Paediatrics Flashcards
1
Q
What are the risk factors for DDH?
A
Female
First Born
Oligohydramnios
FHx
Breech presentation
BW <5kg
2
Q
When do you screen for DDH?
A
NIPE
6 week check
3
Q
How do you screen for DDH?
A
Barlow (dislocate)
Ortolani (relocate)
Look at symmetry of leg length, level of knees in flexion, restricted abduction
4
Q
When do you do a routine USS for DDH?
A
1st degree history of hip problems in early life.
Breech at or after 36 weeks
Multiple pregnancy
4
Q
When do you do a routine USS for DDH?
A
1st degree history of hip problems in early life.
Breech at or after 36 weeks
Multiple pregnancy
5
Q
In which hip is DDH more common?
A
Left
6
Q
How do you investigate DDH?
A
USS
(if >4.5 months then Xray)
7
Q
How do you manage DDH?
A
If younger than 4-5 months: Pavlik Harness
Usually spontaneously stabilises by 3-6 weeks of life.
8
Q
What is ITP?
A
Immune mediated reduction in platelet count.
Type 2 hypersensitivity reaction.
9
Q
What are the symptoms of ITP?
A
Bruising
Petechiae/purpura
Epistaxis
Gingival Bleeding
10
Q
How do you manage ITP?
A
No treatment. No hospital admission.
Resolves within 6 months.
Avoid activities which involve trauma.
Do not give IM injections.
Avoid anti-platelets (aspirin & NSAIDs) and anti-coagulants.
Excessive bleeding: platelet infusion
Bone marrow examination only if there are atypical features.
11
Q
What RSV prophylaxis do you give to patients at high risk?
A
Palivizumab (monoclonal antibody)
12
Q
Who are high risk patients which require RSV prophylaxis?
A
Premature infants
Infants with lung/heart problems
Immunocompromised infants
13
Q
What are the symptoms/signs of Pierre Robin Syndrome (Trisomy 13)?
A
Scalp lesions
Cleft palate
Micrognathia (small jaw)
Microcephalic
Small eyes
Polydactyly
14
Q
What organisms cause meningitis in neonates?
A
Group B Streptococcus (GBS)
E. coli
Listeria Monocytogenes
15
Q
What organisms cause meningitis in 1month-6years?
A
Neisseria meningitides
Streptococcus pneumoniae
Haemophilus Influenza
16
Q
What organisms cause meningitis in >6yos?
A
Neisseria Meningitides
Streptococcus pneumoniae
17
Q
What is a retinoblastoma?
A
Common ocular malignancy.
Autosomal dominant.
18
Q
What are the clinical signs of a retinoblastoma?
A
Absent red reflex
Strabismus (eyes point in different directions)
Visual problems
Occur at 18 months old
19
Q
How do you treat a retinoblastoma?
A
Enucleation
External beam radiotherapy
Chemotherapy
Photocoagulation
20
Q
What is caput succedaneum?
A
Puffy swelling over the head which crosses suture lines following a traumatic delivery.
Bleed in subcutaneous tissue.
Should resolve in a few days.
21
Q
What is a caput succedaneum?
A
Puffy swelling over the head which crosses suture lines following a traumatic delivery.
Bleed in subcutaneous tissue.
Should resolve in a few days.
22
Q
What is a cephalohaematoma?
A
Bleed that occurs between the periosteal membrane and the cranial bone after a traumatic birth.
Jaundice may develop.
Swelling does not cross the suture lines.
23
Q
Where is a cephalohaematoma most common?
A
Parietal region
24
When is a child able to pass objects from one hand to another?
6 months
25
What causes NRDS?
Surfactant deficiency
26
What are the risk factors for NRDS?
Male
Diabetic mother
C section
Second born of premature twins
27
What prophylactic treatment is used to prevent NRDS?
Synthetic steroids (administration of maternal steroids takes 2 days to increase surfactant levels). This is because natural maternal corticosteroids are important in the production of surfactant.
