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Finals > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Neonatal blood spot screening

A

5-9 days of life

  • congential hypothyroidism
  • CF
  • sickle cell disease
  • PKU
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2
Q

cephalhaematoma vs caput succedaneum

A

Cephalhaematoma

  • develops several hours after birth
  • parietal region, does not cross suture lines
  • may take months to resolve

Caput succedaneum

  • present at birth
  • forms over vertex and crosses suture line
  • resolves within days
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3
Q

Mx of hand, foot and mouth

A
  • symptomatic - hydration and analgesia
  • no school exclusion
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4
Q

Vaccines at birth?

A

BCG only if indicated

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5
Q

2 month vaccine

A
  • ‘6-1 vaccine’ (BTWPHD)
  • Oral rotavirus vaccine
  • Men B
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6
Q

3 months vaccine

A
  • ‘6-1 vaccine’ (BTWPHD)
  • Oral rotavirus vaccine
  • PCV
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7
Q

4 month vaccine

A
  • ‘6-1 vaccine’ (BTWPHD)
  • MEN B
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8
Q

12-13 month vaccine

A
  • Hib/Men C
  • MMR
  • PCV
  • Men B
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9
Q

2-8 years vaccine

A

Flu vaccine (annual)

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10
Q

3-4 year vaccine

A
  • ‘4-in-1 pre-school booster’ (DTWP)
  • MMR
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11
Q

12-13 years vaccine

A

HPV

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12
Q

13-18 year vaccine

A
  • ‘3-in-1 teenage booster’ (DTP)
  • Men ACWY
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13
Q

ITP in children

A
  • Immune-mediated reduction in platelet count (Type II hypersensitivty)
  • Antibodies against glycoprotein IIb/IIIa or Ib-V-IX complex
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14
Q

ITP triggers

A

infection or vaccine

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15
Q

Neonatal hypoglycaemia

A

May present as a jittery and hypotonic baby

BM < 2.6 mmol/L

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16
Q

Mx neonatal hypoglycaemia

A

Asymptomatic

  • encourage normal feeding
  • monitor blood glucose

Symptomatic or very low BM

  • admit to neonatal unit
  • IV infusion 10% dextrose
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17
Q

Diagnostic criteria for whooping cough

A

Acute cough for >14 days without another apparent cause, and atleast one of the following:

  • Paroxysmal cough.
  • Inspiratory whoop.
  • Post-tussive vomiting.
  • Undiagnosed apnoeic attacks in young infants.
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18
Q

Dx whooping cough

A
  • nasal swab culture
  • PCR and serology
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19
Q

Mx whooping cough

A
  • < 6 months → admit
  • If onset of cough within 21 days → oral macrolide
  • offer household contacts antibiotic prophylaxis
  • school exclusion: 48 hours after commencing abx (or 21 days from onset of sx)
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20
Q

Vaccinations offered to pregnant woman?

A
  • Pertussis between 16-32 weeks
  • Influenza (at any point of her pregnancy)
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21
Q

Contraindication to lumbar puncture

A

Any signs of raised ICP

  • focal neurological signs
  • papilloedema
  • significant bulging of the fontanelle
  • DIC
  • signs of cerebral herniation
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22
Q

Investigation for meningococcal septicaemia

A

Blood cultures and PCR for meningococcus

lumbar puncture is CI

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23
Q

Mx of Meningitis in children

A
  1. Antibiotics
  • < 3 months: IV amoxicillin+ IV cefotaxime
  • > 3 months: IV cefotaxime
  1. Consider Dex if LP shows:
  • frankly purulent CSF
  • CSF WBC > 1000/microlitre
  • raised CSF WBC with protein >1 g/litre
  • bacteria on Gram stain
  1. Fluids
  2. Cerebral monitoring
  3. Public health notification and antibiotic prophylaxis of contacts (ciprofloxacin)
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24
Q

In what age group should steroids be avoided

A

< 3 months

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25
Q

Most common malignancy affecting children

A
  1. Acute lymphoblastic leukaemia
  2. Acute Myeloid Leukaemia
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26
Q

Features of ALL

A

Predicted by BM failure

  • anaemia: lethargy and pallor
  • neutropaenia: frequent or severe infections
  • thrombocytopenia: easy bruising, petechiae
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27
Q

