Paediatrics Flashcards
Which virus is roseola infantum caused by?
HHV-6 (occasionally HHV-7)
What is the typical clinical picture in roseola infantum?
Fever 3-5 days
Widespread morbilliform rash
3-5mm discrete pink red macules and papules
What type of virus is measles caused by?
Paramyxovirus
How long should children with measles be excluded from school from?
5d from onset of rash
What type of virus is rubella caused by?
Togavirus
What is pinworm infection caused by?
Enterobium vermicularis
How do you treat pinworm infection?
Mebendazole
What does the 6-in-1 vaccine consist of?
DTaP/IPV/Hib/Hep B
Describe the disease course of pertussis
Stage 1: catarrhal
Stage 2: Paroxysmal
Stage 3: Convalescent
Name the triad of congenital rubella syndrome
Sensorineural hearing loss
Ocular abnormalities
Congenital heart defects
Name some risk factors for RDS
Premature
Male sex
Multiple pregnancy
Maternal diabetes
Perinatal asphyxia
Hypothermia
When should a baby be able to sit independently?
7-8 months
What is the definitive treatment for pyloric stenosis?
Ramstedt’s pyloromyotomy
When should a child be able to squat to pick up a toy?
18 months
What is HSP?
A systemic vasculitis characterised by deposition of immune complexes containing IgA in the skin and kidney
Which formula can estimate weight in children aged <10?
(Age + 4) x2
By which age should children turn towards soft sound?
6 months
Name some radiological features of NEC
Pneumatosis intestinalis
Air in the portal vein
Name some features of congenital hypothyroidism
“Good baby”
Lethargy
Poor feeding
Coarse facial features
Macroglossia
May have umbilical hernia
In which condition may you see the “thumbprint” sign?
Epiglottitis
Which organisms now cause epiglottitis?
Streptococci
What is the most common form of childhood epilepsy?
Benign rolandic epilepsy
Most seizures are focal motor aware (simple partial)
Affecting the rolandic area of the brain - centrotemporal area
What is a “stork mark”?
Pink, flat irregularly shaped mark on the back of the neck
What can cause a pseudomembranous pharyngitis?
Diphtheria
How should you treat nappy rash?
Colonisation with C. albicans is usual
Frequent changing
Washing with warm water
Using a barrier preparation such as zinc or metanium
Consider topical hydrocortisone
Consider topical imidazole cream
What treatments can be used for non bullous impetigo?
Hydrogen peroxide 1% cream
Fusidic acid
Mupirocin
Name some risk factors for NEC
Premature
Low birth weight
Abnormal intestinal colonisation
Ischaemia
What is the best test for GH deficiency?
Insulin tolerance test
Name some clinical features of ALL
Anaemia
Bleeding
Infections
Bone pain
Splenomegaly
Lymphadenopathy
Thymic enlargement
CNS involvement
What is Forchheimer’s sign?
Petechia on the soft palate
Sometimes seen in Rubella
What are the key features of Pierre-Robin syndrome?
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
What are the key features of Patau syndrome?
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
What are the key features of William’s syndrome?
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
What are the key features of Noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
By what age to most children achieve day and night time continence?
3-4 years
How can you manage nocturnal enuresis in children?
Look for possible underlying causes/triggers:
constipation
diabetes mellitus
UTI if recent onset
general advice
fluid intake
Toileting patterns: encourage to empty bladder regularly during the day and before sleep
lifting and waking
reward systems (e.g. Star charts)
NICE recommend these ‘should be given for agreed behaviour rather than dry nights’ e.g. Using the toilet to pass urine before sleep
enuresis alarm
generally first-line for children
have sensor pads that sense wetness
high success rate
Desmopressin
particularly if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family
Describe some normal changes in puberty
Gynaecomastia may develop in boys
Asymmetrical breast growth may occur in girls
Diffuse enlargement of the thyroid gland may be seen
Describe some female changes in puberty
First sign is breast development at around 11.5 years of age (range = 9-13 years)
Height spurt reaches its maximum early in puberty (at 12) , before menarche
Menarche at 13 (11-15)
There is an increase of only about 4% of height following menarche
Describe some male changes in puberty
First sign is testicular growth at around 12 years of age (range = 10-15 years)
Testicular volume > 4 ml indicates onset of puberty
Maximum height spurt at 14
What is the triad of shaken baby syndrome?
