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PAEDIATRICS Flashcards

1
Q

What is the treatment for whooping cough?

A

If admission is not needed, prescribe an antibiotic if the onset of cough is within the previous 21 days. A macrolide antibiotic is recommended first-line:

  • -> Prescribe clarithromycin for infants less than 1 month of age.
  • -> Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
  • -> Prescribe erythromycin for pregnant women.
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2
Q

What is the management of an inguinal hernia in infants?

A

Urgent surgery due to high incidence of strangulation

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3
Q

What is the difference between a caput succedaneum and cephalhaematoma?

A

Both cranial swellings that present after birth

Caput succedaneum = Crosses suture lines

Cephalhaematoma is bounded by cranial bones

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4
Q

Where should you check for a pulse in paediatric BLS?
Child < 1 years?
Child > 1 years?

A

Under 1: Femoral, Brachial

Over 1: Femoral, carotid

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5
Q

What are the green features of the traffic light system?

A
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6
Q

What are the amber features of the traffic light system?

A
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7
Q

What are the red features of the traffic light system?

A
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8
Q

How should you use the traffic light system?

A
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9
Q

What are the features of respiratory distress?

A

Tracheal tug
Intercostal recessions
Accessory muscle use

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10
Q

When to admit in bronchiolitis?

A 
Apnoea
O2 <92
Fluid <50%
Severe resp distress
Lower threshold in co-morbidities
Assess care giver
Clinical discretion - senior only
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11
Q

Management of bronchiolitis?

A

O2
NG feed

NOT nebs, steroids or abs

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12
Q

What is the cause of bronchiolitis?

A

RSV

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13
Q

What is the MAB given to high risk children in bronchiolitis?

A

Pavilizumab

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14
Q

Name 3 causes of stridor

A 
croup
foreign body
epiglottis 
anaphylaxis
laryngomalacia
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15
Q

What is the management of croup?

A

Dexamethasone

If can’t swallow - neb budesonide
If very unwell - neb adrenaline

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16
Q

Why should you ask about vaccination status in stridor?

A

H.influenza type B causes epiglottis

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17
Q

Why is it important to distinguish between viral induced wheeze and multiple trigger wheeze?

A

Multiple trigger wheeze benefits from preventer therapy

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18
Q

How should you diagnose asthma in children?

A

< 5 years = symptoms (worse at night, non viral triggers, eczema, atopic, positive response to asthma therapy)
> 5 years = symptoms + objective tests (FeNO)

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19
Q

How do you treat asthma in <5 years?

A
  1. SABA
  2. 8 week trial of paediatric moderate dose ICS, no response = alternative dx, if symptoms reoccur after 4 weeks continue at low dose
    3.
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20
Q

How do we categorise asthma attacks in children?

A

Mild/moderate
Severe
Life-threatening

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21
Q

If a child is shocked, what treatment is needed?

A
  1. 20ml/kg bolus of saline

2. Senior help

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22
Q

Which children need immediate abx?

A

Shocked
unrousable
signs of meningococcal disease

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23
Q

What age do we REALLY worry about high temperatures? When do we start Abx?

A

< 3 months

<1 months, <3 months and unwell

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24
Q

What is the septic screen for a <3 month child?

A

FBC, VBG, blood cultures
Urine dip
CXR
LP (< 1 month, or <3 months unwell)

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25
Q

What do you worry about in a child with fever > 5 days?

A

Kawasaki disease

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26
Q

What are the differentials for Kawasaki disease?

A

Scarlett fever

Multisystem inflammatory syndrome (post-covid)

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27
Q

What investigations should be done to look for congenital cardiac abnormalities?

A

ECG
CXR
ECHO

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28
Q

What are the features of ToF?

A

Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

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29
Q

What murmur is heard in ToF?

A

Loud harsh ejection systolic murmur at left sternal edge

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30
Q

What is the management of ToF?

A

Medical - captopril & diuretics

Surgery - Black-taussig shunt if cyanotic

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31
Q

How do you treat hypercyanotic

A
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32
Q

When does transposition of great arteries present?

A

2 days

Cyanosis

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33
Q

What does the CXR show in transposition of the great arteries?

A

Egg on side appearance

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34
Q

How is transposition of the great arteries managed?

A

Medical - Prostaglandin infusion

Surgery - Artery switch procedure in the first few days of life

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35
Q

How does AS present?