Hirschsprung’s disease

A

aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses

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28
Q

Hirschsprung’s disease associations

A
  • x3 more common in Males
  • Down Syndrome
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29
Q

Hirschsprung’s presentations

A

Neonatal period e.g. failure or delay to pass meconium
Older children: constipation, abdominal distension

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30
Q

Hirshprungs investigation

A

abdominal x-ray
rectal biopsy: gold standard for diagnosis

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31
Q

Hirshprungs Mx

A

Initially: rectal washouts/bowel irrigation
definitive: surgery to affected segment of the colon

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32
Q

Kawasaki disease features

A
  • high-grade fever > 5 days
  • conjunctival injection
  • bright red, cracked lips
  • strawberry tongue
  • cervical lymphadenopathy
  • red palms of hands and soles of feet
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33
Q

Mx Kawasaki disease

A
  • high-dose aspirin
  • IV immunoglobulin
  • echocardiogram (CAA)
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34
Q

Jaundice in the first 24 hrs

A

Always pathological

  • rhesus haemolytic disease
  • ABO haemolytic disease
  • hereditary spherocytosis
  • G6PD
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35
Q

Jaundice from 2-14 days

A

Usually physiological - more common in breastfed babies

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36
Q

Jaundice > 14 days ‘prolonged’

A
  • Prolonged jaundice screen
  • Look for causes/pathologies
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37
Q

Mx UTI in children

A
  • Infants < 3 months → Refer immediately
  • Children > 3 months with upper UTI → consider admission OR oral abx ie. cephalosporin or co-amoxiclav for 7-10 days
  • Children > 3 months with lower UTI → oral antibiotics for 3 days ie. trimethoprim, nitrofurantoin
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38
Q

Fetal alcohol syndrome

A

short palpebral fissure
hypoplastic upper lip
smooth/absent filtrum
learning difficulties
microcephaly
growth retardation
epicanthic folds
cardiac malformations

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39
Q

Developmental problem refferal points

A

doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months

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40
Q

Eczema distribution

A
  • Infants → face and trunk
  • Younger children → extensor surfaces
  • Older children → flexor surfaces and creases of the face and neck (typical)
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41
Q

William’s syndrome

A

Microdeletion on chromosome 7

  • Rlfin-like facies
  • Friendly and social
  • Learning difficulties
  • short stature
  • transient neonatal hypercalcaemia
  • supravalvular aortic stenosis
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42
Q

Gastroschisis + Mx

A

Congenital defect in anterior abdominal wall, lateral to umbilical cord

Mx:

  • vaginal delivery
  • newborns should go to theatre ASAP
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43
Q

Exomphalos (omphalocoele) + Mx

A

Abdominal contents protrude through anterior abdominal wall but are covered in sac formed by amniotic membrane and peritoneum

Mx:

  • C-section
  • Staged repair
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44
Q

Mx of Phimosis

A

< 2 Expectant Mx
> 2 AND recurrent balanoposthitis or UTI → consider treatment

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45
Q

Diagnosis and Mx of pyloric stenosis

A
  • Diagnosis USS
  • Mx is Ramstedt pyloromyotomy
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46
Q

Common cardiac conditions associated with Turners

A
  1. Bicuspid aortic valve
  2. Coarctation of the aorta (5-10%)
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47
Q

Severity of Croup stages

A

Mild

  • Occasional barking cough with no stridor at rest
  • No recessions
  • Well looking child

Moderate:

  • Frequent barking cough and stridor at rest
  • Recessions at rest
  • No distress

Severe:

  • Prominent inspiratory stridor at rest
  • Marked recessions
  • Distress, agitation or lethargy
  • Tachycardia
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48
Q

Mx Croup

A
  • Admit any child with moderate or severe croup
  • Single dose oral dexamethasone (0.15 mg/kg) should be given regardless of severity
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49
Q

Admission criteria for Croup

A
  • Moderate- Severe
  • < 6 months
  • Upper airway abnormalities (eg. Laryngomalacia, DS)
  • Uncertainty about diagnosis
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50
Q

Investigations for Croup

A

Majority diagnosed clinically

Chest x-ray may show

  • PA - subglottic narrowing (‘steeple sign’)
  • Lateral view in acute epiglottis will show swelling of epiglottis ( ‘thumb sign’)
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51
Q

