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PLAB 1 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Rubella symptoms?

A
  • Maculopapular rash (less intense than measles)
  • Conjunctivitis (less intense than measles)
  • Coryza (less intense than measles)
  • Forchheimer spots (red macules on soft palate and tonsils)
  • Fever
  • Lymphadenopathy
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2
Q

Rubella etiology? Risk Factors?

A

Self limiting viral disease usually caused by incomplete history of vaccination;

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3
Q

Rubella diagnosis?

A

LAB TESTING TO CONFIRM THE DIAGNOSIS
- PCR test: oral fluid sample.
- Serology: IgM antibody (positive in acute cases).

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4
Q

Rubella and pregnancy

A

► Congenital Rubella syndrome if < than 20w pregnant

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5
Q

Roseola epidemiology

A

Most common rash seen under the age of 3

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6
Q

Roseola symptoms

A
  • High fever (40C) lasts for 3 days
  • Rash after fever lasts for 3 days
  • Runny nose
    ► In most cases the child is well.
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7
Q

Roseola etiology?

A

Caused by human herpesvirus-6.

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8
Q

Roseola Rx?

A

Rx is supportive.

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9
Q

Paeds:

ASTHMA

In which situations is it recommended to intubate?

A
  • Severe resp. acidosis;
  • Silent chest (severe bronchoconstrition);
  • Altered mental status (sever hypoxia);
  • Fatigue (↓RR);
  • Failure of NIV.
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10
Q

Management of acute exacerbation of asthma in children.

A

◉ Immediate
➜ O₂:
* O₂ if SPO₂ < 94%, goal SPO₂ 94-98%;
➜ Bronchodilators
* B₂-agonist: Salbutamol nebulized or pDMI + spacer (if mild symptoms);
* Anticholinergics: ipratropium bromide;
➜ Corticosteroids:
* Prednisolone
* Hydrocortisone (if vomiting).

◉ 2nd line:
* Mg₂SO₄ IV
* Salbutamol IV
* Aminophiline IV (last resource).

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11
Q

Paeds

Symptoms of ALL (acute lymphoblastic leukaemia).

A
  • Fatigue (anaemia)
  • Bleeding, petechia, purpura, ecchymoses (trombocytopenia)
  • Recurrent infections (low or abnormal WBC’s)
  • LUQ tenderness & early satiety (splenomegaly).
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12
Q

Paeds

Diagnosis of ALL (acute lymphoblastic leukaemia)

A

► Most initial ⟶ FBC depression of all 3 cell lines:
* Anaemia (normochromic normocytic)
* WBC (low, normal or elevated)
* Thrombocytopenia

► Most appropriate ⟶ Peripheral blood test: Leukaemic blasts/lymphoblasts on peripheral blood

► Most definitive test ⟶ Bone marrow biopsy:
* Blasts cells.

Age group: 2-4 YO.

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13
Q

What are the organisms that cause acute epiglottitis?

A

➜ Unvaccinated patients: H. influenzae
➜ Vaccinated patients: Streptococcus

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14
Q

Symptoms of acute epiglottitis

A
  • Stridor
  • Drooling of saliva
  • Muffled / Hot potato voice
  • High temperature
  • Odynophagia (pain when swallowing)
  • Dysphagia
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15
Q

What is the gold standard investigation for epiglottitis?

A

Laryngoscopy.

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16
Q

What is the initial investigation in epiglottitis?

A
  • Lateral neck x-ray: thumb sign
  • Throat swabs

DO NOT USE TONGUE DEPRESSORS ➔ FATAL.

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17
Q

What is the Rx of epigottitis?

A
  • Intubation (on signs of airway obstruction)
  • IV antibiotics
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18
Q

What investigation should be done absence seizures?

A

EEG.

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19
Q

Paeds

What is the time onset of ABO incompatibility?

A
  • < 24h after birth.
  • Can be noticed on day 2-3 (as jaundice progresses).
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20
Q

Paeds

Explain the physiology of ABO incompatibility.

A
  • Mother has type O blood
  • Baby has type A, B, AB blood
  • Mother has anti-A, anti-B antibodies
  • Mother’s antibodies cross the placenta and destroy the infant’s red blood cells.

➜ Can occur in the 1st pregnancy.

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21
Q

What is the investigation in ABO incompability?

A
  • Direct antibody test (DAT) / Coombs test: weakly positive.
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22
Q

Paeds

Rx of ABO incompability

A
  • Phototherapy
  • Exchange transfusion (if severe).
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23
Q

Paeds

What is the management of umbilical hernia in children?

A

Asymptomatic:
* Reasurance
* Closes spontaneously by the 4th year.

> 4 yo asymptomatic:
* Referral to paediatric surgeon

Incarcerated / strangulated:
* Urgent referral surgery

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24
Q

What is the management of inguinal hernia in children?

A

Asymptomatic:
* Refer to 2nd care due to ↑ risk of incarceration.

Incarcerated / strangulated:
* Urgent referral surgery

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25
Q

What are the symptoms of biliary atresia?

High Yield for the exam

A

◆ Jaundice with pale stools and dark urine.
◆ Presents in 3-4 weeks of life.
◆ Hepatomegaly.
◆ Splenomegaly (if late presentation).
◆ Failure to thrive (due to poor absorption).

Obstructive jaundice ⟶ Jaundice with pale stools and dark urine.

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26
Q

How is the INITIAL diagnosis of biliary atresia made?

A

◆ ⬆︎ Conjugated bilirubin (conjugated hyperbilirubinaemia);
◆ ⬆︎ Gamma-glutamyl transferase (GGT);
◆ Abdominal ultrasound;
◆ Cholangiogram.

