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Paediatrics Flashcards

1
Q

What are the components of the APGAR score and when is it performed?

A 
Appearance
Pulse
Grimace
Activity
Respiration
Performed at 1st and 5th minute of life
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2
Q

Outline the components of APGAR that would score 0 for each domain

A 
Appearance: blue all over
Pulse: absent
Grimace: absent
Activity: absent
Respiration: absent
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3
Q

Outline the components of APGAR that would score 1 for each domain

A 
Appearance: blue in extremities, pink body
Pulse: less than 100
Grimace: only on aggressive stimulation
Activity: some flexion
Respiration: slow, irregular
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4
Q

Outline the components of APGAR that would score 2 for each domain

A 
Appearance: pink all over
Pulse: over 100
Grimace: cry on stimulation, coughs well
Activity: flexes arms and legs, resists extension
Respiration: strong cry
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5
Q

What are the ranges of a normal APGAR score?

A

8-10

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6
Q

List aetiology/risk factors for neonatal sepsis

A 
Ascending infection from mother (chorioamnionitis)
Group B Strep
E. coli
Coag -ve Staph
H. influenzae
Listeria
Pre-labour membrane rupture
Prematurity
Parenteral antibiotics used in mother
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7
Q

List clinical features of neonatal sepsis

A 
Seizure
Stiff limbs
Cyanosis
Cap refill greater than 3s
Temp less than 35.5 or over 37.5
Difficulty feeding
Severe chest indrawing
Resp rate over 60
Lethargy
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8
Q

Neonatal sepsis is defined as early onset if it occurs when?

A

First 48-72h of life, mainly due to bacteria acquired before and during delivery (Group B Strep)

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9
Q

What investigations would you order for neonatal sepsis?

A

Bloods: FBC, CRP, culture, glucose
Swab virology
LP for gram stain, cell count, protein, glucose
Urine and stool culture/microscopy

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10
Q

Outline management of neonatal sepsis

A

IV benzylpenicillin + gentamicin empirically

Vancomycin/teicoplanin/amoxicillin

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11
Q

List aetiology/risk factors for neonatal seizures

A

Reduced PaO2
Infection
Hypoglycaemia
CNS injury (haemorrhage, hydrocephalus)

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12
Q

Outline management of neonatal seizures

A 
ABCDE approach, turn on side
EEG and ECG monitoring
IV phenobarbitol
Phenytoin/clonazepam/lorazepam
Pyridoxine
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13
Q

Jaundice after 24h is usually physiological. Why?

A

Immature liver can’t process high Br
Increased RBC breakdown
Starts at day 2, peaks at day 5, resolves by day 10

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14
Q

Visible jaundice on day 1 of life is always pathological. True/False?

A

True

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15
Q

List causes of jaundice on day 1 of life

A

Rhesus haemolytic disease
ABO incompatibility
G6P deficiency
Spherocytosis

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16
Q

Define prolonged jaundice in a neonate

A

Lasts over 14 days in a term baby or 21 days in a preterm baby

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17
Q

List causes of prolonged jaundice in a neonate

A 
Infection
Exclusive breastfeeding
Hypothyroidism
Cystic fibrosis
Biliary atresia
Galactosaemia
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18
Q

List clinical features of neonatal jaundice

A 
Yellow tinge to skin/sclera
Drowsiness
Short feed
Altered tone
Seizures
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19
Q

What investigations would you do for neonatal jaundice?

A

Serum Br if less than 35w gestation or less than 24h old
Br using TCB if over 35w gestation or more than 24h old
FBC, blood groups and film
Coombs test (rhesus haemolysis)

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20
Q

Outline management of neonatal jaundice

A

Phototherapy using plasma Br treatment guide
IV Ig may be warranted
Exchange transfusion via umbilical vein/artery prevents further increase in Br

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21
Q

What is kernicterus?

A

Br -induced brain dysfunction

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22
Q

List clinical features of kernicterus

A 
Sleepy
Poor suck
"setting sun" lid retraction
Odd movements
Cerebral palsy
Deafness
Low IQ
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23
Q

What is the pathophysiology of rhesus haemolytic disease?