Developmental milestones: speech and hearing

A

3 months: Turns towards sound
6 months: Double syllables ‘adah’, ‘erleh’
9 months: Says ‘mama’ and ‘dada’
12 months: Knows and responds to own name

2 years: Combine two words
3 years: Asks ‘what’ and ‘who’
4 years : Asks ‘why’, ‘when’ and ‘how’

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52
Q

When should an acute limp always be reffered

A
  • < 3 years
  • Fever/ suspicion of septic arthritis
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53
Q

Criteria for diagnosing acute pyelonephritis in children

A
  • Temp >38
  • Loin pain or tenderness
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54
Q

Investigating UTI in children

A
  • ALL < 6months → abdo USS within 6 weeks/ during illness
  • Recurrent UTIs → abdo USS within 6 weeks
  • Atypical UTIs → abdo USS during illness
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55
Q

Role of DMSA in UTIs

A
  • Used 4-6 months after illness
  • Assess damage for recurrent or atypical UTI
  • Areas where DMSA has not been uptaken = scarring
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56
Q

Role of MCUG in UTIs

A
  • Investigate recurrent or atypical UTIs in <6 months
  • Diagnose VUR “dilation or ureters on USS or poor urinary flow”
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57
Q

Grading of VUR

A
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58
Q

VUR

A
  • ureters displaced laterally - enter bladder more perpendicular
  • shortened intramural course of ureter
  • VUJ cannot function adequately
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59
Q

Mx Acute asthma in children

A

Mild - Moderate → Steroid + Bronchodilator therapy

  • < 3 years - beta-2 agonist via spacer, 1 puff every 30-60 secs (max 10 puffs)

Severe- life threatening → transfer immediately to hospital.

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60
Q

PDA murmur

A

Continuous crescendo-decrescendo “machinery” murmur

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61
Q

Causes of PDA

A
  • Prematurity
  • Maternal Rubella infection
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62
Q

Features of PDA

A
  • left subclavicular thrill
  • continuous ‘machinery’ murmur
  • large volume, bounding, collapsing pulse
  • wide pulse pressure
  • heaving apex beat
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63
Q

Mx PDA

A

Indomethacin or ibuprofen to neonate

  • Inhibits prostaglandin E2
  • Given if echo shows PDA, few days after birth

If a/w other congenital heart defect → PGE1 to keep duct open

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64
Q

Roseola infantum “sixth disease”

A

Human herpes virus 6 (HHV6)

  • High fever lasting a few days, followed by maculopapular rash
  • Nagayama spots: papular enanthem on uvula and soft palate

Complication: febrile convulsions

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65
Q

Developmental milestones: fine motor and vision

A

3 months: reaches for object, fixes and follows to 180 degrees
6 months: palmar grasp, pass objects from one hand to another
9 months: points with finger, early pincer
12 months: good pincer grip

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66
Q

Bricks

A
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67
Q

Drawing

A

2 3 4
I O X

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68
Q

Hand preference

A

<12 months is abnormal and may indicate cerebral palsy

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69
Q

Chickenpox

A

Primary infection with varicella zoster

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70
Q

Infectivity period of chickenpox

A

4 days before rash, until 5 days after the rash first appeared

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71
Q

Features of chickenpox

A
  • Fever initially
  • Itchy, rash starting on head/trunk before spreading.
  • Macular → papular → vesicular
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72
Q

school exclusion chickenpox

A

Yes

  • Most infectious period is 1–2 days before rash appears
  • Infectivity continues until all lesions are dry and crusted (usually about 5 days after the onset of the rash)
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73
Q

Common complication of chickenpox

A

Secondary bacterial infection of lesions
(NSAIDs increase risk)

Small number progress to invasive group A strep → necrotizing fasciitis

74
Q

What medication should be avoided in chickenpox

A

NSAIDs - increase risk of secondary bacterial infection

75
Q

Rare complications of chickenpox

A
  • pneumonia
  • encephalitis (cerebellar involvement may be seen)
  • disseminated haemorrhagic chickenpox
  • arthritis, nephritis and pancreatitis
76
Q

Measles

A

Prodrome: irritable, conjunctivitis, fever

Koplik spots: white spots (‘grain of salt’) on buccal mucosa

Rash: starts behind ears then whole body, discrete maculopapular rash becoming blotchy & confluent

