Paediatrics Flashcards
Name the infection that the following organisms commonly cause:
1. Parvovirus B19
- Coxsackie virus A
- Group A Strep
- RSV (2)
- Parainfluenza virus
- Slapped cheek
- Hand, foot & mouth
- Scarlet fever
- Bronchiolitis, viral induced wheeze
- Croup
What skills would you expect to see from each developmental domain in an 18m toddler?
- Gross motor (2)
- Fine motor (2)
- Language (1)
- Social (2)
- Self help (1)
- *Gross motor:** 1) walks up/down stairs unsupported
2) kicks a ball - *Fine motor:** 1) scribbles with crayon
2) builds towers with 4+ bricks
Language: 1) starts to join words into sentences
- *Social**: 1) early pretend play
2) says no when interfered with
Self help: 1) eats with fork
What type of bilirubin is always abnormal in infants?
When ordering LFT’s, what should you order specificially to determine the cause of jaundice?
What would you expect the stools of a baby with biliary atresia (obstruction of bile flow) to look like?
Conjugated bilirubin!!
Split bilirubin
Pale, chalky white stools
A 3-week-old boy presents to paediatric A&E with persistent vomiting. The mother reports that vomiting always occurs soon after feeds and often hits the kitchen walls.
On abdominal examination, there are no peritonitic features, but, a small, firm, olive shaped mass is palpable in the epigastric area.
What is the likely diagnosis?
What is the investigation of choice?
What is the definitive management?
Pyloric stenosis
Abdominal US
Management: surgery (laparoscopic pyloromyotomy)
What skills would you expect to see from each developmental domain in an 24m toddler?
- Gross motor (1)
- Fine motor (1)
- Language (1)
- Social (1)
- Self help (1)
Gross motor: climbs on play equipment (eg, slides)
Fine motor: scribbles with circular motion
Language: vocabulary of 30-50 words
Social: helps with simple household tasks
Self help: opens door by turning knob
What are an Exomphalus and Gastroschisis? - whats the difference between them?
Exomphalus = herniation of abdominal contents at birth which ARE COVERED by the peritoneal membrane
Gastroschisis = herniation of abdominal contents at birth which AREN’T COVERED by the peritoneal membrane!
What are the 6 components of sepsis 6?
~ state the order you would do these in
(take 3, give 3)
1) Give O2 if sats are below 94%
2) Take blood cultures
3) Give IV antibiotics
4) Fluid challenge (give IV fluids)
5) Measure blood lactate
6) Measure urine output
A one-year old girl presents to the Emergency department with intermittent abdominal pain. Her father explains that during these episodes the child becomes irritable, pale, and draws her legs up towards her abdomen. There has been no vomiting, but the child has refused feeds for two days. The abdomen is soft, but there is a palpable, sausage shaped mass in the right flank.
What is the likely diagnosis?
What other buzz word would indicate this diagnosis? (common in later presentations)
What is the 1st line investigation & management of this conditon?
If the child had been vomiting & there was abdominal distension, what does this suggest?
Intussusception
Redcurrent jelly stool
Investigation: abdominal US
Management: Enema (commonly air enema)
Obstruction!
What would you hear when ascultating someone with an atrial septal defect? (2)
Explain why you would hear these things!
Fixed, split 2nd heart sound → as blood is being shunted from L→R atria, there is more blood to flow through the pulmonary valve. This causes a delay in the valve closing compared to closing of aortic valve = split 2nd heart sound
Pulmonary flow murmur (ejection systolic murmur) → due to increased blood flowing through the valve
What is Croup?
What is the commonest causative organism?
What are the common presenting features of croup? (6)
How long does croup usually last for?
What is the management of croup?
An URTI causing oedema & swelling of the larynx.
Parainfluenza virus
~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever
1 - 2 days
Oral dexamethasone
If someone is cyanotic, but their SATs are normal (99-100%), what is the likley underlying cause?
Carbon monoxide poisoning
What is Kawasaki disease?
What are the 6 common features of Kawasaki disease? CREAM
What is the main complication of Kawasaki disease? - What investigation is done to screen for this?
What is the treatment of Kawasaki disease?