A

Murmur - ejection systolic upper right sternal edge
Angina
Syncope

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36
Q

How do you manage AS?

A

Balloon valvotomy –> aortic valve replacement

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37
Q

How does coarctation of the aorta present in children?

A

Severe cyanosis

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38
Q

What cardiac abnormalities do you find in Down’s syndrome?

A

AVSD

VSD

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39
Q

What are the cardiac features of Turner’s syndrome?

A

AS

Coarctation of the aorta

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40
Q

What is the genetic abnormality in Down’s syndrome?

A

Trisomy 21:

  • meiotic non disjunction
  • translocation
  • mosaicism
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41
Q

When is screening for Down’s syndrome?

A

Screen 11 weeks to 13 weeks
Nuchal translucency
PAPP-A
b-HCG - if elevated chorionic villous sampling

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42
Q

What are the features of Down’s syndrome?

A 
Short neck
Palmer crease
Wide sandal gap
Hypotonia
Duodenal atresia
Hirschprung's disease

Risks:

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43
Q

What are the features of Turner’s syndrome?

A

Neonates: lymphoedema in hands/feet, spoon shaped nails, neck webbing, widely spaced nipples

Congenital heart defects
Delayed puberty
Hypothyroidism
Renal abnormalities

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44
Q

When should you start insulin in a child with DKA?

A

After 1 hour of fluids

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45
Q

What are the complications of DKA?

A

Cerebral oedema
Hypokalaemia
Shock

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46
Q

What murmur is heard in an ASD?

A

Ejection systolic
Upper left sternal edge
Fixed and split second heart sound

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47
Q

What murmur is heard in VSD?

A

Pansystolic murmur

Lower left sternal edge

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48
Q

What murmur is heard in PDA?

A

Continuous murmur beneath the clavicle

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49
Q

What is the management of an ASD?

A

If causing right ventricular dilation, occlusive device or surgery between 3-5 years

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50
Q

What is the main measure of renal function in children?

A

Serum plasma creatinine

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51
Q

What organism causes acute pyelonephritis in children?

A

E.coli

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52
Q

What organism causes acute cystitis in children?

A

E.coli

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53
Q

How should you collect urine in children? (suspected UTI)

A

Clean catch sample = best option

MSU
Suprapubic aspiration
Catheter (esp if very unwell)

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54
Q

What imaging should be done in a child with a UTI?

A

US - looking for VUR

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55
Q

Which tests should be done in children with atypical (non-e.coli) UTI?

A

US
MCUG
DMSA (checks for renal scarring, 2 months after UTI)

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56
Q

What is vesicouretic reflux?

A

Backflow of urine from bladder into ureters

Common cause of UTI

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57
Q

How do you diagnosed VUR in children?

A

MCUG (Micturating cystourethrogram)

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58
Q

What might be seen on US in VUR?

A

Bilateral hydronephrosis

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59
Q

When should you admit children with a UTI?

A

< 3 months
Systemically unwell
Risk factors: kidney transplant

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60
Q

What is the management of UTI in children?

A

Antibiotics: 7-10 days

  • Stable = PO trimethoprim
  • Unstable/<6 weeks = IV co-amoxiclav

Fluids

Analgesia

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61
Q

Give 7 causes of oedema in children

A 
Lymphoedema
venous osbstruction
Malnutrition
Liver disease
Nephrotic syndrome
Kidney injury
heart failure
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62
Q

What are the 3 features of nephrotic syndrome in children?

A

Heavy proteinuria
Hypoalbuminaemia
oedema

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63
Q

What are the three types of nephrotic syndrome in children?

A

Congenital (< 1 year)

Non-steroid sensitive

Steroid sensitive (minimal change disease)

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64
Q

What is a cause of renal AKI in children post GI infection?

A

HUS (E.coli)

  • AKI
  • Anaemia
  • Thrombocytopenia
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65
Q

What is a cause of AKI in children post nasopharyngeal/skin infection?

A

Post-streptococcal glomerulonephritis

66
Q

What causes Post-streptococcal glomerulonephritis? What is the treatment?

A

Group A beta-haemolytic strep

Penicillin

67
Q

What is seen on urinalysis in Post-streptococcal glomerulonephritis?

68
Q

What causes an intra-renal AKI with rash in children?

A

Henoch Schonlein Purpura nephritis (IgA deposition)

69
Q

What are the causes of CKD in children?

