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Clinical Medicine > paediatrics 👶🏻 > Flashcards

paediatrics 👶🏻 Flashcards

1
Q

classic tetrad for severely infected infants with congenital toxoplasmosis

A

hydrocephalus
chorioretinits
convulsions
cerebral calcifications

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2
Q

what causes toxoplasmosis

A

toxoplasma gondii
eating uncooked meat/exposure to cat faeces

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3
Q

What kind of history will a patient present with who has functional abdominal pain

A

Vague, persistent, central abdo pain
Acute,chronic or cyclic
Girls 8-12
Nausea and vomiting
Fx of functional disorders

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4
Q

What history would a patient with constipation present with

A

Vague abdo pain
Painful defecation
Poor diet and fluid intake
Obesity
Faecal incontinence

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5
Q

On clinical examination of a patient with constipation what would you find

A

Minimal-mild abdo tenderness
Stool in rectum
Abdo distension
Faecal mass palpable

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6
Q

Mx of constipation

A

Stool softening laxatives
Improving water, food and fibre intake

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7
Q

What history would a patient with gastroenteritis present with

A

Vague abdo pain with nausea and vomiting
Diarrhoea +/- mucus
Recent travel, contact with sick person or ingestion of suspicious food/drink

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8
Q

With gastroenteritis, if it last more than 10 days what does that suggest

A

Parasitic or non-infectious cause

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9
Q

On clinical examination of patient with gastroenteritis what would you see

A

Diffuse abdo pain
Abdo distension
Hyperactive bowel sounds
Signs of volume depletion
Low grade fever

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10
Q

What history would a patient with coeliac disease present with

A

Recurrent abdo pain, cramping or distension
Bloating and diarrhoea
Dermatitis herpetiformis
Family history of coeliac disease

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11
Q

On clinical examination of a patients with coeliac disease what would you see

A

Generalised abdo pain or bloating
Underweight or failing to thrive

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12
Q

What history would a patient with TB present with

A

Night fever
Sweating
Cough
Haemoptysis
Poor appetite
Weight loss
Recent travel abroad

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13
Q

Treatment for TB

A

isoniazid
Rifampicin
Ethambutol
Pyrazinamide

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14
Q

History of patient with scarlet fever

A

Under 10
Sore throat
Malaise
GI upset

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15
Q

Clinical examination of pt with scarlet fever will reveal ?

A

Strawberry tongue
Sandpaper-like generalised rash
Fever
Tender cervical lymphadenopathy

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16
Q

Dx scarlet fever

A

Rapid throat swab but abx should be started immediately

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17
Q

Mx scarlet fever

A

Oral phenoxymethylpenicillin 10 days
If PA azithromycin
Children can return to school 24 hours after commencing abx

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18
Q

CREAM
Conjunctivitis
Rash
Erthyema of hands and feet
Adenopathy (cervical)
Mucosal involvement (strawberry tongue, oral fissures)

high grade fevers for >5 days

A

kawasaki disease

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19
Q

Mx of Kawasaki disease

A

High dose aspirin - due to risk of Reye’s syndrome aspirin is usually contraindicated in children
IV immunoglobulin

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20
Q

Sx of staphylococcus toxic shock syndrome

A

High grade fever
Malaise
Erthymematous rash
Syncope
Hypotension

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21
Q

Progression of toxic shock syndrome

A

Initially non specific flu like symptoms possibly with nausea, vomiting and diarrhoea
Then rapid progression to high fever and eruption of widespread rash that covers >90% body surface

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22
Q

Ix toxic shock syndrome

A

CK elevated
Low platelets
Blood, throat or CSF culture: no growth of pathogen

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23
Q

Mx toxic shock syndrome

A

Antibiotics
Fluid resuscitation
Vasopressors
Surgical debridement

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24
Q

Signs and symptoms you would see with coeliac disease paediatric

A

Failure to grow/thrive
buttocks wasting
Foul smelling faeces
Conjunctival pallor
Abdominal distension

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25
Q

Presentation of measles

A

Fever >40
Coryzal sx
Conjunctivitis followed by a rash 2-5 days after onset of sx
Koplik spots
Lasts about 5 days

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26
Q

Other names for fifth disease

A

Parvovirus B19
Slapped cheek syndrome
Erythema infectiosum

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27
Q

Presentation of fifth disease

A

Prodrome of fever, Coryza and diarrhoea
Bright red rash on cheeks followed by lacy rash on extremities

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28
Q

What is roseola

A

Aka sixth disease
Common disease of infancy caused by human herpes virus 6

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29
Q

Complications of roseola

A

Febrile convulsions

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30
Q

Presentation of roseola

A

Febrile and lethargic for up to 5 days
Blanching, rose pink macular rash erupts and covers trunk typically
Can spread to face and limbs
Cervical lymphadenopathy

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31
Q

Mx of roseola

A

Supportive

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32
Q

What history would a patient with asthma present with

A

Family history
Wheezing triggered by change in Weather, Environmental tobacco smoke, exercise, emotion
Tachypnoea
Dry night time cough

