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Year 5 CRAM > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the clinical estimation of dehydration (not DKA)?

A 
3% = dry lips
5% = tachycardia
7.5% = increased cap refill
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2
Q

What haematological malignancy is associated with down syndrome?

A

Epidemiologically, children with Down syndrome are more likely
to get AML than ALL in the first 3 years of their life, but thereafter are
more likely to get ALL, similar to those without Down syndrome.

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3
Q

What is the treatment for hydrocele?

A

< 2 years (congenital hydrocoele) = most resolve spontaneously before the age of 2 –> reassure, observation + safety net

If hydrocele persists beyond 2 years consider surgical repair. Increased risk of inguinal hernia.

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4
Q

Kid with speech problems, other milestones are normal, who do you do refer to?

A

SALT

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5
Q

Maternal T1DM increases risk of what condition in newborn?

A

neural tube defects

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6
Q

Kid with pellets, and loose stool sometimes

A

overflow diarrhoea

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7
Q

How does dyskinetic cerebral palsy present?

Which part of the brain is damaged?

A

Athetoid movements and oro-motor problems

Basal ganglia and substantia nigra

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8
Q

What is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.

A

Meckels diverticulum

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9
Q

Feature of achondroplasia

A

Trident hands

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10
Q

Hypospadias - what congenital defect is this neonate at an increased risk of also having

A

Cryptorchidism

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11
Q

What drug can increase the risk of necrotising fasciitis in patients with chicken pox

A

NSAIDs

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12
Q

What therapy must be given to all children after an asthma attack?

A

Steroid therapy - 3 days of oral prednisolone

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13
Q

When is hypospadias surgery performed?

A

12 months

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14
Q

Methotrexate causes what vitamin deficiency?

A

folate (B9)

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15
Q

5% fluid deficit in mild DKA => pH
7% fluid deficit in moderate DKA => pH
10% fluid deficit in severe DKA => pH

A

pH 7.2-7.29
pH 7.1-7.19
pH < 7.1

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16
Q

Over how long should the fluid deficit be replaced in a patient with DKA?

A

48 hours

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17
Q

What the difference between spina bifida, meningocele, myelomeningocele?

A

1) Spina bifida: vertebral defect - no herniation of meninges or spinal cord, patch of hair/sacral dimple overlies the defect
2) Meningocele: spinal defect with protrusion of the meninges
3) Myelomeningocele: spinal defect with protrusion of the meninges and spinal cord

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18
Q

What is the most common cause of erythema nodosum?

A

Herpes simplex virus

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19
Q

Threadworm species

A

Enterobius vermicularis

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20
Q

What is the treatment of wilson’s disease?

A

penicillamine

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21
Q

Management of pyelonephritis?

A

IV ceftriaxone and gentamicin

22
Q

Alport’s syndrome

A

X linked
SBAs: Haematuria + hearing loss + hereditary
Female carriers may have haematuria

23
Q

What is a very common rash in neonates that resolves in 2 weeks and is non threatening?

A

erythema toxicum neonatorum

24
Q

What can be used to treat muscle stiffness in cerebral palsy?

A

baclofen

25
Q

What is the first sign of puberty in girls?

A

breast development

26
Q

What is the first sign of puberty in boys?

A

testicular growth at around 12 years of age (range = 10-15 years)

27
Q

What is the hearing test for children above 3 years?

A

pure tone audiometry

28
Q

You are in GP, Child with croup comes in - only seal barking cough?

A

Oral dexamethasone + review in 48 hours

only send to hospital/admit if increasing stridor, increasing sternal/intercostal recession or RR>70 = basically if unwell looking

29
Q

FH of T1DM, and the kid is not gaining weight and has loose stools

A

Coeliac disease

30
Q

Maintenance fluid to give to kid with diabetes mellitus

A

0.9% saline without added glucose should be used for rehydration and maintenance until plasma glucose is < 14 mmol/L

Change to 0.9% saline + 5% glucose after plasma glucose drops below 14 mmol/L

ALSO all fluids (except boluses) have 40mmol/L of KCl (unless they have renal failure)

31
Q

Bilateral undescended testes in a phenotypically male newborn examination, most likely dx?

A

Klinefelters

NOT androgen insensitivity syndrome because phenotypically male

Bilateral (at birth) = pituitary causes

32
Q

14-year old girl presented to GP with short stature and no secondary sexual characteristics. Otherwise well. The mean parental height is on the 50th centile. What is most likely dx?

A

constitutional delay - most common cause of delayed puberty

33
Q

Itchy maculovesicular rash w fever started on chest and spread to arms, dx?

A

chicken pox

34
Q

Treatment for scarlet fever

A

Phenoxymethylpenicillin

*azithromycin if allergy

35
Q

Most common allergen in perennial rhinitis?

A

House dustmite

36
Q

Definitive management of intussception

A

air insufflation

37
Q
  1. Girl (pre-pubertal) with offensive vaginal discharge. What is the most common cause of this?
A

vulvovaginitis - likely caused by candida albicans

38
Q

Precocious puberty (5yo and has sparse axillary and pubic hair as well as breast bud development) and high centile growth parents are along some lower centile. What definitive diagnostic test do you do?

A

Gonadotrophin stimulation test

39
Q

Differential diagnoses for hirschprung’s disease

A

Cystic fibrosis (meconium ileus)
Small left colon syndrome
Distal small bowel atresia or stenosis
Constipation

40
Q

What is hirschprungs disease?