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27
Q

How is the DEFINITIVE diagnosis of biliary atresia made?

High Yield for the exam

A

➜ Percutaneous biopsy.

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28
Q

What is the treatment for biliary atresia?

High Yield for the exam

A

➜ Kasai procedure (hepatoportoenterostomy).

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29
Q

What is the initial investigation for any *child with jaundice AFTER 2 weeks of life?

A

◉ Conjugated bilirubin.

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30
Q

What are the symptoms of breast milk jaundice?

A

◆ Jaundice IN THE 2nd week of life (sometimes 1st);
◆ They are usually well;
◆ Yellow normal stools;
◆ May resolve within 6 weeks or continue up to 4 month.

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31
Q

How is the investigation / diagnosis of breast milk jaundice made?

A

◆ Perform split bilirubin test
➜ Will show ⬆︎ unconjugated bilirubin.

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32
Q

What is the management of breast milk jaundice?

A

◆ Continue to breastfeed.
◆ Reassurance.

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33
Q

What are the symptoms of bronchiolitis?

A

◆ Cough / coryza
◆ Expiratory wheeze
◆ Respiratory distress
◆ Bilateral crepitations/crackles
◆ ⬆︎ RR
◆ Chest rectractions
◆ Mild fever

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34
Q

What is the age group of bronchiolitis?

A

< 2 YO.

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35
Q

What is the cause of bronchiolitis?

A

➜ Acute viral infection of the lower respiractory tract, caused by respiratory syncytial virus.

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36
Q

What is the treatment of bronchiolitis?

A

◉ Supportive treatment:
◆ O₂ (humidified)
◆ Nasogastric tube (feeding)

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37
Q

Define Croup.

A

Also known as laryngotracheobronchitis.

It’s an UTRI that affects the:
◆ Larynx
◆ Trachea
◆ Bronchi

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38
Q

What are the symptoms of croup?

Laryngotracheobronchitis

A

◆ Barking cough
◆ Inspiratory stridor
◆ Mild fever
◆ Hoarse voice

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39
Q

What is the treatment for croup?

A

► Mild cases:
◆ Oral dexamethasone

► Moderate cases:
◆ O₂
◆ Nebulised budesonide

► Severe cases:
◆ O₂
◆ Nebulised adrenaline
◆ Intubation if required

NO IV STEROIDS in croup.

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40
Q

What is the cause of croup?

A

Parainfluenza.

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41
Q

Describe what is cerebral palsy and its epidemiology.

A

► Chronic disorder of movement and/or posture, that presents early in life and continues throrought life.

➜ Caused by a non-progressive brain injury

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42
Q

Management of cerebral palsy?

A

Multidisciplinary team involved.

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43
Q

Treatment for hypertonia in cerebral palsy?

A

◆ Botulinum toxin injections
◆ Baclofen

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44
Q

What are the symptoms of coeliac disease?

A

◉ Autoimmune disease due to gluten sensintivity which results in malapsorption.

◆ Diarrhoea (chronic or intermittent)
◆ Stinking stools
◆ Steatorrhea
◆ Bloating, nausea and vomiting
◆ Fatigue
◆ Weight loss
◆ Iron deficiency anaemia

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45
Q

What are the complications of coeliac disease?

A

◆ Osteoporosis
◆ T cell lymphoma of the small intestine

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46
Q

What investigations are done in coeliac disease?

A

These tests must be done with gluten re-introduced in the patients diet for a minimum of 6 weeks!

1. Specific auto-antibodies
◆ Tissue tranglutaminase (TTG) antibodies (IgA)
◆ Endomysial antibody (IgA)

2. Jejunal/Duodenal biopsy

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47
Q

Management of coeliac disease?

A

Gluten free diet.

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48
Q

Describe the symptoms of breath holding spells.

A

◉ Symptoms
◆ Happens after a child that was crying vigourously
◆ Turns blue and then stops breathing

◉ Cause:
◆ Stress, anger, anxiety
◆ Loss of counsciousness <1min

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48
Q

Describe the symptoms of reflex anoxic seizures.

A

◉ Symptoms
◆ Sudden fright or pain (may or may not cry)
◆ Stops breathing and then turns pale

◉ Cause:
◆ Stress, anger, anxiety
◆ Loss of counsciousness <1min

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49
Q

Management of breath holding spells and reflex anoxic seizures?

A

◆ Reassurance
◆ Advise parents to put child on recovery position
◆ Check ferritin and treat iron deficiency if present.

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50
Q

What is the cause of congenital adrenal hyperplasia?

A

Autossomal recessive disorder caused by:
➜ 21-hydroxylase deficiency.

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51
Q

Symptoms of congenital adrenal hyperplasia.

A

► General:
◆ Hyponatraemia
◆ Hyperkalaemia
◆ Vomiting

► Females:
◆ Ambiguous genitalia with enlarged clitoris

► Males:
◆ Hyperpigmentation
◆ Penile enlargement

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52
Q

Treatment of congenital adrenal hyperplasia

A

◆ Glucorticoids (prednisolone, hydrocortisone)
◆ Mineralocorticoids (fludrocortisone)
◆ Surgery (for ambiguous genitalia)

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53
Q

Describe the non classical symptoms of congenital adrenal hyperplasia.

A

◆ Caused by overproduction of 17-hydroxyprogesterone
◆ Presents in late childhood or early adulthood with hirsutism, acne and oligomenorrhoea

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54
Q

What is the management of congenital cytomegalovirus?

A

➜ PCR: oral swabs of the neonate;
➜ Ganciclovir: given to the neonate to slow down disease progression.

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55
Q

What are the complications of congenital cytomegalovirus?