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33
Q

What history would a patient with bronchiolitis present with

A

Under 1 year
Seasonal - common in winter
Passive tobacco exposure
Cough increased in severity over time

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34
Q

Features of bronchiolitis

A

Coryzal symptoms
cough
Increasing breathlessness
Wheezing
Feeding difficulties

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35
Q

In what cases is bronchiolitis more severe

A

Bronchopulmonary dysplasia e.g premature
Congenital heart disease
Cystic fibrosis

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36
Q

Causes of bronchiolitis

A

Most cases = respiratory syncytial virus RSV

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37
Q

What is a common complication seen in bronchiolitis caused by RSV

A

Hyponatraemia

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38
Q

What history would a typical patient with croup present with

A

Male
Between 6 months and 6 years
Seal like barking cough worse at night
Stridor
Incidence in autumn/winter
Mild fever

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39
Q

Mx of croup

A

Dexamethasone
Supportive
Adrenaline nebuliser in emergency

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40
Q

What causes croup

A

Upper airway infection
Vast majority of cases caused by parainfluenza virus
Other viruses include adenovirus, RSV and influenza

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41
Q

What history would a typical patient with acute epiglottis present with

A

Hib unvaccinated
2-6 years of age
Drooling
High fever, generally unwell looking child
Patient finds it easier to breathe if leaning forward and extending neck
Stridor

42
Q

Mx of epiglottis

A

Immediate senior involvement
DO NOT EXAMINE THROAT
Secure airway
Oxygen

43
Q

Clinical features of intussusectpion

A

6-18 months
Severe colicky abdo pain (draws you legs and turns pale)
Vomiting
Sausage shaped mass in RUQ
Red-currant jelly stool
Abdo distension

44
Q

Mx of intussusception

A

Rectal air insufflation

45
Q

What would you see on an abdo x ray for intussusception

A

Target sign +/- free abdo air

46
Q

Clinical features of meckels diverticulum

A

Asymptomatic OR parent Vitelli-intestinal duct
OR painless rectal bleeding OR abdo pain, intussusception, obstruction

47
Q

Describe the tripod position and what is this indicative of

A

Upright leaning forward with extended neck and open mouth
Acute epiglottis

48
Q

Mx of acute epiglottitis

A

Call senior to intubate and secure airway
Then o2 and IV abx

49
Q

Describe wheeze

A

Monophonic or polyphonic musical sound louder on expiration due to narrowing in lower airway

50
Q

Describe Stridor

A

Single note occurs in inspiration due to upper airway obstruction

51
Q

Clinical features of neonatal sepsis

A

Resp distress
Tachycardia
Apnoea
Change in mental status
Jaundice
Seizures
Poor feeding
Abdominal distension
Vomiting
In order of prevalence

52
Q

Describe neonatal resuscitation if baby is not breathing

A

5 inflation breaths
If no improvement - optimise airway and repeat 5 breaths
Once airway is established check pulse If HR <60 ventilate 30 seconds
If still<60 chest compressions

53
Q

Presenting features of necrotising enterocolitis

A

<3 weeks old
Bike streaked vomit
Absent bowel sounds
Abdo distension
Bloody stools

54
Q

Risk factors for necrotising enterocolitis

A

Premature birth

55
Q

Dx of necrotising entercolitis

A

Abdo x ray

56
Q

What would you see on an abdo x ray of a necrotising enterocolitis patient

A

Dilated bowel loops
Pneumotosis intestinalis
Portal venous gas
Pneumoperitoneum

57
Q

Mx of necrotising enterocolitis

A

Drip and suck (IV fluids and antibiotics, nil by mouth so NG tube aswell)
Surgical resection of necrotic bowel

58
Q

Presenting features of acute epiglottis

A

High fever
Toxic appearance
Inspiratory Stridor
Drooling
Absence of cough

59
Q

CXR for acute epiglottis would show ?

A

Thumb sign

60
Q

Triggers for DKA

A

Infection
Non compliance
Inappropriate dose alteration
First presentation of T1DM
Myocardial infarction

61
Q

For paediatric patients coming in when would a CT head in 1 house be indicated

A

GCS <=13 (14 if <1yo)
Post traumatic seizure
Basal skull fracture
(And more)

62
Q

Red flags in a feverish child that you should urgently refer for paediatric assessment

A

Pale, mottled,ashen or blue skin
No response to social cues
Appears ill to a healthcare professional
Does not wake or if roused does not stay awake
Weak high pitched or continuous cry
Grunting
Reduced skin turgor
Bulging Fontanelle, neck stiffness, non-blanching rash
Age<3 months with temp >=38
Status epilepticus, focal seizures, focal neurological deficits

63
Q

features of foetal alcohol syndrome

A

functional or structural nervous system abnormalities

growth impairment

specific facial abnormalities e.g. short palpebral fissures, smooth philtrum and thin upper lip

64
Q

what is an important and common side effect of methylphenidate

A

appetite suppression and subsequent growth suppression

65
Q

inheritance pattern of duchennes muscular dystrophy

A

x linked recessive inherited genetic defect that reduces the expression of dystrophin

66
Q

presentation of duchennes muscular dystrophy

A

muscle wasting and weakness in early childhood

children may have bulky-appearing muscles as degenerated muscle is replaced by fat

parents may notice that the child “slips through their hands” when they pick them up

67
Q

causes of jaundice in the first 24 hours

A

always pathological

  • rhesus haemolytic disease
  • ABO haemolytic disease
  • hereditary spherocytosis
  • glucose-6-phosphodehydrogenase deficiency
68
Q

jaundice in the neonate from 2-14 days ?? what causes this

A

this is common and usually physiological

more commonly seen in breastfed babies

69
Q

jaundice after 14 days of life in a newborn, what do you do?

