Paediatrics Flashcards
What is redcurrant jelly like stool associated with?
Intussusception
What is the gold standard diagnostic test for Intussusception and what would you see in a positive test?
Abdominal USS - should show target-like mass.
What is the key diagnostic investigation in pyloric stenosis?
Abdominal ultrasound scan
What is hand foot and mouth disease (Coxsackie A16) characterised by?
mild systemic upset, oral ulcers followed by vesicles on the palms and soles
Low calcium, low phosphate , high ALP and high PTH are signs of what?
Rickets - can present as widening of wrist joints and prominent forehead (frontal bossing)
Compression:Ventilation ratio in Paediatric life support?
30:2 if solo
15:2 if 2 or more responders present
Most common form of visual impairment in babies delivered under 32 weeks gestation?
Retinopathy of prematurity
Features of ITP in children?
-Bruising
-Petechial or purpuric rash
-Bleeding is less common (Gums or nose)
Investigations for ITP?
FBC - should show isolated thrombocytopenia
Blood film
Bone marrow exams if there is atypical features e.g. lymph nodes, splenomegaly, failure to resolve
Hypochloraemia, hypokalaemia and alkalosis are classic of what condition?
Pyloric stenosis
Neonatal hypotonia is associated with?
Prader-Willi syndrome
First-line treatment for eczema?
Topical emollients
Treatment for viral-induced wheeze?
First-line - SABA e.g. salbutamol
Next step is oral montelukast or inhaled corticosteroids
Features of CMPA?
Regurgitation/Vomiting
Diarrhoea
Urticaria/atopic eczema
Colic - irritable, crying
Wheeze/cough
Management of CMPA if formula fed?
extensive hydrolysed formula (eHF), amino acid formula (AAF) in severe cases
Management of CMPA if breastfed?
Continue breastfeeding
Eliminate cows milk protein from mothers diet
Use eHF from when breastfeeding stops to 12 months of age
Management of rickets?
Oral vitamin D
Severe asthma attack criteria?
Sats < 92%
PEF 33-55% best/predicted
Too breathless to talk/feed
HR of over 125 in older than 5, over 140 in 1-5
Resp rate more than 30 in older than 5, over 40 in 1-5
Use of accessory neck muscles
Life-threatening asthma attack criteria?
Sats < 92%
PEF < 33% best/predicted
Silent chest
Poor resp effort
Agitation
Altered consciousness
Cyanosis
Signs of intestinal malrotation/volvulus?
Distended abdomen
Bilious vomiting
Slow to establish on feeds
Investigation for malrotation/volvulus?
Upper GI contrast study
Ultrasound
When should referral be made for unilateral undescended testis?
After 3 months of age
Tetralogy of Fallot?
Right ventricular hypertrophy
Pulmonary stenosis (Ejection systolic murmur, left sternal edge)
Overriding aorta
VSD
(Cyanosis or collapse in first month of life, hypercyanotic spells)
High risk factors in feverish child?
Pale/mottled/blue skin
Weak, high pitched cry, no response to social cues
Grunting, RR> 60, chest indrawing
Reduced skin turgor
Age < 3 months with temp over 38
Non-blanching rash
Medium risk factors in feverish child?
Pallor
No smile, decreased activity
Nasal flaring, RR>50, Sats < 95%, chest crackles
Tachycardia, CRT > 3 seconds, dry mucous membranes
Fever more than 5 days, rigors, swelling of limb or joint
Late complication of trisomy 21?
Alzheimer’s disease
Main causative organism of croup?
Parainfluenza virus
First line treatment of threadworm?
Single dose of mebendazole for whole household and hygiene advice
Associations of hirschsprung’s disease?
3x more common in males
Down’s syndrome
Presentation of Hirschsprung’s disease?
Neonatal - failure or delay to pass meconium
Older - constipation, abdo distension
Investigations for hirschsprung’s?
Abdo X-ray
Gold standard is rectal biopsy which would show absence of ganglion cells in submucosa
Management for Hirschsprung’s?
Rectal washouts/ bowel irrigation initially, followed by surgery to affected segment of colon for definitive management.
What season is bronchiolitis most common?
Winter
Most common cause of bronchiolitis?
RSV
Management of CF?
Regular chest physio and postural drainage
High calorie diet with high fat intake
Minimise contact with other CF patients
Vitamins
Pancreatic enzyme taken with meals
CFTR modulators e.g. Lumacaftor can be used in patients who are homozygous for delta F508 mutation
Investigation in suspected SUFE?
Plain X-ray both hips with AP and frog-leg views
Apgar score meaning?
7-9 normal ( 10 unusual as normally lose a point for blue extremities)
4-6 moderately low
0-3 - very low
What is Ladd’s procedure for?
