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Things I don't know, but need to know, for fourth year > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Transient Synovitis Management

A

Afebrile and symptoms for less than 72 hours = Analgesia and rest
Febrile = urgent assessment

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2
Q

What are salmon patches?

A

Vascular flat patches on the eyelids and neck that usually fade

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3
Q

At 3 months what would you expect of a child in terms of speech and development?

A

Turns to sounds and quietens to their name.

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4
Q

At 6 months what would you expect of a child in terms of speech and development?

A

Double syllable sounds

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5
Q

At 9 months what would you expect of a child in terms of speech and development?

A

Mamma Dadda

Understands No

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6
Q

At 12 months what would you expect of a child in terms of speech and development?

A

Responds to their name

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7
Q

At 12-15 months what would you expect of a child in terms of speech and development?

A

2-6 words

simple commands

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8
Q

At 2 years what would you expect of a child in terms of speech and development?

A

Combine two words

Points to body parts

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9
Q

At 2.5 years what would you expect of a child in terms of speech and development?

A

200 word vocabulary

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10
Q

At 3 years what would you expect of a child in terms of speech and development?

A

Short Sentences
Colours
Counts to ten

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11
Q

At 4 years what would you expect of a child in terms of speech and development?

A

Asks Why Who When

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12
Q

What is the Antibiotic of choice in Whooping cough

A

Azithromycin or Clarithromycin

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13
Q

Signs of Whooping cough

A

Inspiratory Whoop
Vomiting or Cyanotic spells after coughing
Coughing worse after eating
Subconjuctival Haemorrhage

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14
Q

Who is the Whooping cough vaccine offered to?

A

Pregnant women from 16 weeks

Young children

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15
Q

Gross Motor Milestones - At 3 months what would be expected?

A

No or little headlag

If held sitting lumbar lordosis

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16
Q

Gross Motor Milestones - At 6 months what would be expected?

A

Pulls to sitting
Rolls from front to back
Held sitting back is straight

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17
Q

Gross Motor Milestones - At 7-8 months what would be expected?

A

Sits without support

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18
Q

At what age would you refer a child who cant sit without support?

A

12 months

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19
Q

Gross Motor Milestones - At 9 months what would be expected?

A

Pulls to standing

Crawls

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20
Q

Gross Motor Milestones - At 12 months what would be expected?

A

Cruises

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21
Q

Gross Motor Milestones - At 13-15 months what would be expected?

A

Walks unsupported

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22
Q

At what age would you refer a child who cant walk unaided?

A

18 months

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23
Q

Gross Motor Milestones - At 18 months what would be expected?

A

Squats to pick things up

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24
Q

Gross Motor Milestones - At 2 years what would be expected?

A

Runs

Uses stair railing on stairs

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25
Q

Gross Motor Milestones - At 3 years what would be expected?

A

Using tricycle with pedals

Uses stairs unaided

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26
Q

Gross Motor Milestones - At 4 years what would be expected?

A

Hops on one leg

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27
Q

Is bottom shuffling a normal variant?

A

Yes

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28
Q

How is Necrotising Enterocolitis managed?

A

IV antibiotics + fluids
Bowel Rest and TPN
If rupture - Laparotomy

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29
Q

When is a six week USS of the hips required?

developmental dysplasia

A

Breach Presentation at 36 weeks
Breach Presentation at delivery
Twins
First degree relative with developmental dysplasia

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30
Q

What are the investigations in Hirschprungs Disease?

A

Abdominal Xray

Rectal Biopsy - Gold Standard

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31
Q

What is the management of Hirschprungs Disease?

A

Bowel Irrigation -> Surgical Anorectal Pull through is curative

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32
Q

Causes of Neonatal Hypotonia

A

Sepsis
Hypothyroidism
Prader Willi
Spinal Muscle Atrophy Type 1

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33
Q

What are some causes of Neonatal Hypotonia?