A

◆ Sensorineural hearing loss ⟶ most common
◆ Cataracts
◆ Microcephaly
◆ Low birth weight
◆ Learning disability

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56
Q

What is the most likely outcome of congenital cytomegalovirus?

A

Normal development.

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57
Q

What are the symptoms of congenital hypothyroidism?

A

◆ Prolonged jaundice
◆ Difficulty feeding
◆ Lethargy
◆ Goitre

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58
Q

What are the physical signs of congenital hypothyroidism?

A

◆ Macroglossia
◆ Large fontanelles
◆ Jaundice
◆ Umbilical hernia
◆ Hoarse voice

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59
Q

How is the diagnosis of congenital hypothyroidism done?

A

◉ Heel prick test (when the newborn is 5 days old)
◆ ⬆︎TSH
◆ ⬇︎ T4

◉ If heel prick test positive:
◆ Radioisotope scan
◆ Ultrasound of the neck

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60
Q

Treatment of congenital hypothyroidism?

A

➜ Oral levothyroxine until 2yo.

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61
Q

What is the management of constitutional delay in growth and puberty?

A

X-ray of the left wrist:
◆ Significant short stature / growth delay.

Review in 6 months (no x-ray):
◆ Strong family history of late bloomers.
◆ Minor variations of growth rate.
◆ Healthy child.

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62
Q

Describe the adrenal axis physiology.

Cushings syndrome

A
  1. Hypothalamus releases CRH hormone
  2. CRH acts on the anterior pituitary gland
  3. Anterior pituitary releases ACTH hormone
  4. ACTH acts on the adrenal gland
  5. Adrenal gland releases cortisol
  6. Cortisol does the following:
    ◆ Inhibits the immune system;
    ◆ Inhibits bone formation;
    ◆ ⬆︎ blood glucose
    ◆ ⬆︎ metabolism
    ◆ ⬆︎ alertness
  7. ⬆︎ Cortisol sends a negative feedback to the anterior pituitary and to the hypothalamus, and they ⬇︎ the production of their hormones.
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63
Q

What is Cushings syndrome?

A

Condition caused by prolongued exposure of endogenous or exogenous glucorticoids leading to excessive cortisol on the body.

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64
Q

What are the causes of Cushings syndrome?

A

◉ ACTH dependent disease
◆ Cushings disease: Pituitary adenoma;
◆ Ectopic ACTH: small lung carcinoma

◉ Non-ACTH dependent
◆ Adrenal adenoma/carcinoma
◆ Exogenous steroids

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65
Q

What are the symptoms of Cushings syndrome?

A

◆ Round face
◆ Buffalo hump
◆ Abdominal obesity
◆ Purple abdominal striae
◆ Muscle weakness
◆ Osteoporosis
◆ Depression and insomnia

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65
Q

How is the diagnosis of Cushings syndrome done?

A

1. 24h urinary free cortisol
2. Dexamethasone suppression test (low dose)

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66
Q

Explain how the low dose dexa supression test is done and its clinical relevance.

A

1. 1mg of Dexa is giving at midnight.
2. Cortisol (plasma) is measured the next day at 9 am.

➜ If positive for Cushings:
◆ 1mg of dexa won't be enough to supress the hypothalamus (CRH) or the anterior pituitary (ACTH), as the body is used to ⬆︎ levels of cortisol.

➜ If negative for Cushings:
◆ Cortisol < 50 nmol/L.
◆ 1mg of dexa will be enough to supress the hypothalamus and the anterior pituitary.

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67
Q

After positive dexa supression test (low dose), what is the next step?

Cushings syndrome

A

◉ Differentiate the causes of Cushings by doing:
➜ High dose dexamethasone supression test.

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68
Q

Explain how the high dose dexa supression test is done and its clinical relevance.

✿This one is for that Deo that sat on the Uni’s floor in Shunde, hopeless, aimless.
✿This is for that Deo that decided to not cheat with everyone else on that final exam in Shunde, she was trying to find herself in the mist of it all.

A

◘ 8mg of dexa is administered.

➔ Cushing disease/pituitary adenoma:
◆ ACTH ⬇︎
◆ Cortisol ⬇︎
◆ 8 mg would supress the ACTH/adenoma

➔ Adrenal adenoma:
◆ ACTH ⬇︎
◆ Cortisol ⬆︎
◆ 8 mg would supress the pituitary but the source of the ↑ cortisol is on the kidney itself.

➔ Ectopic ACTH (lung carcinoma):
◆ ACTH ⬆︎
◆ Cortisol ⬆︎
◆ The source of the ↑ cortisol is elsewhere even though the pituitary is supressed.

✿This is for that Deo that sat on the lobby of ICOR, exhausted and scared.
✿This is for that Deo that worked unmotivated at HPM just repeating and copying daily tasks without really understanding the why’s.
✿This is for that Deo that in spite of everything, still found hope and energy to pursue an amazing path.

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69
Q

What is the cause of cystic fibrosis?

A

Autosomal recessive disease caused by:
➜ Defect in CFTR gene.

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70
Q

What are the symptoms of cystic fibrosis?

A

Symptoms usually start on early childhood, and progressively gets worse overtime.

➜ Excretion of Na⁺ and Cl⁻ into the airways which ↑ mucus viscosity.
➜ Thick mucus clogs the lungs and pancreas.
◆ Recurrent lung infections
◆ Cough
◆ SOB
◆ Malabsorption (steatorrhoea/failure to thrive)
◆ Salty skin/sweat
◆ Meconium ileus (newborn)
◆ Delayed sexual development

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71
Q

What microrganisms cause recurrent lung infection in cycstic fibrosis.

A

◆ Children: S. aureus
◆ Adults: Pseudomonas aeruginosa
◆ Haemophilus influenzae

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72
Q

.