A

RhD- delivers RhD+ baby and may produce anti-D IgG against RhD (isoimmunisation) if blood mixes
In subsequent pregnancy, these antibodies may attack a RhD+ foetus

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24
Q

List aetiology/risk factors for rhesus haemolytic disease

A

Threatened miscarriage
Antepartum haemorrhage
Mild trauma
Amniocentesis, CVS

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25
Q

List clinical features of rhesus haemolytic disease

A 
Jaundice on day 1 of life
Yellow vernix
Heart failure
Hepatosplenomegaly
Bleeding
CNS dysfunction
Kernicterus
Stiff, oedematous lungs
Hydrops fetalis
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26
Q

Outline management of rhesus haemolytic disease

A 
Keep baby warm
Exchange transfusion
Phototherapy
Anti-D Ig for Rh- mother
Hydrops fetalis: ventilate if required, vitamin K
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27
Q

What is neonatal respiratory distress syndrome?

A

Increased work of breathing due to insufficient surfactant, potentially leading to respiratory failure

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28
Q

List aetiology/risk factors for neonatal respiratory distress syndrome

A 
Prematurity
Maternal diabetes
Males
2nd twin
C-section delivery
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29
Q

List clinical features of neonatal respiratory distress syndrome

A 
Worsening tachypnoea (RR over 60)
Increased effort, grunting
Cyanosis
Nasal alae flaring
Intercostal recession
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30
Q

Outline management of neonatal respiratory distress syndrome

A

Wrap warmly, incubator
Monitor ABG’s, give O2, support ventilation
Prenatal betamethasone/dexamethasone may prevent RDS
Give surfactant via ET tube

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31
Q

What is necrotising enterocolitis (NEC)?

A

Necrosis of bowel mucosa

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32
Q

List aetiology/risk factors for NEC

A

Prematurity
Weight less than 1500g
Enteral feeds
Mucosal injury

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33
Q

List clinical features of NEC

A

Abdominal distention
PR blood/mucus
Tenderness +/- perforation
Shock

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34
Q

What investigations would you do for NEC?

A

Faecal culture
Abdo and lateral XR shows loops of bowel
Crossmatch blood

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35
Q

Outline management of NEC

A 
Stop oral feeds, continue breastmilk
Probiotics may help
Barrier nursing
Metronidazole + penicillin + gentamicin
or cefutaxime + vancomycin
Laparatomy if progressive distention/perforation
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36
Q

What would be a sign of potential meconium aspiration?

A

Baby born in meconium-stained amniotic fluid

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37
Q

Define prematurity

A

Birth occurring before 37 weeks’ gestation
Pre-term: 32-37w
Very pre-term: 28-31w
Extremely pre-term: 23-27w

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38
Q

List aetiology/risk factors for prematurity

A 
Previous preterm birth
Multiple pregnancy
Smoking + illicit drugs during pregnancy
Early pregnancy (within 6 months of last one)
Infection
Cervix/uterus//placenta pathology
Injury, trauma
Maternal diabetes/hypertension
Pre-eclampsia
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39
Q

Outline general management of a premature birth

A

Monitor airway and breathing
Keep warm - incubator, baby bag, radiant heater, skin-skin contact
Resuscitation if over 23 weeks
Low-pressure CPAP

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40
Q

How is a baby defined as being small for gestation?

A

Birthweight less than 2.5kg

Does vary

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41
Q

List aetiology/risk factors for being small for gestation

A 
Constitutionally small
Intrauterine growth restriction
Malformation
Twin pregnancy
Maternal disease
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42
Q

What is Hirschsprung’s disease?

A

Congenital absence of ganglia in a segment of colon

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43
Q

List clinical features of Hirschsprung’s disease

A

Infrequent narrow stools
GI obstruction
Megacolon
Faeces felt per abdomen

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44
Q

What investigations would you do for Hirschsprung’s disease?

A

Barium enema
Sigmoidoscopy, biopsy of aganglionic segment
Stain for ACh-esterase

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45
Q

How is vomiting described in midgut malrotation/volvulus?

A

Bilious “fairy liquid green” vomit

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46
Q

What is gastroschisis?

A

Paraumbilical evisceration of abdominal contents

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47
Q

What is exomphalos?

A

Ventral defect of umbilical ring causing herniation of abdominal viscera

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48
Q

List clinical features of diaphragmatic hernia

A

Difficult resus at birth
Respiratory distress syndrome
Bowel sounds in hemithorax
Cyanosis

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49
Q

List aetiology/risk factors for cryptorchidism

A 
Prematurity
Small for dates
Family history
Hormone imbalance
Maternal alcohol/analgesics/smoking
Gestational diabetes
Incomplete migration during embryogenesis
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50
Q

Outline management of cryptorchidism

A

Orchidopexy (fix within scrotum) early on in life

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51
Q

What is the commonest intra-abdominal tumour of childhood?