A

Sepsis
Hypothyroidism
Prader-Willi
Spinal Muscular Atrophy Type 1

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34
Q

High Fever followed by a maculopapular rash between 6 months and two years old?

A

Roseola Infantum - Herpes Virus 6

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35
Q

What is screened for in the heel prick test ?

A 
Cystic fibrosis (CF)
Congenital hypothyroidism (CHT)
Phenylketonuria (PKU)
Classical galactosaemia (C Gal)
Glutaric aciduria type 1 (GA1)
MCADD (medium-chain acyl-CoA dehydrogenase deficiency)
Homocystinuria (HCU)
Maple syrup urine disease (MSUD)
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36
Q

If a heel prick comes back positive for elevated immunoreactive trypsinogen what should be undertaken next?

A

Sweat Test for CF

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37
Q

When is the heel prick test done?

A

Day 5

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38
Q

Hand Foot and Mouth - Causative organism

A

Coxsackie or less likely Enterovirus

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39
Q

Hand Foot and Mouth - Symptoms

A

Mild systemic upset
Oral Ulcers
Vesicles on palms or soles

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40
Q

Hand Foot and Mouth - Management

A

Symptomatic only

No school exclusion

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41
Q

Williams Syndrome

A 
Chromosome 7
Elfish Features
Happy Disposition
Short Stature
Aortic Stenosis
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42
Q

Williams Syndrome Diagnosis

A

FISH Studies

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43
Q

Criteria for admitting a child with Bronchiolitis.

A 
Apnoea
Respiratory Distress
RR >70
Central Cyanosis
<92% oxgen
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44
Q

What is the first line management of neonatal hypoxic ischaemic brain injury?

A

Therapeutic cooling

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45
Q

Presentation of Measles

A

High fever >40 degrees
Kopliks spots - grey spots on the mucosa of the mouth
Conjunctivitis then later a rash - usually 2-5 days after

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46
Q

Management of measles

A

Supportive
Vitamin A in all children below 2 years old
exclude 4 days from onset of rash

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47
Q

What are common complications of Measles?

A

Acute otitis media
Bronchopneumonia
Encephalitis

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48
Q

A neonate has rapidly deteriorated after delivery. It is noted that the amniotic fluid was brown stained. What is the likely culprit?

A

Meconium aspiration is likely to cause a Pneumothorax.

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49
Q

What is the first line management of neonatal sepsis?

A

IV Benzylpenicillin

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50
Q

Commonest organisms in Neonatal Sepsis

A

Group B Streptococci

E.Coli

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51
Q

Maintenance Fluids in paediatrics.

A

100ml/kg/day for first 10kg
50ml/kg/day for second 10kg
20ml/kg/day for every kg over 20.

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52
Q

Scarlet Fever - presentation

A 
fever
myalgia
strawberry tongue
sand paper rash
tonsilitis
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53
Q

Scarlet Fever - cause

A

Group A strep

Strep. Pyogenes

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54
Q

Scarlet Fever - complications

A

Otitis Media
Rheumatic Fever
Glomerulonephritis

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55
Q

Scarlet Fever management

A

Oral Penicillin or azithromycin if pen allergic - 10 days

Return to school for 24 hours of Antibiotics

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56
Q

Describe a ceaphalohaematoma

A

Bruising

Doesn’t cross suture lines

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57
Q

Describe a Caput Succedaneum

A

Localised oedema due to vents cup use
Crosses suture lines
resolves in 3-6 weeks

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58
Q

Kawasaki Presentation

A 
High fever resistant to antipyrexics
Conjunctival Injection
Bright red cracked lips
Cervical Lymphadenopathy
Strawberry tongue
Desquamation of palms and soles
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59
Q

Kawasaki - Management

A

Clinical diagnosis requiring 4 symptoms
High dose aspirin
IV immunoglobulin in severe cases
Echocardiogram of coronary arteries

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60
Q

What is a major complication associated with Kawasaki disease?