Tocolytics can be used to suppress labour.
28
How do you treat NRDS?
Extracorporeal membrane oxygenation (ECMO)
CPAP
Curosurf
29
What sign do you see on CXR if you have NRDS?
Ground glass appearance
30
What sign do you see on CXR if you have NRDS?
Ground glass appearance
31
What is the criteria for a severe asthma attack?
pO2<92%
PEF 33-50%
Too breathless to speak
Accessory neck muscles
HR>125 (<5yo) HR>140 (1-5yos)
RR>30 (>5yos) RR>40 (1-5yos)
32
What is the criteria for a life threatening asthma attack?
pO2<92%
Cyanosis
Poor inspiratory effort (normal/high pCO2)
Silent chest
Altered LOC
PEF<33%
33
What are the risk factors for a cleft palate?
Trisomy 13, 15, 18
Smoking
Benzodiazepine
Anti-epileptic
Rubella
33
What are the risk factors for a cleft palate?
Trisomy 13, 15, 18
Smoking
Benzodiazepine
Anti-epileptic
Rubella
34
What are the characteristics of William's Syndrome?
Elfin facies
Broad head
Short stature
Strabismus
35
What are the types of napkin dermatitis?
Irritant dermatitis
- irritation from faeces/urine
- spares creases
Candida dermatitis
- affects flexures
- satellite lesions
Seborrheic dermatitis
- flaky
- often on scalp
Atopic eczema
- affects other areas of the body
Psoriasis
- scaly rash affecting elsewhere
36
How do you manage napkin dermatitis?
Disposable nappies.
Expose area to air.
Barrier cream (zinc and castor oil)
Mild steroid cream in severe cases
Topical imidazole in candida dermatitis.
37
When should a child sit without support?
7-8 months
If cannot do this by 12 months: refer to paediatrician (delay in gross motor skills)
38
What are the clinical features of threadworms?
Anal itching
Girls may have vulval symptoms
Moving white treads in anus at night
39
How do you manage threadworms?
Mebendazole (antiehlmintic) for children >6 months
Hygiene measures (hand washing, washing towels and bedding, disinfecting surfaces)
WHOLE HOUSEHOLD
40
How do you diagnose threadworms?
Clinical diagnosis.
Can use sellotape to the perianal area and send it to the lab for microscopy to see the eggs.
41
What organism causes Whooping cough?
Bordetella Pertussis (gram negative)
42
When are you immunised against whooping cough?
2, 3, 4 months
3-5 years
Women 16-32 weeks pregnant are offered the vaccine
Does not completely immunise you so you can still contract disease
43
What are the diagnostic criteria for whooping cough?
Acute cough lasting 14 days or more with no other cause
Paroxysmal cough (violent/uncontrolled coughing that's exciting and painful)
Inspiratory whoop
Post-tussive vomiting
Apnoeic attacks in infants
44
How do you diagnose whooping cough?
Nasal swab culture
45
How do you manage whooping cough?
Notifiable disease
Azithromycin/clarithromycin if onset of cough within the previous 21 days and should be continued for 14 days.
(Does not alter the course of illness but reduces risk of spread)
Household contacts should be offered prophylactic antibiotics.
School exclusion 48 hours after antibiotics or 21 days after symptoms
46
When should you be admitted with whooping cough?
If <6months old
47
What are the complications of whooping cough?
Pneumonia
Seizures
Bronchiectasis
Subconjunctival haemorrhage
48
What is ADHD?
Inattention, hyperactivity, and impulsivity that are persistent with an element of developmental delay
49
Who is most commonly affected by ADHD?
Males
3-7 yos
50
How do you manage ADHD?
10 week watch and wait period to observe symptoms.
Parents attend education and training programmes.
Drug therapy last resort (>5yo)
- 1st line= methylphenidate (CNS stimulant)
- 2nd line lisdexamfetamine
- 3rd line dexamfetamine
Eat normal balanced diet unless there is link between food and behaviour.