Diagnosis of cystic fibrosis

A

◉ Newborns:
◆ Heel prick test
➝ If positive
◆ Genetic testing for CFTR gene
◆ Sweat test

◉ Older children (not diagnosed when born):
◆ Sweat test
◆ Genetic testing for CFTR gene
◆ Chest X-ray

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73
Q

Rx of cystic fibrosis

A

◆ Pancreatic enzyme replacement
◆ Dornase alfa and hypertonic saline to reduce mucus viscosity
◆ Chest physioterapy
◆ Bronchodilators
◆ Nebulised tobramycin / colistimethate for chronic P. aeruginosa
◆ Lung transplantation if resp. failure.

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74
Q

What is the cause of Erb’s palsy?

A

Injury of the upper brachial plexus at the level of:
◆ C5-C7
It happens during childbirth.

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75
Q

Describe febrile seizures.

A

◆ Seizures accompanied by fever without signs of CNS infection or electrolyte abnormalities.

◆ Most common between 6 mths - 6 YO.

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76
Q

Classification of febrile seizures

A

Simple
◆ < 15 min + generalised tonic clonic.

Complex
◆ > 15 min OR focal.
◆ Recurrent.

Febrile status epilepticus
◆ > 30 min without complete recovery.

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77
Q

Management of febrile seizures

A

◆ Place the patient in recovery position
◆ ABCDE
◆ If seizure > 5min than BZD (buccal midazolan or rectal diazepam)
◆ Search for other cause of seizures (hypoglycaemia, electrolyte imbalances, meningitis).

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78
Q

When to give paracetamol in febrile seizures?

A

Seizures
+
Fever
+
Pain/Distress

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79
Q

What are the symptoms of galactosaemia?

A

◆ Prolonged jaundice
◆ Yellow stools
◆ Pale urine
◆ Failure to thrive
◆ Vomiting
◆ Hepatomegaly

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80
Q

What is the treatment of galactosaemia?

A

Discontinue milk to remove the lactose load and prevent progression to liver disease.

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81
Q

Symptoms of GORD

Gastro-oesophageal reflux disease

A

◆ Recurrent regurgitation
◆ Gagging or choking during feeds
◆ Cries after feeds
◆ Refuses feeds
◆ Aspiration pneumonia

Age group <1 yo.

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82
Q

Risk factors for GORD?

A

◆ Premature birth.
◆ Obesity.

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83
Q

Rx of GORD

A

◆ Smaller and frequent meals
◆ Trial of thickened formula
◆ Alginate therapy (gaviscon)
◆ PPI (proton pump inhibitors) & H2 blockers

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84
Q

Describe the triad of haemolytic uraemic syndrome (HUS)

A

◆ Haemolytic anaemia
◆ Thrombocytopenia
◆ Acute renal failure

85
Q

Describe the peripheral blood smear of HUS

A

Presence of:
◆ Schistocytes
◆ Helmet cells
◆ Fragmented red cells

86
Q

What is the cause of HUS?

A

Occurs after an episode of bloddy diarrhea caused by:
◆ E. coli

87
Q

Rx of HUS

A

➜ DO NOT give antibiotics (E.coli releases toxins upon dying which will worsen the disease)

◆ Fluids (transfusion if needed)
◆ Antihypertensive meds
◆ Dialysis

88
Q

What is the cause of hand, foot and mouth disease?

A

➜ It is a self limiting viral disease caused by:
◆ Coxsackievirus

89
Q

Symptoms of hand, foot and mouth disease?

A

◆ Fever
◆ Sore throat
◆ Oral ulcers
◆ Vesicles on the palms and soles of the feet
◆ Macules on the palms and soles of the feet

90
Q

Describe what is Henoch-Schonlein purpura and its epidemiology.

A

◆ It’s a small vessel systemic vasculitis
◆ Affects children 2 - 11YO.

91
Q

Symptoms of Henoch-Schonlein purpura.

A

◆ Purpura (buttocks & legs)
◆ Joint pain
◆ Abdominal pain
◆ Bloody diarrhoea
◆ Glomerulonephritis (proteinuria & hematuria)
◆ Recent h/o URTI or gastroenteritis

◉ Peter PAAN
➔ Purpura (PLT in the normal range)
➔ Abdominal pain
➔ Arthralgia
➔ Nephropathy

92
Q

Management of Henoch-Schonlein purpura.

A

➜ Conservative management
◆ Arthralgia ⟶ NSAIDS

93
Q

What are the symptoms of idiopathic trombocytopenic purpura?

A

◆ Trombocytopenia
◆ Epistaxis/Menorrhagia/GI bleed

➔ Onset after 1-2 weeks of URTI
➔ Age: 2-10YO

94
Q

Management of idiopathic trombocytopenic purpura?

A

First line:
◆ Prednisolone

Second line:
➔ If bleeding & unresponsive to corticosteroids
◆ IV immunoglobulin

Third line:
➔ Only in life threatening bleeding
◆ Platelet transfusion

Life threatning bleed:
* Intracranial bleeding
* High volume bleeding
* Hypotension
* Etc.

95
Q

What are the symptoms of UTI?

A

◆ Fever
◆ Abdominal pain
◆ Loin pain
◆ Dysuria
◆ Increased frequency

96
Q

Paeds

Risk factors for UTI?

A

◆ Stasis of urine (renal calculi, VUR, phimosis);
◆ Constipation
◆ Sexual abuse
◆ Previous hx of UTI

97
Q

What are the investigations done in UTI?

A

➔ Urine culture & sensitivity:
◆ Clean catch urine sample
◆ Catheter sample
◆ Suprapubic aspiration

➔ Dipstick testing:
◆ Searching for nitrites

98
Q

Rx for UTI?