A

Coronary Artery Aneurysm

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61
Q 
Microcephally 
Small eyes
Cleft lip
Polydactyly
Scalp Lesions 
Dead within months
A

Pataus

Trisomy 13

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62
Q

Micrognathia - small jaw
Low set ears
Rocker bottom feet
Overlapping fingers

A

Edwards

Trisomy 18

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63
Q 
Learning difficulties
Macrocephaly
Long face
Large ears
Macro orchidism
A

Fragile X syndrome

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64
Q

Webbed neck
Pectus excavatum
Short
Pulmonary Stenosis

A

Noonan syndrome

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65
Q

Webbed neck is usually what?

A

Turners - females

Noonan syndrome - both genders

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66
Q

Micrognathia - small jaw
Posterior displaced tongue
Cleft palate

A

Pierre - Robin

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67
Q

Hypotonia
Hypogonadism
Obesity

A

Prader Willi syndrome

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68
Q 
Hypertelorism - increased distance between eyes
Microcephaly
Small jaw
Learning difficulties
Larynx issues
abnormal crying
A

Cri Du Chat

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69
Q

present from birth

Dark red

A

Port wine stain

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70
Q

Asthmatic guideline under 5 years old

A

SABA
SABA + Moderate Dose ICS for 8 weeks - reassess if helped good if not rethink
SABA + Low dose ICS
SABA + ICS + Leukotriene Receptor Antagonist
Refer

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71
Q

Asthmatic guidelines over 5 years old

A 
SABA
ICS + SABA
ICS + Leukotriene Receptor Antagonist + SABA 
ICS + LABA + SABA
ICS/LABA combined + SABA
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72
Q

Short, friendly disposition, aortic stenosis

A

William syndrome

73
Q

What are the five causes of rashes in children?

A 
Roseola Infantum
Measles 
Parvovirus
Scarlet fever 
Rubella
74
Q

Mild fever with a sore throat and lymphadenopathy

Rash starts on the face but spreads to the rest of the body

A

Rubella

75
Q

Erythematous rash starts behind the ear and spreads.

A

Measles

76
Q

Precocious Puberty

A

<8 in girls

<9 in boys

77
Q

Neonatal Resus

A 
Dry and warm
Assess APGAR
Poor resperitory effort or none at all -> 5 ventilation breath 
Reassess
HR <60 -> 5:1 compression to inspiration
78
Q

When would you admit a child for bronchiolitis ?

A

Apnoea
Persistent O2 sats <92
<50% oral intake
Persistent severe reparatory distress

79
Q

When would you refer a newborn to the neonatal ward?

A 
RR >60
Respiratory Distress
bpm -<100 or >160
Capillary refill >3 seconds
>38 degress or 37.5 on two separate occasions
O2 sats <95
Central cyanosis
80
Q

Stridor
Barking cough
Fever

A

Croup

81
Q

Croup causative organism and management

A

Parainfluenza
Oral Steroids
Nebulised Adrenaline and O2 if acutely unwell

82
Q

In a child with difficult to control epilepsy. What diet can be trialled?

A

Ketogenic

83
Q

Neonate born via C section present with respiratory distress.
Chest Xray shows fluid in horizontal fissure and hyper expanded lungs

A

Transient Tachyopnoea of the New born
Supportive treatment only
Oxygen may be required in poor saturations (humidified)

84
Q

A child presents with a new onset purpuric rash. What is your management?

A

regardless of symptoms they should be immediately referred (same day) to rule out Menigococcal infection or ALL.

85
Q

Inverted and plantar flexed foot that cant be passively corrected.

A

Club foot - manage with serial casting - ponseti method

86
Q

Sudden onset bilious vomiting abdominal pain tachyopnoae and tachycardia in previously well child. Normal abdominal exam except tenderness

A

Intestinal malrotation - usually duodenum is obstructed
Upper GI contrast study and USS used
Ladds procedure is management

87
Q

Signs of a shaken baby

A

Retinal haemorrhage, encephalopathy, subdural haematoma

88
Q

Describe the management of a unilateral undescended testicle.