A systemic medium vessel vasculitis
- *Fever for 5+ days** PLUS
- *C** - conjunctivitis (red eyes)
- *R** - rash
- *E** - oedema/ erythema of hands & feet
- *A** - adenopathy (usually cervical)
- *M** - mucosal invovlement (strawberry tongue, cracked lips)
Coronary artery aneurysm - ECHO
Treatment: aspirin (to reduce risk of thrombosis) & IV immunoglobulins IVIg) (to reduce risk of coronary artery aneurysms)
What condition would be indicated by: “a child with a 3 day history of vomiting & diarrhoea”
What is the investigation of this condition?
If the diarrhoea was bloody, what would be the likely causative organism?
This organism increases the risk of developing what condition?
What are the 3 characteristic features of this condition?
What is the management of this condition?
Gastroenteritis
Stool sample sent for microscopy, culture & sensitivies (MCS)
E. Coli
Haemolytic Uraemic Syndrome (HUS)
1) Haemolytic anaemia
2) Thrombocytopenia
3) AKI
Supportive management as it self resolves - monitor fluid balance to detect a worsening AKI
Ventricular-septal defects are associated with which 2 genetic conditions?
What type of murmur is heard when there is a ventricular-septal defect?
Down syndrome, Turner’s syndrome
Pan-systolic murmur
What is the treatment of hydrocephalus in children?
List some complications of this treatment:
VP shunt (ventriculoperitoneal shunt)
Complications:
• infection
• excessive CSF drainage
• shunt can become blocked
• intraventricular haemorrhage *during the surgery*
••• Children outgrow the shunt, so it will need replacing •••
List some common symptoms of asthma: (3)
- Wheeze
- Cough (worse at night)
- SOB
What is the treatment of aortic / pulmonary valve stenosis in children?
What is a common complication of this procedure?
Balloon valvoplasty
Valve regurgitation due to damage of the cusps of the valve
What is the commonest causative organism of bronchiolitis?
~ what is the treatment?
What is the commonest causative organism of viral induced wheeze?
~ what is the treatment?
What is the commonest causative organism of bacterial/ viral pneumonia?
~ what is the treatment for each?
What is the commonest causative organism of croup?
~ what is the treatment?
What is the commonest causative organism of epiglottitis?
~ what is the treatment?
What is the commonest causative organism of whooping cough?
~ what is the treatment?
Bronchiolitis: RSV
~ supportive treatment (viral infection - self resolves)
Viral induced wheeze: RSV
~ 10 puffs of salbutamol +/- O2 if needed
- *Bacterial pneumonia:** Strep pneumonia - amoxicillin
- *Viral pneumonia:** RSV (supportive treatment)
Croup: parainfluenza virus
~ dexamethasone
Epiglottitis: H.influenza B
~ secure airways, ceftriaxone & dexamethasone
Whooping cough: Bordetella pertussis
~ supportive management
What is the most likely diagnosis of the following:
Unvaccinated child presents with a fever, sore throat & difficulty swallowing. The child is sitting forward and drooling.
What is the management of this?
Epiglottitis
1) Secure airway!!!!!
2) IV antibiotics (ceftriaxone) + Steroids (dexamethasone)
What is Tetralogy of Fallot also known as by leymans?
Physiologically, what is it & what are the 4 components to it?
“Hole in the heart”
A congenital heart condition that has 4 components:
1. Ventricular septal defect
- Pulmonary valve stenosis
- Right ventricular hypertrophy
- “Over-riding aorta” - aorta arises from both ventricles
What are the 4 abnormalities seen in Tetralogy of Fallot?
What xray finding is seen in this condition?
What clinical sign may be seen on examination? - Why does this happen?
What is the definitive treatment and when does it occur?
1) Pulmonary valve stenosis
2) R ventricle hypertrophy
3) Ventricularseptal defect
4) Overriding aorta (L & R ventricle drain into aorta)
Boot shaped heart seen on xray
Central cyanosis - high pressure in R ventricle due to hypertrophy causes R→L shunt through ventricularseptal defect - less oxygenated blood enters systemic circulation
Surgical correction: performed when baby is 5kg (~ 6 months)
A 3m girl is brought to the GP as her parents are worried about a skin lump that has appeared on her neck. It is non-tender and isn’t bothering her, but it is growing in size.