A

◆ Nitrofurantoin MR 100 mg BD (2x/day)
◆ Trimethoprim 200 mg BD

99
Q

Describe the imaging for UTI in patients < 6mths.

A

◉ If responds to Rx in < 48h:
◆ USS within 6 weeks
◆ MCUG if USS is abnormal

◉ Atypical UTI:
◆ Immediate USS (during infection)
◆ Perform DMSA scan 4-6 mths after infection
◆ Perform MCGU

◉ Recurrent UTI:
◆ Immediate USS (during infection)
◆ Perform DMSA scan 4-6 mths after infection
◆ Perform MCGU

MCUG: micturating cystourethrography

100
Q

Describe the imaging for UTI in patients between 6mths - 3 YO.

A

◉ If responds to Rx in < 48h:
◆ No imaging required

◉ Atypical UTI:
◆ Immediate USS (during infection)
◆ Perform DMSA scan 4-6 mths after infection
◆ Consider MCGU

◉ Recurrent UTI:
◆ USS within 6 weeks
◆ Perform DMSA scan 4-6 mths after infection
◆ Consider MCGU

101
Q

On children > 6 mths
when can MCGU be performed?

A

◆ Dilation of ureter on USS
◆ Poor urine flow
◆ Family h/o of VUR
◆ Non E.coli infection

102
Q

Describe the imaging for UTI in patients > 3 YO.

A

◉ If responds to Rx in < 48h:
◆ No imaging required

◉ Atypical UTI:
◆ Immediate USS (during infection)

◉ Recurrent UTI:
◆ USS within 6 weeks
◆ Perform DMSA scan 4-6 mths after infection.

103
Q

Describe infantile spasms.

A

◉ Type of a seizure that begins around 6mths of age and is a part of West Syndrome:
◆ Mental retardation
◆ EEG abnormalities
◆ Infantile spasms

104
Q

Cause of infantile spasms?

A

◆ Any condition that results in brain injury (inclunding Down syndrome)
◆ Idiophatic

105
Q

Presentation of infantile spasms?

A

Contractions commonly occur just before sleeping or upon waking up.

106
Q

What is the investigation done in infantile spasms?

A

➔ EEG:
◆ Hypsarrhythmia

107
Q

What is the RX in infantile spasms?

A

◆ ACTH depot (hormone?)
◆ Prednisolone
◆ Vigabatrin (drug of choice in tuberous sclerosis)

ACTH ⬇︎ neuronal excitability by inducing steroids release.

108
Q

What is the cause of infant respiratory distress syndrome?

A

◆ Inadequate surfactant production in the alveoli ⟶ widespread alveolar collapse.

► Surfactant production begins at 24 weeks gestation but adequate amounts to prevent atelectasis begins at 32 weeks.

109
Q

Risk factors for infant respiratory distress syndrome?

A

◆ Premature birth
◆ C-section delivery
◆ Maternal diabetes
◆ Meconium aspiration syndrome

110
Q

What are the symptoms of infant respiratory distress syndrome?

A

◆ ⬆︎ RR
◆ Subcostal and intercostal rectrations
◆ Expiratory grunting
◆ Cyanosis if severe

111
Q

What are the investigations for infant respiratory distress syndrome?

A

◆ SPO₂
◆ Blood gases
◆ Chest x-ray: ground glass (atelectasis) / fine granular opacities

112
Q

What is the Prevention and Rx for infant respiratory distress syndrome?

A

◉ Prevention:
◆ Steroids administered to mother IM antenatally

◉ Rx:
◆ Surfactant administered down the ETT
◆ IPPV
◆ Fluid and electrolyte monitoring

113
Q

Paeds

Describe the characteristics of innocent murmurs.

A

◆ Heard at the lower left sternal edge
◆ Louder (when the child is) in suppine position
◆ Changes with position and respiration

114
Q

Describe the management of innocent murmurs.

A

Reassurance.

115
Q

Paeds

Describe what is intussusception of the intestines.

A

◆ Invagination / telescope of the intestines ⟶ bowel obstruction.

5 mths - 3 YO.

116
Q

What are the symptoms of intussusception?

A

◆ Abdominal pain (knees drawn to chest)
◆ Abdominal distention
◆ Bilious vomiting
◆ Red-currant jelly stool
◆ Palpable sausage shape mass in the abdomen

117
Q

What are the investigations done in intussusception?

A

➔ USS - gold standard:
◆ Doughnut shape / target sign.

➔ Barium enema:
◆ Invasive so not the best option

118
Q

What is the Rx done in intussusception?

A

◆ Electrolyte and fluids correction
◆ Air enema reduction (if no perforation / peritonitis)
◆ Laparatomy

119
Q

What are the symptoms of Kawasaki disease?

A

► It is a systemic vasculitis most commonly seen < 5 YO.

◆ Fever (>39º C for > 5 days)
◆ Conjuctivitis (non exudative)
◆ Strawberry tongue
◆ Cervical lymphadenopathy (painless)
◆ Rash (non vesicular)
◆ Extremities: erythema of the palms and soles that progresses to peeling;

120
Q

What is the severe complication of Kawasaki disease?

A

Coronary artery aneurysm.

Develops if the disease is left untreated.

121
Q

What is the Rx of Kawasaki disease?

A

◉ IV immunoglobulins:
◆ Prevents coronary arteries aneurysm (if given in the first 10 days).

◉ Aspirin (high dose):
◆ Prevents thromboembolism

◉ AAS (low dose):
◆ After fever is controlled
◆ After inflammatory markers have ⬇︎
◆ Given until 6 weeks while awaiting USS (to exclude aneurysm)

122
Q

What is the investigation done in Kawasaki disease?