A

Should have descended by 3 months ->referral to be seen by surgeon by 6 months -> surgery by 6-18 months

89
Q

Describe the management of bilateral undescended testicles.

A

Immediate 24hr referral to paediatrics for endocrine and genetic studies.

90
Q

Jaundice developing after 2 weeks alongside a history of reduced appetite pale stools dark urine and growth disturbance.

A

Biliary atresia - Increased conjugated bilirubin
Surgery is curative
Antibiotics and bile acid enhancers may be beneficial post op

91
Q

Children below 0.4 decile for height

A

Refer to paediatrics

92
Q

Children below 2 decile of height

A

Seen by GP

93
Q

When is bed wetting normal up to?

A

5 years is the cut off point prior to this you simply offer advice on diet and lifestyle factors.

94
Q

What is the management of enuresis?

A

Look for a cause - UTI constipation Diabetes Mellitus
Rewards system - star chart etc
Enuresis alarms
Desmopressin - good for short term control i.e going for a sleep over

95
Q

Inguinal hernia repair

A

<1 year - urgent surgical referral

>1 year - routine surgical referral

96
Q

School exclusion in roseola infantum

A

non required

97
Q

What is the cut of for weight lost in the first week of life?

A

10% weight loss

Any more and a midwife review of feeding is required

98
Q

At what age are Varus knees normal up until?

A

Should resolve by 4 years

99
Q

Neonatal Hypoglycaemia

A

Asymptomatic - Encourage good breast feeding and reassess

Symptomatic or very low - transfer to neonate ward + IV 10% dextrose

100
Q

What is the investigation of choice is suspected developmental dysplasia affecting a child over 4.5 months?

A

X ray

101
Q

Erythematous rash with yellow scale affecting scalp, face, nappy area and or limb flexural lines.

A

Seborrhoic Dermatitis
Mild - Moderate - baby shampoo and oil
Severe - Mild topical steroid
Resolves by 8 months

102
Q

Signs of Down syndrome

A 
Brushfeild spots in iris
Upslanting palpebral fissures
Epicathic folds
Flat occiput
Singla palmar crease
Sandle gap
Hypotonic
Duodenal atresia
Hirschprungs 
Cardiac defects
103
Q

List some cardiac anomalies related to Down syndrome.

A 
Commonest is endocardial cushioning defect
VSD
ASD
Tetralogy of fallot
Isolated PDA
104
Q

Long term effects of Down syndrome

A 
Sub fertility
Short  stature
Recurrent respiratory tract infections + glue ear
Acute lymphoblastic leukaemia 
Hypothyroid
Alzhiemers
Atlantoaxial instability
105
Q

Commonest cause of ambiguous genitalia in newborn

A

Congenital adrenal hyperplasia

106
Q

Inverted and Plantar flexed foot

A

Club foot
Ponseti method - serial casting from soon after birth
Linked to Cerebral Palsy, spina bifida, trisomy 18

107
Q

Billous vomiting on the first day is likely to be?

A

Intestial Atresia - look for double bubble sign on x ray
Surgery is required

Double Bubble = Duodenal
Tripple bubble = jejunal

108
Q

Causes of a cleft lip

A

Inherited

Maternal anti-epileptics

109
Q

Management of a cleft lip

A

Orthodontic devices - help feeding
Speech therapy
Surgery - lip is repaired before the palate

110
Q

Neonatal sepsis develops within 48 hrs of delivery

A

Strep B

Vaginal canal commensals

111
Q

Neonatal sepsis develops after 48 hours of delivery

A

Hospital acquired
Staph Epidermidis
Staph aureus

112
Q

Normal development and no other symptoms
Flat occiput + protruding forehead on opposite site
< 3 years

A

Plagiocephally
Due to sleeping on back
Resolves by 3-5 years - Reassure until then

113
Q

Strawberry Naevi

A

Only treat if obstructing field of view, ulcerated, bleeding
Topical propanolol is now first line

114
Q

Management in a diaphragmatic hernia

A

Immediate intubation

gentle inotropes and fluids

115
Q

Age child smiles

A

6 weeks

116
Q

Age a child who doesn’t smile should be referred by?