51
What are the side effects of methylphenidate?
Abdominal pain
Nausea
Dyspepsia
Weight and height monitored every 6 months
52
What tests need to be done prior to drug treatment for ADHD?
ECG (cardiotoxic)
Measure weight and height.
53
What type of drug is methylphenidate?
CNS stimulant
Doamine/norepinephrine reuptake inhibitor
54
How do you manage constipation in children?
1. Movicol plan using escalating dose regimen
2. Add stimulant (Senna) if no impaction after 2 weeks
Inform family that disimpaction can initially increase soiling and abdo pain
Do not use dietary interventions alone as 1st line.
55
Give some examples of oral live attenuated vaccines:
Rotavirus
Polio
Typhoid
56
When is the rotavirus vaccine given?
Orally at 2 and 3 months of age (2 doses)
If given late there is risk of intussusception.
57
What is genetic anticipation?
Hereditary diseases have an earlier age of onset through successive generations.
e.g. Huntingtons, Myotonic dystrophy, Fragile X syndrome (Trinucleotide repeat disorders: these repeats of nucleotides are unstable and may enlarge leading to an earlier age on onset)
58
What features are present in Noonan Syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
59
What is the inheritance pattern on Noonan Syndrome?
Autosomal dominant
60
What genetic condition is Noonan Syndrome similar to?
Turner's Syndrome
However this is only in females
61
What heart condition is Turner's Syndrome associated with?
Bicuspid aortic valve (ejection systolic murmur)
&
Coarctation of aorta (late systolic murmur)
62
When is the MMR vaccine given?
12-13 months old
&
3-4 years old (pre-school booster)
Given at thee times due to maternal antibodies interfering before this age with MMR.
63
What is a risk factors for NRDS?
Prematurity
64
What is a risk factor for aspiration pneumonia?
Meconium staining
65
What is a risk factor for TTN (Transient tachypnoea of the newborn)?
C section
66
What is a risk factor for TTN (Transient tachypnoea of the newborn)?
C section
67
What is Coeliac Disease?
Sensitivity to gluten.
Gluten leads to villous atrophy which causes malabsorption.
68
What are the clinical signs of Coeliac Disease?
Failure to thrive
Diarrhoea
Abdominal distension
Anaemia
69
When do patients usually present with Coeliac Disease?
Before 3 yo due to introduction of cereal
1:100 incidence
70
How do you diagnose Coeliac disease?
Jejunal biopsy: subtotal villous atrophy
Anti-TTG and Anti-EMA antibodies.
Associated with HLA-DQ2 & HLA-DQ8
71
How do you treat CF?
Regular BD chest physio and postural drainage
High calorie diet, high fat intake
Vitamin supplementation
Pancreatic enzyme supplement with meals
Lung transplant
Minimise contact with other CF patients to reduce cross contamination with Burkholderia and Pseudomonas aeruginosa
Lumacaftor/Ivacaftor (Orkambi)
- increases number of CFTR proteins transported to cell surface an potentiates CFTR that is already at the surface
- for patients homozygous for delta F508 mutation
72
When is a lung transplant contraindicated in CF?
Chronic infection with Burkholderia
73
What is in intraventricular haemorrhage?
Haemorrhage into the ventricular system of the brain.
74
How do you get an intraventricular haemorrhage?
Trauma (head injury)
Spontaneously in premature babies (usually occur in 1st 72 hours in neonates)
75
How do you treat an intraventricular bleed?
Supportive therapy
Hydrocephalus is an indication for shunting
76
What is a complication of intraventricular haemorrhage?
The blood may clot and occlude CSF flow, resulting in hydrocephalus.
77
What are the features of measles
Prodrome (irritable, conjunctivitis, fever)
Koplik spots
Rash starts behind the ears and spreads to the whole body (discrete maculopapular rash which is blotchy and confluent)
Desquamation (spares palms and soles)
78
What are the complications of measles?