A

Congenital

70
Q

What is Meckel’s diverticulum?

A

Outpouching from the ileum
Presents with painless bleed
Associated with intussesseption

71
Q

How do you diagnose colic in children?

A

Rule of 3:
>3 hours inconsolable crying
>3 days a week
>3 weeks

Diagnosis of exclusion

72
Q

How does colic in babies typically present?

A

Back arch, drawing up knees

73
Q

What is the management of colic in babies?

A

Reassurance

74
Q

What is the most common cause of constipation in children?

A

Idiopathic

75
Q

How is constipation in children classified?

A

<3 complete stools per week

Associated with straining, distress on passing stool, overflow soiling

76
Q

Name three signs of faecal impaction in children

A

Severe symptoms
Overflow soiling
Faecal mass palpable in the abdomen (DRE only done by specialist)

77
Q

Name some red flag signs of constipation

A

Reported from birth or first few weeks of life

> 48 hours (meconium ileus)

‘Ribbon’ stools (Hirschprung’s)

Previously unknown or undiagnosed weakness in legs, locomotor delay

Distension (obstruction)

Amberflags:

  • Disclosure or evidence that raises concerns over possibility of child maltreatment
  • Faltering growth
78
Q

What is the treatment for idiopathic constipation in children?

A

Movicol & encourage fluids

Consider investigations if not responsive to treatment

79
Q

What signs suggest a non-viral cause of gastroenteritis in children?

A

^^^fever

bloody diarrhoea

80
Q

What most commonly causes gastroenteritis in children?

81
Q

What symptoms suggest gastroenteritis in children?

A

in 24 hours:

> 5 episodes of diarrhoea
2 episodes of vomiting

82
Q

What is the management of gastroenteritis in children?

A

Give a 2mls/kg of oral rehydration fluid in syringe every 10mins.
Parents record how much is taken.
If they can take fluid for 4 hours, they can be discharged.

83
Q

When is meconium normally passed?

A

within 6 hours of birth

84
Q

What condition is associated with meconium ileum?

85
Q

What is the management of meconium ileus?

86
Q

What are the two types of cow’s milk protein allergy? Which is more severe?

A

IgE mediated

Non-IgE mediated

87
Q

What is the management of CMPA?

A

Hydrolysed formula

Change mothers diet

88
Q

How is CMPA diagnosed?

A

If symptoms resolve after avoiding cow’s milk

89
Q

What should you ask in a vomiting history in children?

A 
Colour of vomit? – is it bilious (dark green)
Projectile?
Feeding hx?
Hungry after?
Fontanelles
Hernial orifices
Patent anus
90
Q

Name 4 red flag causes of vomiting

A

Obstruction
Infection
Raised ICP
Bleeding

91
Q

Name some red flag symptoms of vomiting

A 
Bilious
Distension
Mass
Tenderness
Projectile vomiting
Fever
Irritiability
Bulging fontanelles
Blood vomit
92
Q

What can cause vomiting in children? (proximal –> distal)

A 
Overfeeding
GORD
Pyloric stenosis
Duodenal atresia
Malrotation with volvulus
Intussusception
Hirschprung's
NEC
93
Q

What is the average weight at birth?

94
Q

How much should babies be fed per day?

A

150ml/kg/day

95
Q

Name an important differential for overfeeding (vomiting) in babies

96
Q

What are the symptoms of GORD in children?

A

Vomiting & distress.
No red flags.
<1 year.

97
Q

What causes GORD in children?

A

Inappropriate relaxation of the LOS due to functional immaturity.
Spontaneously resolves by 12 months.

98
Q

What are the risk factors for GORD in babies?

A

cerebral palsy and other neurological conditions
Pre-term
Post surgical (atresia)

99
Q

What is the management of GORD in babies?

A
  1. Conservative: reassurance, advice, positioning and prone feeding
  2. Medical: H2 antagonist (reduces acid), PPI (4-week course)
  3. Surgical: Nissen’s fundoplication (if severe/causing apnoea)
100
Q

When should you refer in children with GORD?

A

Persists for longer than 6 months

> 1 year old

101
Q

How does pyloric stenosis present?

A

Projectile vomiting after feeds (<30 mins).

3-5 weeks.

102
Q

What might be seen on examination in pyloric stenosis?

A

Olive shaped mass.

Visible peristalsis.

103
Q

What is the management of pyloric stenosis?

