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Med School Finals > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Immunisations for 2 months, 3 months, 4 months, 1 year, 3-4 years, 12-13 years, 14 years?

A

2 months = 6-in-1, oral rotavirus, Men B
3 months = 6-in-1, oral rotavirus, PCV
4 months = 6-in-1, Men B
1 year = Hib/Men C, MMR, PCV, Men B
3-4 years = 4-in-1, MMR
12-13 years = HPV (6, 11, 16 & 18)
14 years = 3-in-1, men ACWY

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2
Q

When should premature babies be immunised?

A

No adjustment needed
→ if < 28 weeks vaccines should be given in hospital

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3
Q

What is included in the 6-in-1, 4-in-1 and 3-in-1 vaccines?

A

6-in-1 = diphtheria, tetanus, whooping cough, polio, Hib and hep B
4-in-1 = diphtheria, tetanus, whooping cough and polio
3-in-1 = diphtheria, tetanus and polio

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4
Q

Extra vaccination offered at birth if TB risk factors?

A

BCG

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5
Q

Features and management of measles?

A

Generally unwell e.g. fever
White (Koplik) spots in mouth
Rash that starts behind ears
Management = supportive

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6
Q

Features and management of mumps?

A

Generally unwell e.g. fever
Parotitis, orchitis, pancreatitis
Management = supportive

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7
Q

Features and management of rubella?

A

Generally unwell e.g. fever
Lymphadenopathy
Rash that starts on face
Management = supportive

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8
Q

School exclusion for children with measles vs mumps vs rubella?

A

Measles = 4 days from rash onset
Mumps = 5 days from swollen gland onset
Rubella = 5 days from rash onset

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9
Q

Hearing test done after birth vs before entering school?

A

Birth = otoacoustic emission test
→ brainstem response test is abnormal
Before school = pure tone audiometry

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10
Q

When is the heel-prick test carried out?

A

5-9 days after birth

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11
Q

Conditions the heel-prick test screens for?

A

Congenital hypothyroidism
Maple syrup urine disease
Cystic fibrosis
Sickle cell disease
Phenylketonuria
Homocytinuria
MCADD
Isovaleric acidaemia
Glutaric aciduria type 1

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12
Q

When should a child smile?

A

6 weeks

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13
Q

When should a child sit without support vs crawl vs walk unsupported?

A

Sit = 7-8 months
Crawl = 9 months
Walk = 13-15 months

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14
Q

When should a child hold things with palmar grasp vs have good pincer grip?

A

Palmar grasp = 6 months
Pincer grip = 12 months

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15
Q

Referral indications for child developmental delay?

A

Does not smile by 10 weeks
Cannot sit unsupported by 12 months
Cannot walk unsupported at 18 months

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16
Q

Hand preference before 12 months?

A

May indicate cerebral palsy

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17
Q

Milestone age correction for premature baby?

A

Normal age + number of weeks born early

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18
Q

Neonatal period?

A

0-28 days

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19
Q

APGAR score components and when is it assessed?

A

Appearance, Pulse, Grimace, Activity, Respiration
1, 5 and 10 minutes post-delivery

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20
Q

Normal HR and RR for children < 1?

A

HR = 100-160
RR = 30-40

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21
Q

Newborn resuscitation?

A
  1. Dry baby and maintain temperature
  2. Gasping or not breathing = 5 inflation breaths
  3. Reassess and repeat inflation breaths if needed
  4. No improvement = 30 seconds ventilation
  5. No improvement = 3:1 CPR
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22
Q

Most common cause of NRDS and main risk factor?

A

Transient tachypnoea of the newborn (TTN)
C-section delivery

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23
Q

Features, investigation and management of TTN?

A

Tachypnoea
Nasal flaring and grunting
Use of accessory muscles
Investigation = CXR (fluid in horizontal fissure)
Management = supportive

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24
Q

Features and management of meconium aspiration syndrome?

A

Meconium stained liquor
Green staining of infant
Post-term or difficult delivery
Respiratory distress
Management = supportive

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25
Q

Acute management of congenital heart disease?