A

Congenital disease resulting in the absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel - results in narrow constricted segment. Extends from the rectum for variable distance to normally innervated dilated colon.

Commonly affects down syndrome children

41
Q

How would you investigate hirschprungs disease

A

Full examination
Rectal examination - may result in explosive bowel movement - symptomatic improvement immediately
Basic observations rule out other causes of vomiting e.g. infection
Urine dipstick if possible
Imaging - Abdominal x-ray, contrast enema
Diagnosis: Suction rectal biopsy to demonstrate the absence of ganglion cells with presence of large acetylcholinesterase positive nerve trunks.
Removal of mucosa and submucosa - shouldn’t be painful and can be done at bedside.
Anorectal manometry and barium studies may be useful in giving surgeon idea of length of aganglionic segment (but not useful for dx)
Anorectal manometry - measures pressure in anus and rectum - uses balloon and pressure gauge
Barium studies - used to image gut and can see where narrowing occurs

42
Q

How do you management hischprungs disease?

A

ABCDE approach
And discuss with seniors
Initial colostomy followed by anastomosing normally innervated bowel to anus - “pull through”
Laparoscopic or open

Older children/ if unwell:
Wash out - tube inserted into child’s bottom and filled with warm salt water to soften faeces and flush out from bowel
Parents taught how to do it.
Surgery - step approach
Create stoma as temporary measure
Involvement of stoma nurse
Few weeks later -pull through examination

43
Q

What are the complications of hirschprungs disease?

A

Acutely:
May present with hirschsprung’s enterocolitis/ sepsis in first few weeks of life due to C. diff → if fever/ diarrhoea
Rx: admission with abx (metronidazole) and fluids

Late presentation:
In later childhood may present with chronic constipation
May also present with growth failure.

After treatment:
Constipation is common after pull through operation - may need medication
incontinence/ soiling

Further children may be at risk → genetics

44
Q

Management of constipation

A

Disimpaction regimen:
Stool softeners, initially macrogol laxative eg polyethylene glycol + electrolytes (movicol paediatric plain)
Escalating dose regimen administered over 1 -2 weeks unwin impaction results
If unsuccessful add in stimulant laxative eg senna or sodium picosulphate
(if polyethylene gycp; and electrolytes not tolerated osmotic laxative can be substitutes 0
Disimpactment must be followed by maintenance treatment to ensure ongoing regaur pain free defecation - often polyethylene glycol - gradually reduce over period of months

Dietary interventions

Explore child’s concerns
Star chart

45
Q

Differential diagnoses for testicular pain?

A

Torsion
Hernia
Epididymo-orchitis
Testicular tumour

46
Q

Counsel a patient with testicular torsion

A

Testicular torsion
Each testicle is connected to the rest of the body by a blood vessel called the spermatic cord. Testicular torsion happens when a spermatic cord becomes twisted, cutting off the flow of blood to the attached testicle
It can be really painful and cause the twisted testicle to swell up and be tender
Really important we treat it now because it is a serious matter but can be easily resolved if act quickly
Risks of not treating include the testicle blood flow being blocked > testicle may die > testicular removal

Treatment is a simple operation: can only be offered if 6-8 hours.
During the operation a small cut is made in the skin of the scrotum (midline scrotal incision} to expose the testes. The affected testis and spermatic cord are untwisted. The testis is then stitched to the surrounding tissue and fixed so that it is unable to twist in the future. The other testis will also be fixed at the same time so it cannot twist in the future either.
Risks of operation short term: general anaesthetic, infection risk, bleeding postoperatively
Risk - removal of non-viable testicle

If >24 hours
Where the testicle is known to be non-viable because the torsion has lasted more than 24 hours, a semi-urgent orchidectomy is performed with fixation of the contralateral testicle.
If a non-viable testicle is found at the time of exploration, then a scrotal orchidectomy is performed, again with fixation of the contralateral testicle.

47
Q

How could you differentiate between testicular torsion and epididymitis?

A

Ultrasound
Loss of Cremasteric reflex
In testicular torsion there is no improvement of the pain on elevating the scrotum, whereas the pain improves in cases of epididymitis (Prehn’s sign)

48
Q

Will a 3 in 1 vaccine overload my childs immune system?

A

Given as 1 in 3 is just as safe, doesn’t ‘overload’ immune system and makes sure the baby goes through as little pain as possible
3 separate vaccines have no safety evidence
Only a tiny amount of your Charles’ immune system will be used to develop a response to this vaccine, the rest will be used to fight off the many bugs they come into contact with every day!
The vaccines work at different times so won’t be overloaded
6-10 days measles
2-3 weeks mumps
12-14 days rubella

49
Q

What are the differential diagnoses for persistent cough in children?

A

bronchiolitis, croup, pneumonia, TB, pertussis

50
Q

Would you see any changes on an x-ray for bronchiolitis?

A

probably not but hyperinflated lungs

pneumonia would show focal areas of consolidation.
If there is significant respiratory distress + fever –> carry out a CXR to help rule out pneumonia

51
Q

When would you admit a child with bronchiolitis?

A

ADMIT if: apnoea, severe resp distress, RR>70, central cyanosis, not feeding

52
Q

What are the three phases of whooping cough?

A

catarrhal phase
paroxysmal
convalescent

Year 5 CRAM (7 decks)

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