Retinal haemorrhages
Subdural haematoma
Encephalopathy
What is the most common cause of congenital hypothyroidism in the UK?
Autoimmune thyroiditis
Name some fine motor developmental milestones at 3 months
Reaches for object
Holds rattle briefly if given to hand
Visually alert, particularly human faces
Fixes and follows to 180 degrees
Name some fine motor developmental milestones at 6 months
Holds in palmar grasp
Pass objects from one hand to another
Visually insatiable, looking around in every direction
Name some fine motor developmental milestones at 9 months
Points with finger
Early pincer
Name some fine motor developmental milestones at 12 months
Good pincer grip
Bangs toys together
How many bricks should a child be able to stack at 15 months?
Tower of 2
How many bricks should a child be able to stack at 18 months?
Tower of 3
How many bricks should a child be able to stack at 2 years?
Tower of 6
How many bricks should a child be able to stack at 3 years?
Tower of 9
By what age should a child be able to copy a circle?
3 years
What are the characteristics of an irritant dermatitis nappy rash?
The most common cause, due to irritant effect of urinary ammonia and faeces
Creases are characteristically spared
What is the most common cause of headache in children?
Migraine without aura
What is hypospadias?
Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants
Name some potential consequences of HHV-6 infection
Aseptic meningitis
Hepatitis
Name some major risk factors for SIDS
Prone sleeping
Parental smoking
Bed sharing
Hyperthermia and head covering
Prematurity
Name some potential complications of scarlet fever
Otitis media: the most common complication
Rheumatic fever: typically occurs 20 days after infection
Acute glomerulonephritis: typically occurs 10 days after infection
Invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
Name some features of Kawasaki disease
High-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms of the hands and the soles of the feet which later peel
Describe the management of Kawasaki disease
High-dose aspirin
Kawasaki disease is one of the few indications for the use of aspirin in children. Due to the risk of Reye’s syndrome aspirin is normally contraindicated in children
Intravenous immunoglobulin
Echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms
When is the Men B vaccine given?
2 months
4 months
12-13 months
What is ITP?
(ITP) is an immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.
How do you manage ITP?
Usually, no treatment is required
ITP resolves in around 80% of children with 6 months, with or without treatment
advice to avoid activities that may result in trauma (e.g. team sports)
Other options may be indicated if the platelet count is very low (e.g. < 10 * 109/L) or there is significant bleeding.
Options include:
Oral/IV corticosteroid
IV immunoglobulins
Platelet transfusions can be used in an emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by the circulating antibodies
What are the clinical features of TGA?
Cyanosis
Tachypnoea
Loud single S2
Prominent right ventricular impulse
‘egg-on-side’ appearance on chest x-ray
What may be given to ensure maintenance of the ductus arteriosus?
Prostaglandin E1
What is gastroschisis?
Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord
What is exomphalos?
In exomphalos (also known as an omphalocoele) the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.
What are some associations of exomphalos?
Beckwith-Wiedemann syndrome
Down’s syndrome
Cardiac and kidney malformations
Name some important development referral criteria
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
hand preference before 12 months is abnormal and may indicate cerebral palsy
What type of hearing test is performed for newborns?