A

Prostaglandin E1 e.g. alprostadil

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26
Q

Anatomical features of TOF and implication?

A

Ventricular septal defect
Right ventricular hypertrophy
Pulmonary stenosis
Overriding aorta
Implication = right-to-left shunt

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27
Q

What determines the severity of TOF?

A

Degree of pulmonary stenosis

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28
Q

Features and management of TOF?

A

Cyanotic “tet” spells
Apnoeic episodes
Tachypnoea
Failure to thrive
Ejection systolic murmur
Management = surgery, beta-blockers for tet spells

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29
Q

CXR feature of TOF?

A

“Boot-shaped” heart (due to RVH)

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30
Q

Anatomical feature of patent ductus arteriosus and implication?

A

Connection between pulmonary trunk and descending aorta
Implication = left-to-right shunt

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31
Q

Features and management of patent ductus arteriosus?

A

Continuous “machine-like” murmur
Left subclavicular thrill
Collapsing pulse
Wide pulse pressure
Management = NSAID e.g. indomethacin

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32
Q

Features of innocent murmur?

A

5 S’s:
→ soft
→ short
→ systolic
→ symptomless
→ situational (postural)

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33
Q

Management of neonatal hypoglycaemia?

A

Asymptomatic = encourage breast/bottle feed + monitor
Symptomatic or severe = IV dextrose 10%

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34
Q

Is jaundice normal in newborns?

A

Yes, between 2-14 days
< 24 hours or > 14 days = assess for pathology

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35
Q

Causes of jaundice in < 24 hours old?

A

Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency

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36
Q

Causes of jaundice in > 14 days old?

A

Biliary atresia
Hypothyroidism
Infection
Prematurity
Breast milk jaundice

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37
Q

Features and management of biliary atresia?

A

Jaundice > 14 days old
Hepatosplenomegaly
High conjugated bilirubin
Management = kasai procedure, liver transplant

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38
Q

Features of neonatal GORD?

A

Milky vomit after feeds
Worse when laid flat
Cough, hoarse crying

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39
Q

Parental counselling on GORD?

A
  • Due to immature LOS
  • 90% improve by age 1
  • Give small and frequent feeds
  • Keep baby upright and burp regularly
  • Other options = Gavison, thickened formulas, PPI trial
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40
Q

Features of cow’s milk protein intolerance and cow’s milk protein allergy?

A

Milky vomit after feeds
Diarrhoea, bloating, irritability
Urticaria, pruritis, rash (CMPA only!)

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41
Q

Parental counselling on CMPA/CMPI?

A
  • Most grow out of it by 2-3 years
  • Other CMPA options = hydrolysed formula or breast feeding with mum avoiding dairy
  • Other CMPI options = hydrolysed formula or breast feeding
42
Q

Parental counselling on breastfeeding?

A
  • Recommended exclusively until 6 months
  • Benefits = contains antibodies and nutrients required by baby, less likely to be overweight, reduced maternal breast and ovarian cancer risk
  • Disadvantages = cracked/sore nipples, risk of mastitis and abscess
43
Q

Features and management of neonatal sepsis?

A

Respiratory distress
Tachycardia
Jaundice, seizures
Group B strep infection
Management = IV benzypenicillin + IV gentamicin

44
Q

Capput succedaneum vs cepahlohaematoma?

A

Capput succedaneum = present at birth, vertex, swelling crosses suture lines, resolves quickly
Cephalohaematoma = develops after birth, parietal, swelling does not cross suture lines, resolves slowly

45
Q

Main risk factor and management of intraventricular haemorrhage?

A

Preterm birth
Management = supportive, shunt if hydrocephalus

46
Q

Management of undescended testes?

A

Unilateral = consider referral around 3 months
Bilateral = paediatric review < 24 hours

47
Q

Management of hypospadius?

A

Surgery around 12 months

48
Q

Shaken baby syndrome features?

A

Triad of:
→ retinal haemorrhages
→ subdural haematoma
→ encephalopathy

49
Q

Inheritance patterns that can only be passed down from maternal line?