Otitis media (most common as virus can spread to ear canal)
Pneumonia (most common cause of death)
Encephalitis (1-2 weeks after)
Subacute sclerosing pan encephalitis (5-10 years after)
Myocarditis
Appendicitis
Diarrhoea
Febrile convulsions
79
What blood test can you do to diagnose measles?
IgM antibodies detected
(few days after rash onset)
80
What should you do if you come into contact with someone who has measles and you are not immunised?
MMR vaccine within 72 hours
81
What is the pathophysiology of Hirschprung disease?
Aganglionic segment of the bowel.
82
Who is most affected by Hirschprung's disease?
Males
Down's syndrome
83
What are the clinical features of Hirschprung's?
Failure to pass meconium
Abdominal distension
No palpable mass
Bilious vomiting
84
How do you diagnose Hirschprung's Disease?
Full rectal biopsy= gold standard
Xray shows dilated loops of bowel with fluid level
85
How do you treat Hirschprung's Disease?
Rectal washout/bowel irrigation
&
Surgery (Ano-rectal pull through)
86
What is plagiocephaly?
Skull deformity producing unilateral occipital flattening which pushes the ipsilateral forehead and ear forwards producing a parallelogram appearance.
More common since campaign to encourage babies to sleep on back to reduce SIDS.
87
How do you manage plagiocephaly?
Resolves by age 3-5 due to upright posture.
- Give baby time on tummy during the day
- Rotating cot round
- Moving toys around cot
88
When do you consider hospital admission with bronchiolitis?
RR>60
Difficulty feeding/inadequate oral intake
Clinical dehydration
89
When do you call 999 with bronchiolitis?
Apnoea
Looks unwell
Grunting
RR>70
Chest recessions
Central cyanosis
O2 sats <92%
90
What are the signs of Prada-willy syndrome?
Hypotonia
Dysmorphic features
Short
Hypogonadism
Infertility
Childhood obesity
LD
Behavioural problems
91
What is Androgen Insensitivity Syndrome?
X- linked recessive disorder.
Genetically XY (male).
Phenotypically female.
Due to reduced/absent testosterone receptors in target tissues.
92
What are the clinical features of Androgen Insensitivity Syndrome?
Masses in the groin which are undescended testes.
Primary amenorrhoea.
Breast development due to conversion of testosterone to oestradiol.
93
What is the management of Androgen Insensitivity Syndrome?
Counselling.
Bilateral orchidectomy (there is an increased risk of testicular cancer due to undescended testes).
Oestrogen therapy
94
What are the most common fractures associated with child abuse (NAI)?
Radial
Humeral
Femoral
95
What are some common fractures NOT associated with NAI?
Elbow
Clavicular
Tibial
96
What are the features of CF?
Presenting features
- Meconium ileus
- Prolonged jaundice
- Recurrent chest infections
- Steatorrhoea
- Failure to thrive
- Liver disease
Other features
- Short stature
- DM
- Delayed puberty
- Rectal prolapse due to bulky stools
- Nasal polyps
- Infertility
97
What are the signs of meconium ileus?
Gross abdomen distension
Bilious vomiting
Xray findings:
- Distended bowel
- Mottled ground glass appearance
- Scarce fluid levels as meconium is viscid
98
What is Osgood-Schlatter disease?
Inflammation of the tibial tubercle (just under the knee) caused by chronic irritation.
99
Who does Osgood-Schlatter disease normally effect?
Muscular, athletic adolescents.
100
What are the features of Osgood-Schlatter
Swelling & tenderness over the tibial tubercle that increases with exercise.
Pain is:
- Unilateral
- Gradual in onset
- Relieved by rest
- Worse by kneeling & activity
101
What are the features of an atypical UTI?
- Seriously ill
- Poor urine flow
- Abdominal/bladder mass
- Raised creatinine
- Septicaemia
- Failure to respond to antibiotics within 48 hours
102
What organisms cause an atypical UTI?