A

◆ Ultrasound (after 6 weeks of treatment with aspirin).
◆ To exclude aneurysm.

123
Q

What are the symptoms of malrotation and volvulus?

A

Sudden onset of symptoms in neonates characterised as:
◆ Vomiting (green, bilious)
◆ Rectal bleeding

124
Q

What are the investigations done in malrotation and volvulus?

A

➔ Abdominal x-ray:
◆ Double bubble sign

➔ Barium enema

125
Q

What is the Rx of malrotation and volvulus?

A

◆ ABCDE
◆ Nasogastric tube for decompression
◆ URGENT laparatomy

126
Q

What is Marfan syndrome?

A

◆ Autossomal dominat condition
◆ Caused by mutation in fibrillin gene

127
Q

Symptoms of Marfan syndrome?

A

◉ General:
◆ Tall & thin
◆ Long: arms, finger, legs and toes
◆ Flexible joints
◆ Scoliosis

◉ Cardiovascular:
◆ Mitral valve prolapse
◆ Mitral regurgitation
◆ Aortic regurgitation
◆ Aortic dissection & aneurysm

◉ Pulmonary:
◆ Recurrent pneumothorax

◉ Eyes:
◆ Lens dislocation
◆ High myopia

128
Q

What are the symptoms of Measles?

A

◆ Koplic spots (white spots on oral mucosa BEFORE RASH)
◆ Itchy maculopapular rash that starts behind the ear (Head ➜ Body);
◆ Cough, coryza
◆ Conjuctivitis
◆ Fever

129
Q

Rx for measles?

A

Supportive Rx:
◆ Paracetamol
◆ Fluids
◆ Calamine lotion (for rash)

Avoid contact with young children and pregnant woman.

130
Q

Describe the characteristics of Meckel's diverticulum?

A

◆ Age 2-3 YO
◆ 2 feet away from ileo-caecal valve

131
Q

Describe the symptoms of Meckel's diverticulum?

A

◆ Most patients are asymptomatic
◆ Painless rectal bleeding
◆ If obstruction: vomiting and abdominal pain.

132
Q

What is the cause of meconium aspiration syndrome?

A

◆ Aspiration of meconium before or at the time of delivery.
◆ Meconium will inhibit surfactant and obstruct the respiratory tract.

133
Q

What are the risk factors for meconium aspirated syndrome?

A

◆ Post term date (>42 weeks)
◆ Maternal hypertension
◆ Oligohydramnious
◆ Placental insufficiency

134
Q

Rx of meconium aspirated syndrome?

A

◆ Suction of airways
◆ O₂
◆ Fluid and electrolyte
◆ Antibiotics (when needed)

135
Q

Cause of nephrotic syndrome?

A

◆ Minimal change disease

136
Q

What are symptoms of nephrotic syndrome?

A

◆ Proteinuria (> 3.5g/24h)
◆ Hypoalbuminaemia (< 30g/L)
◆ Oedema

137
Q

Rx of nephrotic syndrome?

A

First line:
◆ Steroids

Second line:
◆ Cyclophosphamide

138
Q

Paeds

What are the symptoms of necrotising enterecolitis?

A

◆ Abdominal x-ray: air in the bowel wall
◆ Bloody stools
◆ Vomiting
◆ Doesnt’s tolerate feeding
◆ Abdominal distension

139
Q

What are the investigations in necrotising enterecolitis?

A

Most initial:
◆ X-ray

Others:
◆ Cultures
◆ Blood films
◆ Coagulation studies

140
Q

What is the Rx in necrotising enterecolitis?

A

Initial:
◆ Stop feedings

Others:
◆ NG tube (free drainage & aspiration)
◆ Fluids + electrolytes
◆ Antibiotics
◆ Surgery (if pneumoperitoneum)

141
Q

What is the MOA of physiological / neonatal jaundice?

A

◆ ⬆︎ RBC breakdown
◆ Immature liver to process bilirubin

142
Q

Rx of physiological jaundice?

A

Phototherapy
◆ If bilirubin is midly above the cut-off point for age.

Exchange transfusion
◆ If bilirubin is highly elevated above the cut-off point for age

143
Q

What are the pathological causes of physiological / neonatal jaundice?

A

◆ Rhesus incompability
◆ ABO incompability
◆ G6PD
◆ Sepsis

144
Q

What is the time onset of physiological jaundice?

A

24h to 2weeks after birth.

145
Q

What is the step by step management of jaundice after 2 weeks of life?

A

◉ First step:
◆ Bilirubin investigation

➔ If ⬆︎unconjugated bilirubin:
◆ Breast milk jaundice
◆ Reasurrance

➔ If ⬆︎conjugated bilirubin:
◆ Biliary atresia
◆ Surgery: Kasai procedure

146
Q

What are the risk factors for neonatal sepsis?

A

◆ Premature rupture of membranes
◆ Chorioamnionitis
◆ Prematurity

147
Q

What is the investigation in neonatal sepsis?

A

◆ Blood culture

148
Q

NICE🚦light system

A

Admit patients if < 5YO presenting with any of the following features.

RED features:

Infectious:
◆ Fever > 38C (0-3 months)

Skin:
◆ Blue
◆ Pale
◆ Non-blanching rash

Respiratory:
◆ Grunting
◆ RR > 60 cpm
◆ Moderate chest indrawing

Hydration:
◆ Reduced skin turgor

Neuro:
◆ Focal seizures
◆ Neck stiffness

149
Q

What are the features of non-accidental injury?