A

10 weeks

117
Q

Age a child should laugh by

A

3 months

118
Q

Age child is not shy at

A

6 months

119
Q

Age child becomes shy

A

9 months

120
Q

At what age is the child competent with a spoon and doesn’t spill their cup.

A

2 yers

121
Q

Age child plays peekaboo

A

9 months

122
Q

Age child waves bye bye

A

12 months

123
Q

Age child plays alone

A

18 months

124
Q

Age child plays alongside but not with other children

A

2 years

125
Q

Age child plays with other children

A

4 years

126
Q

Management of a child <3 with an acute limp

A

Urgent assessment as septic arthritis is more common in this age group

127
Q

Hearing tests in children

A

Newborn = Otoacoustic emissions test
Infant or abnormal Otoacoustic emission test = Auditory Brainstem Test
6-9 months = distraction test
School entry = Pure tone audiometry

128
Q

Child with croup and stridor at rest - managment

A

Immediate paediatric admission

129
Q

Commonest cause of a massive painless GI bleed in 1-2 year olds?

A

Meckels diverticulum

130
Q

Basic paediatric referral timeline

A

Doesn’t smile at 10 weeks
Doesn’t sit unsupported at 12 months
Doesn’t walk at 18 months

131
Q

Small red growth within centre of umbilicus, producing clear or yellow fluid
Within few months of birth
Systemically well

A

Umbilical Granuloma - overgrowth from healing

Regular application of salt -> silver nitrate

132
Q

When might you consider pneumonia rather than bronchiolitis?

A

Focal crackles

Persistent high fever

133
Q

What are some RED flag symptoms in paediatrics?

A 
Moderate to severe intercostal recession 
Doesn't wake if roused
Reduced skin turgor
Mottled or blue skin 
Grunting
134
Q

Describe a mild croup

A

Occasional barking cough
No stridor at rest
No/mild intercostal recession
Well looking child

135
Q

Describe a moderate croup

A

Frequent barking cough
Stridor
Recession at rest
No distress

136
Q

Describe a severe croup

A

Prominent inspiratory stridor at rest
Marked recession
Distressed agitated lethargic
Tachycardia

137
Q

Croup admission

A

<6 months
Mod/severe croup
Uncertain diagnosis - epiglottitis supraglottitis

138
Q

Bruising in a non mobile infant

A

All should be referred to paediatrics

139
Q

Circulatory collapse around day 2
Heart failure
Reduced femoral pulses
Systolic murmur heard under left clavicle and over the back

A

Coarctation of the aorta

140
Q

What can be used in severe Tet spells

A

Phenylephrine

141
Q

Epiglottitis managment

A 
Call for help Senior ENT, Anaesthetic and alert PICU
Don't alarm or examine throat of child
Secure airway
Culture and examine once secured
Cefuroxamine
142
Q

Diagnostic of mumps

A

Salivary IgA

143
Q

Constipation in children - management

A

Movical Paediatric plan is first line -> + stimulant (Senna) -> swap movicol for lactulose

144
Q

Management of GORD in a infant

A

Gaviscons + thickened foods trial for 1-2 weeks
PPI if feeding issues, distressed, faltering growth
-trial for 4 weeks

145
Q

A pearly mass on the midline of the posterior hard palate of a newborn.

A

Epsteins Pearl - no treatment is needed as its a benign cyst

146
Q

Measles prodrome

A

Cough Coryza Conjunctivitis

147
Q

If someone is suspected of having delayed puberty what test can they undergo?