77
Q

Mumps

A

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

78
Q

Rubella

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day

Lymphadenopathy: suboccipital and postauricular

79
Q

Erythema infectiosum

A
  • ‘Fifth disease’ or ‘slapped-cheek syndrome’
  • Parvovirus B19
  • Lethargy, fever, headache
  • ‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
80
Q

Scarlet fever

A
  • Rxn to erythrogenic toxins produced by Group A haemolytic strep
  • Fever, malaise, tonsillitis
  • ‘Strawberry’ tongue
  • Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
81
Q

Hand, foot and mouth disease

A
  • Coxsackie A16
  • Mild systemic upset: sore throat, fever
  • Vesicles in mouth and on palms and soles of feet
82
Q

Positive Brudzinski’s sign

A

Sign of meningitis

Severe neck stiffness that causes patient’s hips and knees to flex when the neck is flexed

83
Q

Men B vaccine

A

2, 4 and 12-13 months

84
Q

6-in-1’ vaccine

A

2, 3 and 4 months

85
Q

Genetic association with Coeliacs

A

HLA-DQ2 and HLA-DQ8

86
Q

Diagnosis of coeliacs

A
  • anti-EMA and anti-gliadin antibodies are useful screening tests
  • jejunal biopsy showing subtotal villous atrophy and crypt hyperplasia ???/
87
Q

What determines degree of cyanosis and clinical severity in TOF

A

The severity of the right ventricular outflow tract obstruction

88
Q

When does ALL vs AML peak in incidence

A

ALL: 2-3 years
AML: < 2 years

89
Q

Main environmental RF for leukaemia

A

Radiation exposure during pregnancy (eg. abdo x-ray)

90
Q

Conditions a/w leukaemia

A
  • DS
  • Kleinfelters
  • Noonan
  • Fanconi’s anaemia
91
Q

Suspected leukaemia refferal

A

Refer any child with unexplained petechia or hepatosplenomegaly for urgent FBC within 48 hours

92
Q

APGAR score

A
  • 0-3 is very low score,
  • 4-6 is moderate low
  • 7 - 10 baby is in a good state
93
Q

First line pharmacotherapy for ADHD

A

Methylphenidate

  • Initially given on a six-week trial basis
  • CNS stimulant, dopamine/NA reuptake inhibitor
  • SE: abdo pain, nausea and dyspepsia.

In children, weight and height should be monitored every 6 months

Drug therapy is a last resort after holistic approach has failed (>5y)

94
Q

Fragile X syndrome

A

Trinucleotide repeat disorder
Features in females less severe

Features in males
* Learning difficulties
* Macrocephaly
* Long face, Large ears
* Macro-orchidism

95
Q

Surfactant deficient lung disease

Also known as neonatal RDS

A

Premature infants
Chest x-ray → ‘ground-glass’ with an indistinct heart border

96
Q

Babies who requires USS screening for DDH

A
  • first-degree FxH of hip problems in early life
  • breech presentation ≥36 weeks, irrespective of mode of delivery
  • multiple pregnancy
97
Q

Standard screening for DDH

A

All infants are screened at NIPE and at 6 week baby check using Barlow and Ortolani tests

98
Q

Barlow vs Ortalani test

A

Barlow test: attempts to dislocate an articulated femoral head

Ortolani test: attempts to relocate a dislocated femoral head

99
Q

Imaging for DDH

A

USS to confirm diagnosis if clinically suspected

EXCEPT if infant is > 4.5 months then x-ray is the first line

100
Q

RF for SDLD

A
  • male sex
  • diabetic mothers
  • C-section
  • second born of premature twins
101
Q

Traffic light system - red sign

A
  • Moderate or severe chest wall recession
  • Does not wake if roused
  • Reduced skin turgor
  • Mottled or blue appearance
  • Grunting

If not one of these and seems concering, most likley ‘amber’

102
Q

Investigation of choice for intersusseption

A

USS → target sign

103
Q

Patau syndrome (trisomy 13)

A
  • Microcephalic, small eyes
  • Cleft lip/palate
  • Polydactyly
  • Scalp lesions
104
Q

Patau syndrome (trisomy 13)

A
  • Microcephalic, small eyes
  • Cleft lip/palate
  • Polydactyly
  • Scalp lesions
105
Q

Edward’s syndrome (trisomy 18)