A

Wilm’s nephroblastoma

52
Q

What is congenital adrenal hyperplasia?

A

Increased androgens cause decrease in 21-hydroxylase, causing decrease in cortisol and increase in ACTH, leading to hyperplasia and overproduction of cortisol precursors

53
Q

List clinical features of congenital adrenal hyperplasia

A 
Ambiguous genitalia
Vomiting
Dehydration
Precocious puberty
Hypospadius
Cryptorchidism
54
Q

What would levels of Na and K be like in congenital adrenal hyperplasia?

A

Hyponatraemia

Hyperkalaemia

55
Q

Which drugs are used in adrenocortical crisis?

A

Fludricortisone

Hydrocortisone

56
Q

What are orofacial clefts?

A

Failure of maxillary and premaxillary processes to fuse during week 5
Usually causes cleft lip and/or palate

57
Q

List aetiology/risk factors for orofacial clefts

A 
Genes
Benzodiazepines
Anti-epileptics
Rubella
Trisomy 18
58
Q

List clinical features of foetal alcohol syndrome

A 
Microcephaly
Short palpebral fissure
Hypoplastic upper lip
Absent philtrum
Small eyes
Reduced IQ, learning difficulty
Cardiac malformations
Growth retardation
Epicanthic folds
59
Q

List the main acyanotic congenital heart defects

A 
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
Coarctation of aorta
Aortic stenosis
Aortopulmonary window
60
Q

List the main cyanotic congenital heart defects

A

Tetralogy of Fallot

Transposition of the great vessels

61
Q

List clinical signs of ventricular septal defect

A

Harsh loud pansystolic “blowing” murmur
Thrill
Left ventricular hypertropgy

62
Q

List clinical signs of atrial septal defect

A 
Pulmonary flow murmur
Widely fixed split S2
Cardiomegaly
Globular heart (primum defect)
RVH +- incomplete RBBB
63
Q

List clinical signs of patent ductus arteriosus

A 
Systolic pulmonary "machinery" murmur
Collapsing pulse
Thrill
Increased S2
Failure to thrive
64
Q

List clinical signs of coarctation of aorta

A

Systolic murmur at left back
Radiofemoral delay
Increased BP in arms
Rib-notching on XR

65
Q

What are the components of tetralogy of Fallot?

A

Ventricular septal defect
Right ventricular hypertrophy
Pulmonary stenosis/RVOT obstruction
Overriding aorta

66
Q

List clinical signs of tetralogy of Fallot

A

Ejection systolic murmur
Boot-shaped heart on XR
R-L shunt
Cyanosis

67
Q

Which virus causes measles and what is the incubation time?

A

RNA paramyxovirus

Incubation 7-21 days

68
Q

List clinical features of measles

A

Conjunctivitis
Koplik spots: “grain of salt” spots on buccal mucosa
Rash behind ear on days 3-5
Rash spreads confluently down body
Neck spasms
May lead to fits, meningitis, encephalitis, deafness

69
Q

Outline management of measles

A

Isolate, ensure adequate nutrition
Continue breastfeeding
Treat secondary infection
Immunisation is 80% effective

70
Q

Which virus causes mumps and what is the incubation period?

A

RNA paramyxovirus

Incubation 14-21 days

71
Q

List clinical features of mumps

A

Infective 7d before + 9d after parotid swelling
Malaise
Painful parotid swelling
Fever

72
Q

Which virus causes rubella and what is the incubation time?

A

RNA virus

Incubation 3-4 weeks

73
Q

List clinical features of rubella

A

Infective 5d before + 5d after rash
Macular rash
Suboccipital lymphadenopathy

74
Q

Which virus causes erythrovirus infection?

A

Parovirus B19

75
Q

List clinical features of erythrovirus

A 
Mild acute infection
Malar erythema (slapped cheek appearance)
Glove + stocking rash
Arthralgia
Aplastic crisis
76
Q

Which virus causes hand, foot and mouth disease?