On examination there is a 2 x 2cm firm, well demarcated lesion with visible telangiectasia. There are no other skin lesions.
What is the likely diagnosis? - what is this?
What would the treatment be here?
What would the treatment be if the lesion was near the eyes/ rapidly enlarging or was ulcerating?
Haemangioma - a vascular birth mark that isnt present at birth but appears from 6 weeks onwards. It will proliferate & grow up until 8m and then self resolve.
Treatment if asymptomatic: nothing - they will self resolve (involute)
Treatment if problematic: Oral propanolol
List the distinguishing features that differentiate IgA nephropathy from post-streptococcal glomerulonephritis: (2)
IgA Nephropathy:
~ 1-2 days post URTI
~ Renal biopsy: IgA immune complex deposits in the glomerulus
Post-strep GN:
~ 1-3 weeks post URTI (usually strep throat)
~ Renal biopsy: IgG immune complex deposits in the glomerulus
What changes occur at birth regarding the foetal circulation? (6)
1) foramen ovale closes
2) ductus arteriosus closes
3) ductus venosus closes (blood vessel connecting umbilical vein→IVC)
4) Pulmonary vascular resistance falls
5) Pulmonary blood flow increases
6) Systemic vascular resistance increases
What skills would you expect to see from each developmental domain in a 3y?
- Gross motor (1)
- Fine motor (1)
- Language (2)
- Social (1)
- Self help (1)
Gross motor: 1) Rides a tricycle
Fine motor: 1) Draws/ copies a complete circle
- *Language**: 1) Identifies 4+ colours
2) Asks questions: ‘why’ ‘how’
Social: 1) Gives directions to other children
Self help: 1) Toilet trained (may still need help with wiping)
What is Hirschprung’s Disease?
What is a common presentation of it?
What investigation is done? - what is used to confirm the diagnosis?
What is the definitive management?
Congenital condition in which nerves of the distal bowel & rectum are absent (myenteric plexus)
24h neonate hasnt passed meconium, distended abdomen and vomiting!
Rectal exam (forecful evacuation of stool will occur!!!) - confirmation is made by suction rectal biopsy
Definitive management: surgical removal of aganglionic bowel
State the 3 vaccines that are live, attenuated:
Live attenuated:
• MMR
• Rotavirus
• Nasal flu vaccine
What is Kawasaki disease?
What are the 6 common features of Kawasaki disease? CREAM
What is the main complication of Kawasaki disease? - What investigation is done to screen for this?
What is the treatment of Kawasaki disease?
A systemic medium vessel vasculitis
- *Fever for 5+ days** PLUS
- *C** - conjunctivitis (red eyes)
- *R** - rash
- *E** - oedema/ erythema of hands & feet
- *A** - adenopathy (usually cervical)
- *M** - mucosal invovlement (strawberry tongue, cracked lips)
Coronary artery aneurysm - ECHO
Treatment: aspirin (to reduce risk of thrombosis) & IV immunoglobulins IVIg) (to reduce risk of coronary artery aneurysms)
What is the management of a baby with symptomatic patent ductus arteriosus? - what is the mechanism behind this?
When would this management not be used and why?
In these babies, what would the management be? - what is the timeframe for this?
Indomethacin (an NSAID) - it is a prostagland inhibitor so causes closure of ductus arteriosus
Not used in term babies as their patent ductus arteriosus isnt prostaglandin sensitive!
Watch & wait - most will close spontaneously within 1y. IF symptomatic, can be surgically ligated
What is SUFE?
What age group & sex is it most common in?
What is the biggest RF for SUFE?
List some features seen in someone with SUFE: (3)
It’s when the head of femur is displaced along the growth plate (it looks like it has slipped off)
Teenage boys
Obesity
~ Hip/ groin/ knee pain with insidious onset
~ Restricted ROM of hip
~ Painful limp
What is osteomyelitis?
What is the commonest causative organism?
List some investigations usually performed if osteomyelitis is suspected: (3)
An infection of the bone and bone marrow.
Staph aureus
- Xray of the bone (it may be normal - MRI is the best for a diagnosis)
- Bloods (raised CRP, ESR, WBC)
- Blood cultures (bone marrow aspirate/biopsy is sometimes required)
What skills would you expect to see from each developmental domain in an 24m toddler?