A
  • Micrognathia
  • Low-set ears
  • Rocker bottom feet
  • Overlapping of fingers
106
Q

Noonan syndrome

A
  • Webbed neck
  • Pectus excavatum
  • Short stature
  • Pulmonary stenosis
107
Q

Pierre-Robin syndrome

A
  • Micrognathia
  • Posterior displacement of the tongue
  • Cleft palate
108
Q

Prader-Willi syndrome

A
  • Hypotonia
  • Hypogonadism
  • Obesity
109
Q

William’s syndrome

A
  • Short stature
  • Learning difficulties
  • Friendly, extrovert personality
  • Transient neonatal hypercalcaemia
  • Supravalvular aortic stenosis
110
Q

Cri du chat syndrome (chromosome 5p deletion syndrome)

A
  • Characteristic cry due to larynx and neurological problems
  • Feeding difficulties and poor weight gain
  • Learning difficulties
  • Microcephaly and micrognathism
  • Hypertelorism
111
Q

Kocher’s criteria

probability of septic arthritis in children

A
  • Non-weight bearing - 1 point
  • Fever >38.5ºC - 1 point
  • WCC >12 * 109/L - 1 point
  • ESR >40mm/hr
112
Q

RF for NEC

A
  • Very low birth weight or very premature
  • Formula feeds
  • RDS assisted ventilation
  • Sepsis
  • PDA and other CHDs
113
Q

Investigation of choice for NEC

A

Abdominal x-ray (supine - lying face up)

  • Pneumatosis intestinalis (intramural gas)
  • Pneumoperitoneum (free gas → perforation)
  • Dilated bowel loops
  • Bowel wall oedema
  • Gas in the portal veins
  • Air both inside and outside bowel wall (Rigler sign)
  • Air outlining falciform ligament (football sign)
114
Q

Complications of measles

A
  • otitis media (most common)
  • pneumonia (most common cause of death)
  • encephalitis (1-2 weeks after onset)
  • subacute sclerosing panencephalitis (rare, presents 5-10 years after illness)
115
Q

TRIAD congenital rubella syndrome

A

deafness, blindness, congenital heart disease

116
Q

Mx measles contacts

A
  • If a child not immunized comes into contact with measles → offer MMR
  • Should be given within 72 hours
117
Q

5S’s

Features of innocent murmurs

A
  • Soft
  • Short
  • Systolic
  • Symptomless
  • Situation dependent
118
Q

3

Pan-systolic murmurs

A
  • Mitral Regurg
  • Tricuspid Regurg
  • VSD
119
Q

Ejection systolic murmurs

A
  • Aortic stenosis
  • Pulmonary stenosis
  • HOCM
120
Q

ASD features

A
  • mid-systolic, cresendo-decresendo
  • fixed splitting of second heart sound
121
Q

Compare a normal vs pathological splitting of heart sounds

A
  • normal if occurs during inspiration
  • pathological (ASD) if occurs on both inspiration and expiration ‘fixed’
122
Q

What causes the murmur in TOF

A

Ejection systolic due to pulmonary stenosis

123
Q

Developmental milestones: social behaviour and play

A

6 weeks: Smiles (Refer at 10 weeks)
3 months: Laughs and enjoys friendly handling
6 months: not shy
9 months: shy, takes everything to mouth

124
Q

Secondary causes of constipation

A
  • Hirshprungs
  • CF (meconium ileus)
  • Hypothyroidism
  • Sexual abuse
125
Q

Red flags for constipation

A
  • Not passing meconium within 48
  • Neurological signs or symptoms
  • Vomiting
  • Ribbon stool
  • Abnormal anus
  • Abnormal lower back or buttocks
  • Failure to thrive
  • Acute severe abdominal pain and bloating
126
Q

Red flags for constipation

A
  • Not passing meconium within 48
  • Neurological signs or symptoms
  • Vomiting
  • Ribbon stool
  • Abnormal anus
  • Abnormal lower back or buttocks
  • Failure to thrive
  • Acute severe abdominal pain and bloating
127
Q

Factors which suggest faecal impaction

A
  • Symptoms of severe constipation
  • overflow soiling
  • faecal mass palpable in the abdomen
128
Q

Mx of faecal impaction

A
  1. Movicol (polyethylene glycol 3350 + electrolytes)
  2. Add a stimulant laxative