A

Coxsackie virus A16

Enterovirus 71

77
Q

List clinical features of hand foot and mouth disease

A

Mildly unwell
Vesicles on palms, soles and mouth
No crusting

78
Q

Which syndrome involves trisomy 21?

A

Down’s syndrome

79
Q

List clinical features of Down’s syndrome

A 
Flat facial profile
Excess neck skin
Dysplastic ears
Muscle hypotonia
Widely spaced toes
High arched palate
Simian palmar crease
Brushfield spots on iris
80
Q

Which syndrome involves trisomy 18?

A

Edward’s syndrome

81
Q

List clinical features of Edward’s syndrome

A 
Rigid baby, limbs flexed
Low-set ears
Receding chin
Proptosis
Rockerbottom feet
Cleft
Umbilical/inguinal hernia
Short stature
Fingers cannot be extended
82
Q

What is the karyotype of Klinefelter’s syndrome?

A

XXY or XXYY

83
Q

List clinical features of Klinefelter’s syndrome

A 
Small firm testes
Small penis
Reduced cognition
Reduced libido
Gynaecomastia
Delayed/reduced sexual maturation
84
Q

Which syndrome involves trisomy 13?

A

Patau syndrome

85
Q

List clinical features of Patau’s syndrome

A 
Cleft
Microcephaly
Omphalocele
Hernias
Congenital heart defects
Dextrocardia
Capillary hemangiomata
Polycystic kidneys
Flexion contractures
Narrow fingernails
86
Q

What is the karyotype of Turner’s syndrome?

A

XO

87
Q

List clinical features of Turner’s syndrome

A 
Short stature
Hyperconvex nails
Wide carrying angle
Inverted nipples
Broad chest
Ptosis, nystagmus
Webbed neck
Coarctation of aorta
Absent/rudimentary gonads
Delayed/absent puberty
88
Q

List aetiology/risk factors for acute bronchiolitis

A

RSV
Mycoplasma
Parainfluenza
Adenovirus

89
Q

List clinical features of acute bronchiolitis

A 
Coryza before cough
Fever
Tachypnoea
Wheeze
Intercostal recession
Poor feeding
Dehydration
Cyanosis
90
Q

Outline management of acute bronchiolitis

A

Neb salbutamol +/- dexamethasone may help
Oxygen
NG tube support

91
Q

Which organism causes whooping cough?

A

Bordetella pertussis

92
Q

List clinical features of whooping cough

A

Apnoea
Bouts of coughing worse at night or after feed
Vomiting
Cyanosis
Inspiratory whoop
Subconj haemorrhage if persistent coughing
No fever or wheeze

93
Q

What investigations would you do for whooping cough?

A

Nasal swab culture
PCR and serology
Lymphocytosis typically seen

94
Q

Outline management of whooping cough

A

Erythromycin
School exclusion
Vaccination prophylaxis

95
Q

What is cystic fibrosis?

A

Autosomal recessive mutation in CFTR gene on c7 that codes cAMP Na-Cl channel, causing impaired exocrine function and increased viscosity of secretions

96
Q

List clinical features of cystic fibrosis

A 
Meconium ileus as neonate
Recurrent chest infections
Clubbing
Steatorrhoea
Failure to thrive
Malabsorption
Short stature
Delayed puberty
97
Q

What investigations would you do for cystic fibrosis

A

Cl sweat test over 60 mmol/l

Immune reactive trypsin neonatal screen

98
Q

Outline management of cystic fibrosis

A

Chest physiotherapy, postural drainage
Increase calories and fat intake
Treat organisms/bacterial colonisation
Pancreatic enzyme supplements

99
Q

List features of acute severe asthma

A 
Too breathless to talk/feed
Use of accessory muscles to breathe
RR over 30 (over 40 if under 5yo)
HR over 120 (over 140 if under 5yo)
PEF less than 50% predicted
SPO2 92%
100
Q

List features of life-threatening asthma

A 
Silent chest
Poor expiratory effort
Altered consciousness, confusion
Cyanosis
PEF less than 33% predicted
SPO2 92%
101
Q

List clinical features of pyloric stenosis

A 
Vomiting after feed, projectile
NOT bilious
Constipation/starvation tools
Always hungry
Olive-sized pyloric mass
102
Q

What metabolic disturbance may occur in pyloric stenosis?

A

Hypochloraemic hypokalaemic alkalosis

103
Q

Outline management of pyloric stenosis

A

NG tube

Pyloromyotomy

104
Q

What is intussusception?