Otoacoustic emission test
All newborns should be tested as part of the Newborn Hearing Screening Programme. A computer-generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea
Give some examples of trinucleotide repeat disorders
Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
spinocerebellar ataxia
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy
Name some causes of obesity in children
growth hormone deficiency
hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader-Willi syndrome
Give some causes of microcephaly
normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis
Describe the clinical features of TOF
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
Describe some features of fragile X syndrome
learning difficulties
large low set ears, long thin face, high arched palate
macroorchidism
hypotonia
autism is more common
mitral valve prolapse
Name some complications of pertussis
subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures
How do you treat pertussis?
Oral macrolide
Name some causes of snoring in children
obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism
Name some clinical features of osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
Name some features of Pierre-Robin syndrome
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
Name some features of Cri-du-Chat syndrome
Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism
Name some speech and language milestones at 3 months
Quietens to parents voice
Turns towards sound
Squeals
Name some speech and language milestones at 6 months
Double syllables ‘adah’, ‘erleh’
Name some speech and language milestones at 9 months
Says ‘mama’ and ‘dada’
Understands ‘no’
Name some speech and language milestones at 12 months
Knows and responds to own name
Name some speech and language milestones at 12-15 months
Knows about 2-6 words (Refer at 18 months)
Understands simple commands - ‘give it to mummy’
Name some speech and language milestones at 2 years
Combine two words
Points to parts of the body
Name some speech and language milestones at 2.5 years
Vocabulary of 200 words
Name some speech and language milestones at 3 years
Talks in short sentences (e.g. 3-5 words)
Asks ‘what’ and ‘who’ questions
Identifies colours
Counts to 10 (little appreciation of numbers though)
Name some speech and language milestones at 4 years
Asks ‘why’, ‘when’ and ‘how’ questions
Name some investigations of vesicoureteric reflux
VUR is normally diagnosed following a micturating cystourethrogram
a DMSA scan may also be performed to look for renal scarring
Name some gross motor milestones at 3 months
Little or no head lag on being pulled to sit
Lying on abdomen, good head control
Held sitting, lumbar curve
Name some gross motor milestones at 6 months
Lying on abdomen, arms extended
Lying on back, lifts and grasps feet
Pulls self to sitting
Held sitting, back straight
Rolls front to back
Name some gross motor milestones at 9 months
Pulls to standing
Crawls
Name some gross motor milestones at 7-8 months
Sits without support (Refer at 12 months)
Name some gross motor milestones at 12 months
Cruises
Walks with one hand held
Name some gross motor milestones at 13-15 months
Walks unsupported (Refer at 18 months)
Name some gross motor milestones at 18 months
Squats to pick up a toy
Name some gross motor milestones at 2 years
Runs
Walks upstairs and downstairs holding on to rail
Name some gross motor milestones at 3 years
Rides a tricycle using pedals
Walks up stairs without holding on to rail
Name some gross motor milestones at 4 years
Hops on one leg
Name some features of Patau syndrome (trisomy 13)
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
How do you manage labial adhesions?
conservative management is appropriate in the majority of cases
if there are associated problems such as recurrent urinary tract infections oestrogen cream may be tried
if this fails surgical intervention may be warranted
When do ‘bow legs’ typically resolve by?
Typically resolves by the age of 4-5 years
How long should children with mumps be excluded from school for?
5 days from onset of swollen glands
What is the risk of Down’s syndrome in 40 year old mothers?
1/100
What are the forms of Down’s syndrome?
Nondisjunction
Robertsonian translocation
(usually onto 14)
Mosaicism*
Which organisms may colonise in CF?
Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus
Which cardiac complications are common in Down’s syndrome?
multiple cardiac problems may be present
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)
Which vaccines are given at 2 months?
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B
Which vaccines are given at 3 months?
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
PCV
Which vaccines are given at 4 months?
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Men B
Which vaccines are given at 12-13 months?
Hib/Men C
MMR
PCV
Men B
Which vaccines are given at 2-8 years?
Flu vaccine (annual)
Which vaccines are given at 3-4 years?
‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR
Which vaccines are given at 12-13 years?
HPV vaccination
Which vaccines are given at 13-18 years?
‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