A

AE and STABILISE

Blood capillary gas - metabolic acidosis:

  • Hypochloraemia
  • Hypokalaemia
  • Hyponatraemia

Test feed

USS: thickened pylorus “hamburger/cervical appearance”

Surgery

104
Q

What is the investigation of choice in pyloric stenosis?

A

USS: Hamburger sign

105
Q

When does duodenal atresia present?

A

Few hours old!

106
Q

How does duodenal atresia present?

A

Bilious (atresia is distal to ampulla of vater), BUT no distension (not THAT distal).

107
Q

What might be seen on prenatal scans if the foetus has duodenal atresia?

A

Associated with polyhydramnios = can’t swallow amniotic fluid in the womb during breathing practice.

108
Q

What is the investigation of choice for duodenal atresia? What is seen?

A

AXR - double bubble sign

109
Q

What is the management of duodenal atresia?

A

”drip and suck” – NG and IV fluids + surgery

110
Q

How does malrotation with volvulus present?

A 
Bilious vomiting.
Shock.
< 1 month.
No distension.
Surgical emergency
111
Q

What is seen on AXR in malrotation?

A

AXR = shows malrotation: ‘corkscrew jejunum’.

Also need a barium swallow = volvulus.

112
Q

What is the management of malrotation with volvulus?

A

Ladd’s procedure (Ladd’s bands are cut)

113
Q

How can you distinguish between malroation with volvulus and intusseception?

A

fever = intusseception

114
Q

How do babies present with intesussception?

A 
Biliary vomit.
3 months-2 years.
Shock AND fever.
Surgical emergency
RED CURRENT JELLY STOOLS
115
Q

What is found on examination in a baby with intesussception?

A

‘Sausage shaped mass’ in RUQ.

116
Q

What imaging should be done in suspected intesussuption?

A

USS - donut/target sign

117
Q

What is the management of intesusseption?

A

Air enema (x3)

–> surgery

118
Q

What is Hirschprung’s disease?

A

Distal section of the bowel cannot contract properly due to failed nerve cell migration.

119
Q

How does Hirschprung’s disease present?

A 
Bilious vomiting (25%).
Failure to pass meconium.
Abdominal distension (75%) - due to distal obstruction.
Ribbon stools
120
Q

When should you definitely do a PR exam in paediatrics?

A

Suspected Hirschprung’s - gold standard

121
Q

How is Hirschprung’s investigated?

A

DRE = GOLD STANDARD

Confirmed by rectal biopsy = aganglionic portion.

122
Q

What is the management of Hirshprung’s?

A

Laxatives

Surgical resection

123
Q

How does NEC present?

A

< 2 weeks.
Abdominal distension.
Blood stools.

124
Q

What are the risk factors for NEC?

A

Premature babies!!! And feeding too much too quickly.

125
Q

What is the imaging of choice for NEC? What is seen?

A

AXR: intramural gas and “thumb printing” = oedema

126
Q

What is the management of NEC?

A

GUT REST: NBM and consider TPN

Perforation = laparotomy

127
Q

What can cause neonatal hypotonia?

A

neonatal sepsis
Werdnig-Hoffman disease (spinal muscular atrophy type 1)
hypothyroidism
Prader-Willi

128
Q

What are the four fields of development in children?

A

Gross motor
Fine motor and vision
Hearing, speech and language
Social, emotional and behavioural

129
Q

What are the developmental milestones at 6 months?

A

Sits without support (with round back), head control

Palmar grasp, reaches for objects, transfer from hand to hand

Vocalises alone or when spoken to, monosyllabic

Puts food in mouth

130
Q

What are the developmental milestones at 12 months?

A

Stands independently

Draws, pincer grip
3-4 word sentences, understands two joined commands

Drinks from cup, waves, fear of strangers

131
Q

Give three causes of delayed puberty with short stature

A

Turner’s syndrome
Prader-Willi syndrome
Noonan’s syndrome

132
Q

Give four causes of delayed puberty with normal stature

A

Polycystic ovarian syndrome
Androgen insensitivity
Kallman’s syndrome
Klinefelter’s syndrome

133
Q

When should you review an undescended testicle?

134
Q

When should you refer for an undescended testicle?

A

> 3 months (routine referral)

135
Q

What is the most common cause of respiratory distress in newborns?