- Gross motor (1)
- Fine motor (1)
- Language (1)
- Social (1)
- Self help (1)
Gross motor: climbs on play equipment (eg, slides)
Fine motor: scribbles with circular motion
Language: vocabulary of 30-50 words
Social: helps with simple household tasks
Self help: opens door by turning knob
What skills would you expect to see from each developmental domain in a 12m toddler?
- Gross motor (2)
- Fine motor (2)
- Language (2)
- Social (1)
- Self help (2)
- *Gross motor:** 1) stands without support
2) starts to walk without help (by 18m) - *Fine motor:** 1) stacks 2+ blocks
2) picks up 2+ toys in 1 hand - *Language**: 1) know’s the meaning of 1 or 2 words
2) uses mama / dada specifically for parents
Social: 1) points to things of interest
- *Self help:** 1) feeds themself with spoon
2) lifts cup to mouth and drinks
What is the 1st line treatment of atonic seizures in children?
Sodium valproate
A 7y old boy is brought in because parents are concerned that he still wets the bed most nights (dry throughout the day).
He has no fever and abdominal/ spinal/ neuro examination is normal.
What is the likely diagnosis? - how does this differ if the boy had previously been continent at night?
What is the diagnosis if urinary incontinence occurs throughout the day too?
What is the management of this boys condition?
- *Primary nocturnal enuresis**
- Secondary* notcurnal enuresis
Diurenal enuresis
Management: identify underlying cause & treat!
~ eg, reduce fluid intake in evenings
~ eg, check for UTI
What is cerebral palsy & what causes it?
Cerebral palsy: a group of permanent neurological problems (deficits) that present in early childhood
Cause: damage to the brain around the time of birth (commonly hypoxic brain injury during birth)
Describe what coarctation of the aorta is:
List the clinical signs/ symptoms of coarctation of aorta: (3)
How would a child with coarctation of aorta usually present?
What congenital condition is associated with coarctation of the aorta?
Narrowing of the descending aorta
1) Weak/ absent femoral pulse
2) Radio-femoral delay
3) Systolic murmur that’s loudest at the back
Presentation: sudden deterioration & collapse
Turner’s syndrome
Anaphylaxis is what type of hypersensitivity reaction?
This type of reaction is mediated by what?
Type 1 hypersensitivity reaction
IgE mediated mast cell degranulation
What is Croup?
What is the commonest causative organism?
What are the common presenting features of croup? (6)
How long does croup usually last for?
What is the management of croup?
An URTI causing oedema & swelling of the larynx.
Parainfluenza virus
~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever
1 - 2 days
Oral dexamethasone
Erb’s palsy results in damage to what nerves of the brachial plexus?
What obstetric emergency can result in Erb’s palsy?
C5 & C6
Shoulder dystocia
When would baby blues typically present?
When would postnatal depression typically present?
Baby blues: Within 2 weeks of delivery
Postnatal depression: several weeks after delivery up to 1y
A 5y old boy complains of difficulty in hearing. He has had several fractures following minor falls. O/E his legs appear short & deformed and his sclera have a blue tinge.
What is the likely diagnosis?
Osteogenesis imperfecta (brittle bone disease)
What direction is blood shunted in a ventricular-septal defect?
What pathology can occur over time if a ventricular-septal defect isnt corrected? What causes this?
What condition does this result in and why?
What clinical sign will be seen when this happens?
L→R ventricle
Increased blood in R ventricle → increased blood (and thus pressure) in pulmonary circulation → pulmonary hypertension
Pulmonary hypertension causes Eisenmenger syndrome: pressure in R ventricle is higher than L which causes blood to be shunted from R→L
Central cyanosis (more blood is bypassing the lungs)
What is the commonest type of headache in children?
Tension type headaches
What are the 2 criteria’s/ tools that GP’s often use to determine a bacterial or viral cause of a sore throat?
CENTOR & feverPAIN
What is SUFE?
What age group & sex is it most common in?
What is the biggest RF for SUFE?
List some features seen in someone with SUFE: (3)
It’s when the head of femur is displaced along the growth plate (it looks like it has slipped off)
Teenage boys
Obesity
~ Hip/ groin/ knee pain with insidious onset
~ Restricted ROM of hip
~ Painful limp