A

◆ Delayed time to medical presentation
◆ Step-father/boyfriend accompanies the child
◆ Bruises of varying degrees and colours
◆ Bruises at unusual sites
◆ Fractures: rib & spiral

150
Q

Rx of non accidental injury:

A

◆ Admit
◆ Pain management
◆ Call safeguarding team
◆ Referral to social services
◆ Management of other conditions

151
Q

Paeds

What is the cause of OSA?

A

Enlarged:
◆ Tonsils
◆ Adenoids

152
Q

Paeds

Symptoms of OSA?

A

◆ Snoring
◆ Mouth breathing
◆ Witnessed apnoeic episodes
◆ Nasal speech

153
Q

What is the GOLD standard *investigation* of OSA?

A

Polysomnography.

Sleep study.

154
Q

Rx of OSA?

A

◆ Surgery
◆ Referral to ENT.

155
Q

What is the organism associated with osteomyelitis?

Bone infection

A

◆ S. aureus.

156
Q

Difference between Otitis media and Otitis externa?

A

Otitis externa:
◆ Pain and discharge simultaneously

Otits media:
◆ Pain before discharge

157
Q

What is the most common cause of conductive hearing loss in childhood?

A

◆ Otitis media with effusion (ear glue)
◆ Often painless

158
Q

Management of:

Primary bedwetting: overactive bladder WITH DAYTIME symptoms.

DAYTIME SYMPTOMS

A

◆ If > 2YO: Referal to secondary care / enuresis clinic

First line:
◆ Bladder retraining / behavioral therapy

Second line:
◆ Oxybutin

Others:
◆ Desmopressin (oral or sublingual ONLY)

159
Q

Management of primary bedwetting
WITHOUT DAYTIME symptoms

A

◉ < 5 YO
◆ Reassurance

◉ > 5 YO
➔ < 2x/week: Reassurance + Positive reward system
➔ ≥ 2x/week short term control: desmopressin
➔ ≥ 2x/week long term control: Enuresis alarm + Positive reward system

160
Q

Describe the developmental milestones.

A

3 months:
◆ Holds neck

6 months:
◆ Body rolls on both directions

9 months:
◆ Crawling

12 months:
◆ Walk

161
Q

Describe the fine motor skill milestones.

A

2 years:
◆ Draws a line

3 years:
◆ Draws a cirlce

4 years:
◆ Draws a cross and a square

5 years:
◆ Draws a triangle

6 years
◆ Draws a diamond

162
Q

When to refer to specialist community paediatric assesment?

If delayed milestones

A

5 months:
◆ Unable to hold object placed in hand

6 months:
◆ Unable to reach for objects

12 months:
◆ Unable to sit unsupported

18 months:
◆ No speech
◆ If no monosylabic words at 15 months ⟶ hearing test

2 years:
◆ Unable to put 2 words together in a phrase (push car).

2.5 years
◆ Unable to run

163
Q

What are the types of paeds fluids therapies?

A
  1. Ressuscitation
  2. Maintenance
  3. Replacement
164
Q

Fluids therapy

Resuscitation IV fluids

A

➔ Indicated in shock

◆ 10ml/Kg IV in < 10 min
◆ In moderate to severe dehydration

165
Q

Fluids therapy

Maintenance IV fluids

A

➔ Indicated if oral intake insufficient to maintain hydration.
➔ Indicated in the perioperative period when patint is nill by mouth.

► Holliday-Segar formula
◆ Child > 28 days old.
◆ First 10 Kg ⟶ 100 ml/Kg/day
◆ Next 10 Kg ⟶ 50 ml/Kg/day
◆ Reimaning ⟶20 ml/Kg/day

➔ Rate calculation
◆ Divide the total by 24
◆ Administer in 48h in hypernatreamia

166
Q

What is the cause of slapped cheek syndrome / erythema infectiosum?

A

Parvovirus B19

167
Q

Symptoms of slapped cheek syndrome / erythema infectiosum?

A

◆ Fever
◆ Coryza
◆ Erythematous maculopapular rash on the cheeks

168
Q

Management of slapped cheek syndrome / erythema infectiosum?

A

◆ Supportive

➔ Once rash develops no need to stop school

169
Q

What is the management of Vitamin D supplementation?

A

0 - 1 years:
◆ 340 - 400 UI daily

> 1 year:
◆ 400 UI daily

170
Q

What is the cause of pertussis?

Whooping cough

A

◆ Bordetella pertussis
◆ Lack of vaccinations

171
Q

Symptoms of of pertussis?

A

◆ Bout of cough
◆ Vomiting after coughing
◆ Inspiratory whoop
◆ Apnoea or cyanosis

172
Q

Investigations for pertussis?

Whooping cough

A

Young children and infants:
◆ Pernasal swab for PCR

Older children & adults:
◆ Nasopharygeal swabs for PCR

If > 2 weeks of coughing:
◆ Serology

173
Q

Rx for pertussis

Whooping cough

A

Macrolides: azithromycin, clarithromicyn

174
Q

What are the symptoms of pyloric stenosis?

A

◆ Olive shape mass in the abdomen
◆ Projectile non-bilious vomiting after feeding
◆ Constant hunger
◆ Weight loss
◆ Dehydration
◆ Electrolyte abnormalities
◆ Metabolic alkalosis

175
Q

Investigations done in pyloric stenosis

A

Most initial:
◆ Serum K⁺

Most definitive:
◆ USS

176
Q

Rx in pyloric stenosis

A

First line:
◆ Correction of fluids and electrolytes imbalance

Most definitive Rx:
◆ Surgery

176
Q

Cause of scarlet fever?