A

a prolonged jaundice screen is performed

70
Q

causes of prolonged jaundice (>14 days) in a newborn

A

biliary atresia
hypothyroidism
galactosaemia
UTI
breast milk jaundice
prematurity
congenital infections

71
Q

what is staphylococcal scalded syndrome and how does it present

A

severe desquamating rash that affects infants

presentation: systemically ill child presents with superficial fluid-filled blisters with acute-onset erythroderma with a positive Nikolsky sign, oral mucosa is usually unaffected

72
Q

Nikolsky sign

A

slight pressure on skin causes peeling of superficial epidermis

positive is SSSS, TEN and pemphigus vulgaris

73
Q

mx SSSS

A

IV abx and supportive treatment

74
Q

what enterovirus causes hand-foot-and-mouth disease

A

typically Coxsackie A

75
Q

presentation of henoch-schonlein purpura

A

purpuric rash classically over lower limbs
abdo pain
arthralgia

76
Q

what is ALL

A

acute lymphoblastic leukaemia
most common paediatric cancer

77
Q

clinic presentation of ALL

A

pallor
unexplained bruising
persistent fatigue
hepatosplenomegaly
lymphadenopathy
increased susceptibility to infection so they might be having a huge reaction to a simple infection

most common in children 2-5 years

78
Q

mx ALL

A

treatment included chemotherapy and stem cell transplantation

79
Q

investigations for measles

A

3-14 days after onset of sx - measles specific IgG and IgM serolgy
1-3 days - PCR

80
Q

most common complication associated with measles

A

acute otitis media

81
Q

presentation of rubella

A

nonspecific sx
coryzal sx
arthralgia
rash that spreads from face to reset of body sparing limbs
lymphadenopathy

82
Q

what are the characteristic features of congenital rubella infection

A

cataracts
deafness
patent ductus arteriosus - machine-like murmur
brain damage
purpuric skin rash aka “blueberry muffin” rash

83
Q

presentation of mumps

A

high fever and multiple organ involvement
most common - parotitis
2nd most common - orchitis - swelling of the testicles

other rare presentations include
deafness
aseptic meningitis
encephalitis

84
Q

investigating mumps

A

saliva specific IgM

85
Q

how is impetigo presented

A

pruritic rash on the face usually with golden crusting
usually presents in infants and school age children

86
Q

management of impetigo

A

topical fusidic acid is the first line
oral flucloxacillin can be used if still persists

87
Q

when infected with impetigo when can children return to school

A

48 hours after abx therapy or after the lesions have crusted over

88
Q

1st and 2nd line mx tonic clonic seizures

A

1st - sodium valporate
2nd - lamotrigine/carbamezapine

89
Q

1st and 2nd line mx focal seizures

A

1st - carbamezapine/lamotrigine
2nd - sodium valporate

90
Q

what are atonic seizures

A

brief lapses in muscle tone
known as drop attacks

91
Q

what is status epilepticus

A

medical emergency

defined as when a seizure lasts longer than 5 minutes or they have 2 or more seizures without regaining consciousness in interim

92
Q

mx of status epilepticus

A

A-E
IV lorazepam twice
then final step is IV phenytoin or IV phenobarbital

93
Q

what are febrile convulsions

A

type of seizure that occurs in children with high fevers
not caused by epilepsy or any underlying neurological condition
appears in 6 months - 5 years old

94
Q

management of febrile convulsions

A

Identify and treat the underlying cause of high fever
control fever with simple analgesia

95
Q

what is west syndrome aka infantile spasms

A

rare disorder that occurs in infants aged around 6 months
characterised by a cluster of full-body spasms
poor prognosis

96
Q

management of west syndrome

A

prednisolone and vigabatrin

97
Q

EEG findings for West syndrome

A

hyps arrhythmia

98
Q

what are benign rolandic seizures?

A

occurs in 3-10-year-olds and almost exclusively in sleep
generalised tonic clinic seizures in their sleep
excellent prognosis - most outgrown by puberty
EEG findings - centrotemporal spikes

99
Q

what is a Wilm’s tumour

A

embryological tumour from developing kidney
most common abdomen tumour in children especially under 5

100
Q

presentation of Wilm’s tumour

A

abdominal mass that does not cross the midline
abdominal distension
haematuria

101
Q

diagnosis of Wilms tumour

A

initial ix: USS
diagnostic : biopsy

Clinical Medicine (26 decks)

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