Surgical treatment of intestinal malrotation with volvulus
Treatment for pyloric stenosis?
Pyloromyotomy - usually laparoscopic
Treatment for scarlet fever?
Oral penicillin V for 10 days
When can a child safely return to school after scarlet fever?
24 hours after starting antibiotics
Elevation of the testicle relieves pain in?
Epididymitis
Short stature + primary amenorrhoea = ?
Turners syndrome
What should you not use in children under 3 months in treating bacterial meningitis?
Corticosteroids
What virus causes Roseola infantum?
Herpes virus 6
Meconium should be passed by?
48 hours of birth - red flag if more (CF, Hirschsprung’s)
Most common cause of painless massive GI bleed requiring transfusion in children aged 1-2?
Meckel’s diverticulum
How to correct age for prematurity?
Age minus number of weeks born early from 40 weeks
What oral antibiotic should be used to treat mycoplasma pneumonia in children?
macrolides e.g. erythromycin.
Features of oligoarticular JIA?
Pain and swelling in joints (Knees, ankles, elbows)
Worse in mornings
Limp
ANA may be +ve
First line treatment in PDA?
Indomethacin or ibuprofen - to promote duct closure
NSAIDs increase the risk of what in chickenpox?
Necrotising fasciitis
Management of croup?
Single dose oral dexamethasone at 0.15mg/kg
In emergency/severe - high flow O2 and nebulised adrenaline
Features in child with maternal Syphillis infection?
-Snotty (rhinitis)
-Saddle shaped nose
-Sensorineural hearing loss,
-Small and spaced teeth
-Swollen liver/spleen
-Swollen lymph nodes
What conditions are commonly associated with Down’s syndrome?
Heart defects - usually repairable
Visual problems - cataracts
Hearing loss
Hypothyroidism
Hypotonia - developmental motor delay
Leukaemia
Easily disclocated neck - especially in those that do certain sports
Features of Noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis - mid-systolic high pitched crescendo-decrescendo heard at upper left sternal edge
Features of edward’s syndrome (trisomy 18)?
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
Features of Patau syndrome (trisomy 13)?
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Features of fragile X syndrome?
Learning difficulties
Macrocepaly
Long face
Large ears
Macro-orchidism
Severity of alpha-thalassaemia?
1 - 2 globulin chains affected - hypochromic and microcytic but Hb level normal
3 chains - + anaemia and splenomegaly (Hb H disease)
4 chains - death in-utero (Hydrops fetalis)
Classic triad of shaken baby syndrome?
Retinal haemorrhages
Subdural haematoma
Encephalopathy
Features of PDA?
Left subclavicular thrill
Continuous ‘machinery’ murmur
Large volume, bounding, collapsing pulse
Wide pulse pressure
Heaving apex beat
Paediatric maintenance fluid requirements?
100ml for first 10kg
50ml for next 10kg
20ml for each kg above 20
Divide by 24 to calculate infusion rate per hour
What should be given before surgery in transposition of the great arteries?
Alprostadil (prostaglandin E1) - maintains PDA in cyanotic congenital heart diseases
Benign cause of stridor/noisy breathing?
Laryngomalacia - usually self resolves by 2 years of age`
Signs of congenital Rubella syndrome?
Sensorineural deafness
Congenital cataracts - absent fundal/red reflexes bilaterally
Signs of congenital CMV?
Hearing loss
Low birth weight
Petechial rash
Microcephaly
Seizures
First-line investigation for Duchenne?
Genetic testing
Most common cause of early onset neonatal sepsis (within first 72 hours)
Group B Strep (Agalactiae)
What cardiac abnormality can be caused by lithium use in pregnancy?
Ebstein’s anomaly (tricuspic regurgitation and stenosis)
First-line laxative for constipation in children?
Movicol ( Osmotic - Real name is macrogol)
What is the medical term for growing pains?
Benign idiopathic nocturnal limb pains of childhood
Features of benign rolandic epilepsy?
Partial seizures at night
What is gas in the intestines a sign of ?
Necrotising enterocolitis
Initial management for transposition of great arteries?
Prostaglandins
Edward’s syndrome quadruple test result?
Lowered AFP, Oestriol ,hCG
Normal Inhibin A
First line investigation for meckel’s diverticulum?
Technetium scan
Whooping Cough Treatment?
Azithrommycin/Clarithromycin if within 21 days of onset of cough
What are undescended testicles associated with?
Testicular torsion
Testicular cancer
Infertility
What heart defects are associated with Turners syndrome?
Ejection systolic murmur most common - bicuspid aortic valve
Coarctation of the aorta
Triad of shaken baby syndrome?
Retinal haemorrhages
Subdural haematoma
Encephalopathy
What treatment should be given in suspected Nec?
Broad spectrum antibiotics
Peak incidence of ALL?
2-5 years