A

X-linked recessive
Mitochondrial

50
Q

Genetics and features of Down’s syndrome?

A

Trisomy 21
→ small, low-set ears
→ epicanthic folds
→ single palmar crease
→ learning difficulties
→ hypotonia
→ heart defect
→ duodenal atresia
→ hirchsprung’s disease

51
Q

Most common congenital heart defect in Down’s syndrome?

A

Endocardial cushion defect
Ventricular septal defect

52
Q

Complications of Down’s syndrome?

A

Glue ear
Recurrent infection
Hypothyroidism
Alzheimer’s disease

53
Q

Genetics and features of Turner’s syndrome?

A

45 X or 45 XO
→ wide chest
→ webbed neck
→ primary amenorrhea
→ learning difficulties
→ heart defect
→ horseshoe kidney

54
Q

Most common congenital heart heart defects in Turner’s syndrome?

A

Bicuspid aortic valve
Coarctation of the aorta

55
Q

Male version of Turner’s syndrome?

A

Noonan syndrome

56
Q

Genetics and features of Prader-Willi syndrome?

A

Deletion on chromosome 16
→ childhood obesity
→ hypotonia
→ hypogonadism
→ learning difficulties

57
Q

Genetics and features of Fragile X syndrome?

A

Trinucleotide repeat (CGG)
→ large, low-set ears
→ long, thin face
→ high arched palate
→ macroorchidism
→ learning difficulties

58
Q

Genetics and features of Klinefelter’s syndrome?

A

47 XXY
→ tall
→ delayed puberty
→ small, firm testes
→ gynaecomastia

59
Q

Genetics and features of Kallman’s syndrome?

A

X-linked recessive
→ anosmia
→ delayed puberty
→ hypogonadism
→ cryptorchidism

60
Q

Genetics and features of androgen insensitivity syndrome?

A

46 XY (male) with female phenotype
→ primary amenorrhea
→ undescended testes in groin

61
Q

First sign of puberty in males vs females?

A

Males = testicular growth
Females = breast development

62
Q

Definition of precocious puberty?

A

Secondary sexual characteristics in females < 8 years and males < 9 years

63
Q

When should a child be urinary continent?

A

3 to 4 years old

64
Q

Management of nocturnal enuresis?

A

1st line = lifestyle advice
2nd line = enuresis alarm
3rd line = desmopressin
N.B. desmopressin may also be used short-term e.g. for a sleepover

65
Q

Management of UTI in children?

A

< 3 months = urgent paediatric referral
> 3 months upper UTI = admission + antibiotics
> 3 months lower UTI = antibiotics

66
Q

Features and investigation for vesicoureteric reflux?

A

Hydronephrosis
Recurrent UTIs
Chronic pylonephritis
Investigation = micturating cystourethrogram

67
Q

Red flag in dehydrated child?

A

Reduced skin turgor

68
Q

Dehydration management in children?

A

Give 50ml/kg ORS over 4 hours + ORS maintenance

69
Q

Features of infantile colic?

A

Irritability
Crying
Drawing up of knees

70
Q

Management of constipation (< 3 stools a week) in children?

A

1st line = movicol paediatric plain
2nd line = add stimulant laxative
3rd line = stimulant + osmotic laxative

71
Q

Feature, investigation and management of Hirschprung’s disease?

A

Feature = failure to pass meconium
Investigation = AXR, rectal biopsy (gold standard)
Management = bowel irrigation, surgery

72
Q

Features, investigation and management of intussusception?

A

Features = bilious vomit, abdominal pain, drawing knees up and turning pale, bloody stool, sausage-shaped mass
Investigation = abdo USS
Management = air insufflation, surgery

73
Q

Abdominal USS feature of intussusception?

A

Target sign

74
Q

Most common cause of painless, massive GI bleed in young children?

A

Meckel’s diverticulum

75
Q

Features, investigation and management of Meckel’s diverticulum?

A

Features = usually asymptomatic, abdominal pain mimicking appendicitis, melaena, obstruction
Investigation = 99m technetium scan
Management = surgery

76
Q

Features, investigation and management of pyloric stenosis?