If Movicol is not tolerated: substitute stimulant laxative OR combine with osmotic laxative (ie. lactulose)

Inform families that disimpaction tx can initially increase symptoms of soiling and abdominal pain

129
Q

Precocious puberty

A
  • development of secondary sexual characteristics before 8 in females and 9 in males
  • more common in females
130
Q

What is thelarche and adrenarche

A
  • Thelarche - first stage of breast development
  • Adrenarche - first stage of pubic hair development
131
Q

Classification of precocious puberty

A
  1. Gonadotrophin dependent (‘central’, ‘true’)
    * premature activation of HPG axis
    * FSH & LH raised
  2. Gonadotrophin independent (‘pseudo’, ‘false’)
    * excess sex hormones
    * FSH & LH low
132
Q

How may the tests determine cause of precocious puberty

A
  • bilateral enlargement = gonadotrophin release from intracranial lesion
  • unilateral enlargement = gonadal tumour
  • small testes = adrenal cause
133
Q

Features of threadworm

A
  • perianal itching, particularly at night
  • girls may have vulval symptoms
134
Q

Mx of threadworm

A
  • Single dose Mebendazole given to entire household
  • Hygiene advice
135
Q

Mx of exomphalos vs gastroschisis

A
  • Exomphalos - gradual repair to prevent respiratory complications
  • Gastroschisis - requires urgent correction, bowel should be protected with cling-film
136
Q

Most common cause of bacterial pneumonia in children

A

S .pneumoniae

137
Q

Tx pneumonia in children

A
  • First line: Amoxicillin (macrolide can be added if no response)
  • Macrolide if mycoplasma or chlamydia
  • Co-amoxiclav if influenza
138
Q

Age group for Febrile convulsions

A

6 months and 5 years

139
Q

Types of febrile convulsion

A
140
Q

Mx of febrile convulsion

A

First seizure OR complex seizure → Admit

Ongoing management
* phone ambulance if seizure > 5 minutes
* specialist may consider benzos if recurrent febrile convulsions (ie. rectal diazepam or buccal midazolam)
*

141
Q

Newborn hearing test

A

Otoacoustic emission test
If abnormal → Auditory Brainstem Response test

142
Q

6-9 months hearing test

A

Distraction test

143
Q

hearing test done in > 3 years

A

Pure tone audiometry

Done at school entry in most areas of the UK

144
Q

Shaken baby syndrome TRIAD

A
  • retinal haemorrhages
  • subdural haematoma
  • encephalopathy
145
Q

Ebstein’s anomaly

A
  • Low insertion of tricuspid valve resulting in a large RA and small RV
  • Caused by exposure to lithium in-utero
146
Q

Mx whooping cough

A
  • Notify PHE
  • Oral azithromycin within first 21 days of symptom
147
Q

Compare presentation of TGV vs TOF

A
  • TGA - cyanosis presenting within the first days
  • TOF - cyanosis presenting at 1-2 months of age
148
Q

Compare presentation of TGV vs TOF

A
  • TGA - cyanosis presenting within the first days
  • TOF - cyanosis presenting at 1-2 months of age
149
Q

Mx of paediatric malrotation with volvulus

A

Ladd’s procedure

(Division of Ladd bands and widening of the base of the mesentery)

150
Q

Initial Mx of CDH

A

Itubation and ventilation - aim of keeping air out of the gut

151
Q

Most common cause of childhood hypothyroidism in the UK

A

Autoimmune Thyroiditis

152
Q

Newborn resuscitation

A
  1. Dry baby and maintain temperature
  2. Assess tone, RR, HR
  3. If gasping or not breathing give 5 inflation breaths
  4. Reassess (chest movements)
  5. If HR is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
153
Q

Rickets

A
  • Inadequately mineralised bone in developing bones
  • Results in soft and easily deformed bones
  • Usually due to vitamin D deficiency
154
Q

Features of Rickets

A
  1. Aching bones and joints
  2. lower limb abnormalities:
    * toddlers = genu varum (bow legs)
    * older children = genu valgum (knock knees)
  3. ‘rickety rosary’ - swelling at costochondral junction
  4. kyphoscoliosis
  5. craniotabes - soft skull bones in early life
  6. Harrison’s sulcus
155
Q