A

Transient tachypnoea of the newborn

Associated with c-sections
Fluid in horizontal fissure (CXR)
Settles within 1-2 days

136
Q

Why is aspirin normally contraindicated in children?

A

Reye’s syndrome

137
Q

What is the management of Kawasaki disease?

A

High dose aspirin
IVIg

+ECHO (coronary artery aneurysms)

138
Q

What is the management of nocturnal enuresis?

A

<5 years = reassurance/safety-netting

> 5 years = desmopressin

139
Q

Which rash is seen in scarlet fever?

A

Sand paper rash

140
Q

What is the management of neonatal hypoglycaemia?

A

asymptomatic =
encourage normal feeding (breast or bottle)
monitor blood glucose

symptomatic or very low blood glucose =
admit to the neonatal unit
intravenous infusion of 10% dextrose

141
Q

What factors indicate poor prognosis in ALL?

A

Male sex
presenting <2 years or >10 years
B or T cell surface markers
WCC > 20 * 10^9/l at diagnosis

142
Q

How does HSP present?

A

Painful non-blanching rash.
Abdominal pain.
N&V.

143
Q

When does HSP present?

A

10 days post URTI

144
Q

What is the management of HSP? When should you admit?

A

Prednisolone & paracetamol

Admit: bleed, ileum, renal failure

145
Q

How does meningococcal septicaemia present?

A

Non-blanching petichiae.

Meningism: headache, nuchal rigidity, photophobia.

146
Q

What is the most common cause of meningococcal septicaemia in <3 months and >3 months?

A

<3 months = Group B strep

>3 months = N.meningitides

147
Q

What is the treatment for meningococcal septicaemia?

A

GP: IM Benzylpenicillin

IV Cefotaxime & amoxicillin < 3 months

IV Ceftriaxone > 3 months

Penicillin allergy: chloramphenicol

148
Q

What can be given in meningococcal septicaemia to prevent damage to leptomeninges?

A

+ IV dexamethasone (> 3 months) to prevent damage to the leptomeninges

149
Q

Which two signs are seen on examination in meningococcal septicaemia?

A

Kernig’s sign (back pain on leg flexion)

Brudzinski’s sign (neck raised in hip flexion)

150
Q

What is the management of Steve Johnson syndrome?

A 
Stop causative agent.
\+ prophylactic AC
\+ PPI
\+ analgesia
\+ Ciclasporin
151
Q

Which investigation is contraindicated in meningococcal septicaemia?

152
Q

What are the three main types of cerebral palsy?

A

Spastic cerebral palsy (10%) - upper motor neurone corticospinal pathway
Ataxic hypotonic (10%) - cerebellar dysfunction
Dyskinetic (10%) - basal ganglia

153
Q

What are the three types of spastic cerebral palsy?

A

Hemiplegia
Quadriplegia
Diplegia (legs>arms)

154
Q

What is the most common cause of cerebral palsy?

A

Antenatal causes:

  • Cortical migration (genesis of corpus callosum)
  • Vascular occlusion
  • Structural maldevelopment
  • Congenital infection
155
Q

Give some post-natal causes of cerebral palsy

A 
Meningitis
Encephalitis
Head trauma
Hypoglycaemia
Hydrocephalus
Hyperbilirubinaemia
156
Q

Give 3 causes of delayed puberty with short stature

A

Turner’s syndrome
Prader-Willi syndrome
Noonan’s syndrome

157
Q

Give four causes of delayed puberty with normal stature

A

polycystic ovarian syndrome
androgen insensitivity
Kallman’s syndrome
Klinefelter’s syndrome

158
Q

What is the definition of precocious puberty?

A

‘development of secondary sexual characteristics before 8 years in females and 9 years in males’
more common in females

159
Q

How can precocious puberty be classified?

A
  1. Gonadotrophin dependent (‘central’, ‘true’)
    due to premature activation of the hypothalamic-pituitary-gonadal axis
    FSH & LH raised
  2. Gonadotrophin independent (‘pseudo’, ‘false’)
    due to excess sex hormones
    FSH & LH low
160
Q

What will be seen on blood results in disorders of sex hormones?

A

Primary hypogonadism (Kleinfelter’s) - LH high, testosterone low

Hypogonadotrophic hypogonadism (Kallman’s) - LH low, testosterone low

Androgen insensitivity syndrome - LH high, testosterone normal

Testosterone secreting tumour - LH low, testosterone high

FINALS (26 decks)

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