A

X-ray hands and wrist - bone age will be delayed

148
Q

Neonatal phototherapy

A

Check their bilirubin after 4-6 hours - if 50 below threshold then stop

Recheck bilirubin 12-18 hours after this - if still 50 below they require no more monitoring
- if within 50 of the threshold recheck in 12 hours and consider restarting

149
Q

Jaundice within 24 hours

A

Rhesus
ABO incompatibility
G6PD
Hereditary Spherocytosis

150
Q

What tests should be done in a case of neonatal jaundice occurring within 24 hours

A

Coombs
Osmotic fragility
Blood film

151
Q

Causes of jaundice over 14 days.

A 
Hypothyroidism
Biliary Atresia
UTI
Breast milk jaundice
Premature 
Infection
152
Q

What tests should be done in a case of neonatal jaundice occurring over 14 days?

A 
FBC
Unconjugated and conjugated bilirubin
Coombs
TFT
Blood film
Urine 
U+Es
LFT
153
Q

What is used to asses renal function in <18?

A

Creatinine

eGFR isn’t licensed for children

154
Q

Management of a UTI

A

<3 months = immediate admission
>3 months upper UTI = consider admission or 7-10 days of antibiotics
>3 months lower UTI = 3 days antibiotic

155
Q

How long should a newborn stay in hospital if they have a risk factor for developing sepsis?

A

24 hour for observations

156
Q

What other condition is strongly linked to hypospadias?

A

Cryptochordism

157
Q

Paediatric Red Flags - Colour

A

Pale
Mottled
Blue

158
Q

Paediatric Red Flags - Activity

A

No responce to social cues
Very difficult to rouse and if aroused falls back to sleep
Weak high pitched continuous cry

159
Q

Paediatric Red Flags - Respiratory

A

Grunting
Tachypnoea >60
Mod/severe chest indrawing

160
Q

Paediatric Red Flags - other

A 
Looks ill to a healthcare professional 
Reduced skin turgor 
<3 months >38 degrees
Non blanching rash
Bulging fontanelles
Neck stiffness
Status epilepticus
Focal neurological signs
161
Q

Paediatric amber flags - Colour

A

Pallor reported by carer

162
Q

Paediatric amber flags - activity

A

No smile

Prolonged stimulation required to wake them

163
Q

Paediatric amber flags - Respiratory

A

Nasal flaring
<95% oxygen
Crackles
RR >50

164
Q

Paediatric amber flags - Circulation

A

Dry
Cap Refil - >3
Poor feeding
Reduced urine output

165
Q

Paediatric amber flags - other

A

> 39 degrees 3-6 months
Fevere for over 5 days
Swelling
Non weight bearing leg

166
Q

What age do children reach for objects

A

3 months

167
Q

What age do children show a palmar grip and pass objects between hands?

A

6 months

168
Q

What age do children point with a finger and use an early pincer grip?

A

9 months

169
Q

What age do children show a good pincer grip?

A

12 months

170
Q

How many bricks in a tower by 15 months?

A

2

171
Q

How many bricks in a tower by 18 months?

A

3

172
Q

How many bricks in a tower by 2 years?

A

6

173
Q

How many bricks in a tower by 3 years?

A

9

174
Q

Hand dominance before 12 months.

A

Always pathological - strong indicator for cerebral palsy

175
Q

Respiratory Distress
Distended abdomen
Chocking / problems swallowing
Overflow salivation

A

oesophageal atresia

Polyhydramnious during pregnancy is an indicator swell.

176
Q

Investigation and management in oesophageal atresia

A

NG tube is passed down as far as it can go. Chest x-ray is taken which will show the level of the atresia due to radiopaque NG tube.

Management is surgery

177
Q

Management of a squint before 8 weeks old.

A

Squints are not abnormal before 8 weeks observe and refer if persist over 8 weeks

178
Q

Congenital heart block - cause and management

A

Maternal SLE with Anti Ro and LA

Pacemaker is required

179
Q

All children under three months with a fever require.

A

Blood, Urine and CSF culture

Things I don't know, but need to know, for fourth year (31 decks)

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