Osgood-Schlatter disease

A

Type of osteochondrosis caused by inflammation (apophysitis) at the tibial tuberosity

156
Q

Emergency treatment of Croup

A
  • high-flow oxygen
  • nebulised adrenaline
157
Q

Types of biliary atresia

A

Type 1: proximal ducts are patent, common duct is obliterated

Type 2: atresia of cystic duct, cystic structures are found in the porta hepatis

Type 3: atresia of the L and R ducts to level of the porta hepatis (>90% of cases)

158
Q

Infantile colic

A
  • infants < 3 months
  • bouts of excessive crying and pulling-up of the legs
  • often worse in the evening.
159
Q

Most common causes of neonatal sepsis

A

GBS and E-coli

160
Q

Classification of neonatal sepsis

A

early-onset - within 72 hours of birth
late-onset - between 7-28 days of life

161
Q

RF for neonatal sepsis

A
  • Mother with previous baby with GBS infection, who has current GBS, bacteruria, intrapartum temp ≥38ºC, PRM ≥18 hours, or chorioamnionitis
  • Premature <37 weeks
  • LBW <2.5kg
162
Q

Duchenne muscular dystrophy

A

X-linked recessive disorder in dystrophin genes

163
Q

Features of DMD

A
  • progressive proximal muscle weakness from 5 years
  • calf pseudohypertrophy
  • Gower’s sign: child uses arms to stand fromsquatted position
  • 30% of patients have intellectual impairment
164
Q

Investigation for DMD

A
  • Raised CK
  • Genetic testing to obtain definitive diagnosis
165
Q

Staging of Perthes

A

Catterall staging

166
Q

Perthes

A
  • AVN of the femoral head, specifically the epiphysis
  • 5 times more common in boys
167
Q

Mx Perthes

A

To keep femoral head within the acetabulum: cast, braces
* < 6 years: observation
* > 6 years: surgical management

168
Q

Associations with Ebstein’s anomaly

A
  • PFO or ASD
  • WPW
169
Q

Clinical features of Ebstein’s

A
  • cyanosis
  • prominent ‘a’ wave in distended DVP
  • hepatomegaly
  • tricuspid regurg → pansystolic murmur, worse on inspiration
  • RBBB → widely split S1 and S2
170
Q

Oral rotavirus vaccine

A
  • oral, live attenuated vaccine
  • 2 doses required: 2 and 3 months

First dose cannot be given at 14 weeks + 6 days and second dose cannot be given >23 weeks + 6 days → risk of intussusception

171
Q

Asthma ladder in <5y

A
  1. SABA
  2. SABA + 8-week trial of paediatric MODERATE-dose ICS
  3. SABA + paediatric low-dose ICS + LRTA
  4. Stop LTRA and refer
172
Q

Asthma ladder > 5y

A
  1. SABA
  2. Paediatric low dose ICS
  3. SABA + paediatric low-dose ICS + LRTA
  4. SABA + paediatric low-dose ICS + LABA
  5. SABA + MART
  6. SABA + high dose ICS or thoephylline
173
Q

Mx Scarlet Fever

A
  • oral penicillin V for 10 days
  • can return to school 24 hours after commencing antibiotics
174
Q

Complications of scarlet fever

A
  • otitis media (most common)
  • rheumatic fever
  • acute glomerulonephritis
  • Invasive complications are rare (eg. bacteraemia, meningitis, nec fac)
175
Q

Core components of the Child Health Promotion Program

A
  • GP exam at 6-8 weeks
  • Newborn clinical examination (NIPE)
  • Heel-prick test at 5-9 days
  • Newborn hearing check
176
Q

Meningitis organisms in neonates - 3 months

A
  • GBS
  • Ecoli
  • Listeria
177
Q

Meningitis organisms in 1 month to 6 years

A
  • Neisseria meningitidis (meningococcus)
  • Strep pneumoniae (pneumococcus)
  • Haemophilus influenzae
178
Q

Meningitis organisms in > 6 years

A
  • Neisseria meningitidis (meningococcus)
  • Strept pneumoniae (pneumococcus)
179
Q

TTN

A
  • commonest cause of respiratory distress in newborn period
  • caused by delayed resorption of fluid in the lungs
  • RF: C-section
180
Q

x-ray finding of TTN

A

Hyperinflation of the lungs and fluid in the horizontal fissure

Finals (10 decks)

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