A

Features = non-bilous projectile vomit, dehydration, abdominal mass
Investigation = abdo USS
Management = ranstedt pyloromyotomy

77
Q

Metabolic derangement associated with pyloric stenosis?

A

Hypochloraemic hypokalaemic metabolic alkalosis

78
Q

Management of gastroschisis vs exomphalos?

A

Gastroschisis = urgent surgery
Exomphalos = staged repair, cover with sac until ready for surgery

79
Q

Features of growing pains?

A

Not present when child wakes up
Intermittent symptoms
Systemically well
No limp or examination findings

80
Q

Barlow and Ortolani test?

A

Barlow = trying to dislocate femoral head
Ortolani = trying to relocate femoral head

81
Q

Babies who automatically need USS for DDH?

A

Breech presentation
FH of hip problems at birth
Multiple pregnancy

82
Q

Investigations and management of DDH?

A

< 4.5 months = USS
> 4.5 months = X-ray
Management = Pavlik harness

83
Q

Features and management of transient synovitis?

A

Mostly children aged 3-8
Limp/not weight bearing
Groin or hip pain
Should NOT have high fever
Management = supportive

84
Q

Features and management of slipped capital femoral epiphysis?

A

Obese child
Hip, groin or knee pain
Loss of internal rotation in flexion
Management = internal fixation

85
Q

Features and management of Perthe’s disease?

A

Progressive hip pain
Limp/not weight bearing
Reduced range of movement
Management = brace/cast + observation (< 6), surgical management (> 6)

86
Q

Pathophysiology of cerebral palsy and causes?

A

Non-progressive lesion of the motor pathways in the developing brain
→ cerebral malformation
→ congenital infection e.g. rubella
→ IVH
→ hypoxia/asphyxiation

87
Q

Most common meningitis organisms in neonates vs > 1 year?

A

Neonates = group B strep
> 1 year = neisseria meningitidis

88
Q

Management of paediatric meningitis?

A

< 3 months = IV amoxicillin or ampicillin + IV cefotaxime
> 3 months = IV cefotaxime or ceftriaxone
Steroids can be used in children > 3 months

89
Q

Child has clusters of movements like body scrunching or head bobs?

A

Infantile spasms

90
Q

Child goes pale, falls to floor and recovers quickly after pain or intense emotion?

A

Reflex anoxic seizure

91
Q

Child has exclusively nighttime seizures?

A

Benign rolandic epilpesy

92
Q

Features and management of simple vs complex febrile seizure?

A

Simple = < 15 mins, generalised, no recurrence within 24 hours
Complex = 15-30 mins, focal, may recur within 24 hours
Management = supportive, BZD if needed

93
Q

Parental counselling for febrile seizures?

A
  • Affects children 6 months-5years
  • 1 in 3 risk of recurrence
  • Anti-pyretics do not reduce risk
  • Call ambulance if lasts > 5 mins
  • Small risk of developing epilepsy especially if complex seziures
94
Q

Nerve roots affected in Erb’s vs Klumpke’s palsy and clinical sign?

A

Erb’s = C5, C6
→ waiter’s tip
Klumpke’s = C8, T1
→ claw hand

95
Q

Management of a pulled elbow (radial head subluxation)?

A

Passive pronation with elbow flexed at 90°

96
Q

Management of talipes equinovarus (club foot)?

A

Ponseti method (progressive casting)
Night-time braces until age 4

97
Q

Paediatric resuscitation?

A
  1. Airway manoeuvres
  2. Give 5 rescue breaths
  3. Check femoral or brachial pulse
  4. Give 15:2 CPR
98
Q

Features and management of Kawasaki disease?

A

Fever resistant to antipyretics
Conjunctival injection
Red, cracked lips
Strawberry tongue
Red palms/soles → desquamation
Management = high-dose aspirin + IV immunoglobulins

99
Q

Complication of Kawasaki disease and screening test?

A

Coronary artery aneurysm
Echocardiogram

100
Q

Management of threadworms?

A

Mebendazole and hygiene advice for all household members

Med School Finals (18 decks)

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