammation/ischaemia

Perinatal: complicated labour, asphyxia, cord around neck

Postnatal: NAI, head trauma, meningitis, encephalitis, cardiopulmonary arrest, hypoglycaemia, stroke, choking/drowning

163
Q

What are characteristic features of cerebral palsy?

A 
Developmental delay
Seizures
Altered tone and power in the limbs, head lag
Speech and language difficulty
Jerky/clumsy/uncontrolled movements
Seizures, scoliosis, hip dislocation
Muscle spasm and tiptoe walking
164
Q

What management is available for cerebral palsy?

A
  1. Physiotherapy to maintain and improve strength- splinting and stretching to prevent contractures
  2. SALT and OT
  3. School support
  4. Symptom control:
    Baclofen/botox for spasm
    Diazepam/botox for stiffness
    Anticonvulsants
    Laxatives
    Analgesia
165
Q

How would you treat group B strep infections of a newborn?

A

Benzylpenicillin or ampicillin + gentamycin

If over a month old: cefuroxime, cefotaxime or ceftriaxone

166
Q

What are characteristic features of autism spectrum disorders in children?

A
  1. Speech and language delay/difficulty
  2. Social impairment
  3. Rigid behaviours and interests
  4. Motor stereotypes: hand flapping, flicking, bouncing, rocking
  5. Inability to grasp social cues and difficulty making friends
  6. Difficulty and stress in new situations
167
Q

What are the three domains of ADHD?

A
  1. Impaired attention
  2. Hyperactivity
  3. Impulsivity
168
Q

How is ADHD diagnosed?

A

6+ features of impaired attention
6+ features of hyperactivity/impulsivity

  • > Present in more than 1 environment/situation
  • > Duration >6 months
169
Q

What is the first line medical management for ADHD?

A

Methylphenidate

170
Q

What should be monitored regularly in children taking pharmacological management for ADHD?

A

Height and weight

171
Q

What is the inheritance pattern for Duchenne muscular dystrophy?

A

X-linked recessive

172
Q

What are the key features of Duchenne’s?

A 
Waddling gait
Language delay
Gower's sign: pronating and using hands to walk back up body to stand
Calf hypertrophy as initial compensation
Scoliosis
Nocturnal hypoxia
Cardiomyopathy and respiratory failure
173
Q

What pH places DKA in the severe category?

174
Q

What complication of DKA treatment must be avoided?

A

Cerebral oedema

  • Do not routinely give fluid boluses
  • Lower limits for maintenance fluids
175
Q

What must be added to fluids in treating DKA?

A

Potassium - insulin causes shift into the cells

0.9% NaCl + 40mmol/L KCl should be used

176
Q

How is DKA managed in children?

A
  1. A-E assessment, full set of obs, blood gas
  2. IV fluids first
  3. Commence IV insulin 1-2 hours afterwards

Fluid: 0.9% NaCl + 40mmol KCl
Assume 5% deficit or 10% if severe
For each kg <10= 2ml/kg/hr then for each kg 10-40= 1ml/kg/hour
If >40kg= 40ml/hr max

Start insulin IV 0.05-0.1unit/kg/hr

Once glucose <14mmol/L, introduce NaCl with 5% glucose

IV fluids can be stopped once ketosis resolved

Patients should have continuous ECG monitoring due to the risk of potassium disturbance.

177
Q

How would you manage cerebral oedema?

A

IV mannitol

Hypertonic saline

178
Q

What is the diagnostic test for vesicoureteric reflux?

179
Q

At what ages do children have the DTPP vaccine?

A

8 weeks
12 weeks
16 weeks
3 years 4 months

180
Q

At what ages do children have the HiB vaccine?

A 
8 weeks
12 weeks
16 weeks
1 year
3 years 4 months
181
Q

At what ages do children have the hep B vaccine?

A

8 weeks
12 weeks
16 weeks
3 years 4 months

182
Q

At what ages do children have the men B vaccine?

A

8 weeks, 16 weeks, 1 year

183
Q

At what ages do children have the MMR vaccine?

A

1 year

3 years 4 months

184
Q

At what age is corrective surgery for hypospadias performed?

Finals Revision (23 decks)

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