A

◆ Streptococcus pyogenes

177
Q

Symptoms of scarlet fever

A

◆ Fever (> 38ºC)
◆ Sore throat
◆ Strawberry tongue
◆ Cervical lymphadenopathy
◆ Rash:
- Torso ⟶ extremities
- Sandpaper texture

178
Q

Rx of scarlet fever

A

1st line:
◆ Penicilin for 10 days

2nd line:
◆ Azithromycin for 10 days

179
Q

Advice to give to parents regarding ⬇︎ risk in sudden infant death syndrome?

A

◆ Avoid smoking near infants
◆ Infants should sleep on their back (not front or sides)
◆ Feet of infant at the foot of the cot
◆ Avoid pillows
◆ Avoid overheating by heavily wrapping
◆ Use sheets or blankets, avoid duvets
◆ Blankets should not be higher than shoulders
◆ Avoid taking infant into bed with parents after alcohol or sedatives consumption
◆ Avoid sleeping with infant on sofa

180
Q

What are the symptoms of Tourette's syndrome?

A

◆ Obscene verbal ejaculation
◆ Tics

181
Q

Rx of Tourette's syndrome?

A

◆ Behavioural therapy
◆ Risperidone and haloperidol if necessary

182
Q

Cause of transient tachypnoea of the newborn

A

◆ Delay of reabsortion of lung liquid

183
Q

Symptoms of transient tachypnoea of the newborn

A

Respiratory distress

184
Q

Investigations of transient tachypnoea of the newborn

A

◆ X-ray: Fluid in the horizontal fissure.

185
Q

Management of transient tachypnoea of the newborn

A

◆ O₂

186
Q

What is the vesicoureteric reflux?

A

➔ The retrograde flow of urine from bladder ➝ ureters ➝ kidneys.

187
Q

Symptom of vesicoureteric reflux?

A

◆ Usuallly asymptomatic
◆ May present as UTI

188
Q

Investigation of vesicoureteric reflux?

A

Initial:
◆ Urinalysis, urine culture + sensitivity
◆ Renal uss

Goldstandard:
◆ Micturating cystourethrogram

Parenchymal damage dtected:
◆ DMSA

189
Q

RX of vesicoureteric reflux

A

Grade I-IV reflux
◆Prophylaxis Low dose antibiotics (trimethropin)

Surgical correction
◆ High grade reflux IV - V
◆ Failed prophylaxis
◆ Parenchymal damage

190
Q

Define Wilson’s disease.

A

◆ Autossomal recessive disorder
◆ ⬇︎ Serum copper concentrations
◆ ⬆︎ Liver copper concentrations ➝ liver failure.

191
Q

Cause of Wilson’s disease?

A

◆ Gene mutation afecting copper transport.

192
Q

What are the symptoms of Wilson's disease?

Copper

A

Eyes:
➔ Kayser-Fleischer rings

Liver:
◆ Deranged liver function tests
◆ Cirrhosis

Neuro:
◆ Ataxia
◆ Dysarthria
◆ Dystonia

Behavioural:
◆ Personality changes
◆ ⬇︎ school perfomance

193
Q

What are the investigations done in Wilson's disease?

A

◆ Liver function tests
◆ Serum ceruloplasmin
◆ Hepatic parenchymal copper [.]

194
Q

Rx of Wilson’s disease

Copper

A

◆ Lifelong Penicillamine
◆ Acute liver failure or cirrhosis: liver transplant

195
Q

Describe what is Wilm’s tumour.

A

◆ Renal neoplasm
◆ < 5 yo
◆ Also known as nephroblastoma.

196
Q

Symptoms of Wilm’s tumour.

A

◆ Abdominal palbable firm and smooth mass
◆ Asymptomatic

197
Q

Management of Wilm's tumour?

A

◆ Urgent referral to paediatric team.

198
Q

Name the diseases that present with strawberry tongue.

A

◆ Kawasaki disease
◆ Scarlet fever

199
Q

Name the paeds rashes that present with fever.

A

High fever:
◆ Kawasaki
◆ Roseola
◆ Scarlet fever

Mild fever:
◆ Measles
◆ Rubella

200
Q

Name the paeds rashes that present with lymphadenopathy.

A

◆ Kawasaki
◆ Scarlet fever
◆ Rubella

201
Q

Name the paeds rashes that present with oral spots.

A

Measles:
◆ Koplik spots (white spots oral mucosa)

Rubella:
◆ Forchheimer spots(red macules on soft palate and tonsils)

202
Q

Name the paeds rashes that present with conjuctivitis.

A

◆ Kawasaki
◆ Measles
◆ Rubella

203
Q

What is the age group for normal puberty development?

A

Girls:
◆ 8 - 13 YO
◆ Breast begin to develop

Boys:
◆ 9 - 14 YO
◆ Testicular enlargement

204
Q

Abnormal puberty development?

A

Early puberty:
Girls: before 8 YO
Boys: before 9 YO

Late puberty:
Girls:
◆ No breast development until 13 YO
◆ Breast developed but no period until 15 YO

Boys:
◆ No testicular development until 14 YO.

205
Q

Describe ostogenesis imperfecta

A

◆ Autosomal dominant disease
◆ Defect in type 1 collagen

206
Q

Symptoms of ostogensis imperfecta

A

◆ Blue sclerae
◆ ⬆︎ risk of bone fracture
◆ Teeth imperfections
◆ Hearing loss

207
Q

When should you worry about weight loss in the first few days of life?

A

◆ Weight loss >10%
◆ Infant does not regain weight by week 3 of life.

208
Q

When are live vaccination contraindicated?

A

◆ Immunosuppressed patients
◆ Pregnancy

209
Q

When should vaccination be delayed?

A

➔ Child with fever or confirmed infection.

210
Q

Rx of osteogenesis imperfecta

A

Biphosponates.

PLAB 1 (24 decks)

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