A

Small bowel telescopes by invagination, usually at ileo-caecal region

105
Q

List clinical features of intussusception

A 
Abdo colic pain
Episodic crying
Drawing legs up, pale-looking
Blood-stained "redcurrant jelly" faeces
\+- vomiting
Sausage-shaped mass felt
106
Q

Outline management of intussusception

A

Air insufflation works in most

Laparoscopic resection/laparotomy

107
Q

List typical causes of bruising in neonates and infants

A 
Haemorrhagic disease of newborn
Haemophilia
Thrombocytopenia
ITP
Birth trauma
Congenital infection (Rubella)
Accidental/non-accidental injury
108
Q

What is fragile X syndrome?

A

Stretch of CGG repeats in FMR-1 gene on Xq27 results in cognitive impairment

109
Q

List clinical features of fragile X syndrome

A 
Learning difficulty
Large, low set ears
Big jaw
Long, thin face
High arched palate
Big testes
Hypoonia
Autism
110
Q

List clinical features of Noonan syndrome

A 
Ptosis
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Down-slanting eyes
Cardiac defects
111
Q

List the main causes of bacterial meningitis

A

Neonates: E. coli, Listeria, Group B Strep
Children: H. influenza
Young adults: N. meningitidis
Adults: Strep. pneumoniae

112
Q

List clinical features of meningitis

A 
Unusual crying, poor feeding, vomiting
Tense fontanelles
Stiff neck (after 18mo), photophobia
Opisthotonus
Pink maculo purpuric rash
Sepsis, shock, seizures
Kernig sign: resistance to extending knee with hip flexed
Brudeinski sign: hip flexion on bending head forward
113
Q

What investigations would you do for meningitis?

A

Lumbar puncture
FBC, U+E, blood + urine culture, stool virology
Gram stain

114
Q

What would CSF show in bacterial meningitis? (describe appearance, cells, glucose and protein levels)

A

Appearance: turbid
Cells: polymorphs
Glucose: less than 1/2 of blood
Protein: raised

115
Q

What would CSF show in viral meningitis? (describe appearance, cells, glucose and protein levels)

A

Appearance: clear
Cells: mononuclear cells
Glucose: more than 1/2 of blood
Protein: low

116
Q

What would CSF show in TB meningitis? (describe appearance, cells, glucose and protein levels)

A

Appearance: turbid/viscous
Cells: mononuclear cells, variable polymorphs
Glucose: less than 1/2 of blood
Protein: moderately raised

117
Q

Outline management of meningitis

A 
ABCDE, O2, fluids
Benzylpenicillin before hospital
Ceftriaxone + dexamethasone IV
\+ ampicillin if Listeria
Chloramphenicol if cef-allergic
\+ gentamicin if E. coli
118
Q

What is a febrile convulsion?

A

Single seizure typically lasting less than 20 mins, usually occurring in a child with preceding febrile illness/temp rise

119
Q

Outline management/advice for febrile convulsion

A

Lie prone
Paracetamol syrup
Consider blood tests if worrying signs
Lorazepam/diazepam if unresolving

120
Q

What organ is represented by a “sail sign” on a neonatal XR?

A

Wide mediastinum enables identification of the thymus

121
Q

List all the respiratory conditions you can think of that may cause respiratory distress in a neonate

A 
Respiratory distress syndrome
Bronchopulmonary dysplasia
Meconium aspiration
Transient tachypnoea of the newborn
Infection
Pneumothorax
Pulmonary hypoplasia
Congenital diaphragmatic hernia
122
Q

How does hypothermia lead to hypoglycaemia in a neonate?

A

Increased metabolic rate
Increased uptake of glucose
Increased use of glycogen stores
HYPOGLYCAEMIA

123
Q

How does hypoglycaemia lead to hypoxia in a neonate?

A

Reduced surfactant production
Increased work of breathing
Respiratory distress
HYPOXIA

124
Q

How does hypothermia lead to hypoxia in a neonate?

A 
Increased metabolic rate
Reduced O2 consumption
Increased resp rate
O2 demand greater than supply
Anaerobic respiration
Metabolic acidosis
HYPOXIA
125
Q

When does intraventricular haemorrhage typically occur in neonates?

A

Day 1 of life

May present within 72 hours

4MB Medicine (19 decks)

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