Non-Coli organisms
103
What imaging is ordered in an atypical UTI in <6 month olds?
USS
104
What is gastrochisis?
Congenital defect in anterior abdominal wall, lateral to the umbilicus.
105
What is the management for gastrochisis?
Surgery immediately within 4 hours.
106
What are some risk factors for gastrochisis?
- Socioeconomic deprivation
- Maternal smoking/alcohol use
- Age <20
107
What is an omphalocoele?
Defect in the umbilicus itself.
Abdominal contents protrude through anterior abdominal wall which are covered in amniotic sac.
108
How do you manage an omphalocoele?
Staged repair.
C section to reduce risk of sac rupture.
109
What condition is omphalocoele associated with?
Down's syndrome
110
When do you repair an umbilical hernia?
They usually self resolves.
Large (>1.5cm) OR Symptomatic
- perform elective repair at 2-3 yo
Small & Asymptomatic
- perform elective repair at 4-5 yo
Elective repair due to risk of incarceration.
111
What are the risk factors for an umbilical hernia?
Down's syndrome
Afro-Caribbean
Mucopolysaccharide storage diseases
112
What do you do when an umbilical hernia incarcerates?
Manually reduce it with pressure.
Surgically repaired within 24 hours.
If it cannot be reduced an emergency operation is required.
112
What do you do when an umbilical hernia incarcerates?
Manually reduce it with pressure.
Surgically repaired within 24 hours.
If it cannot be reduced an emergency operation is required.
113
What is the most common cause of gastroenteritis?
Rotavirus
114
What are the features of rotavirus?
Fever & vomiting for first 2 days.
Diarrhoea may last a week.
115
What is the risk of gastroenteritis?
Severe dehydration.
116
What are the causes of Chronic Diarrhoea?
Cow's Milk Intolerance
Toddler's Diarrhoea (undigested food due to fast transit)
Coeliac Disease
Post-gastroenteritis lactose intolerance
117
What is Ebstein's anomaly?
Leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle.
Creates tricuspid regurgitation (pan-systolic murmur) and tricuspid stenosis (mid-diastolic murmur).
Leads to enlargement of the right ventricle.
118
What is Ebstein's abnormality caused by?
Use of lithium in pregnancy.
119
What are some common referral points showing developmental delay?
Doesn't smile by 10 weeks.
Cannot sit unsupported at 12 months.
Cannot walk at 18 months.
120
What can hand preference before 12 months indicate?
Cerebral palsy
121
What are some causes of Gross Motor Problems?
Cerebral palsy
Neuromuscular disorders
Normal variant
122
What are some causes of Speech & Language problems?
Hearing
Environmental deprivation
General developmental delay
123
What are the features of growing pains?
- Never present at the start of the day after waking up
- No limp
- No limitation of physical activity
- Systemically well
- Normal physical exam
- Symptoms are intermittent and worse after exercise
- Motor milestones normal
124
What is tested for in neonatal blood screen (Guthrie test/heel prick test)?
Congenital hypothyroidism
CF
Sickle cell disease
PKU
Maple syrup urine disease
Homocystinurea
MCADD
GA1
IVA
125
When is the neonatal blood screen done?
5-9 days of life
126
What is meconium aspiration syndrome?
Respiratory distress in a newborn as a result of meconium in the trachea.
Occurring in the immediate neonatal period.
127
What are the risk factors for meconium aspiration syndrome?
- Post-term deliveries
- History of maternal HTN
- Pre-eclampsia
- Smoking
- Substance abuse
- Chorioamnionitis
128
What is pityriasis versicolour?
Common fungal skin infection.
129
What are the features of pityriasis versicolour?
Becomes more noticeable after spending time in the sun.
- healthy skin becomes darker
- white/light brown patches become more prominent
130
How do you treat pityriasis versicolour?
Ketoconazole shampoo (topical antifungal)
131
What are the features of pityriasis rosea?
Flat/slightly raised pink/red lesions.
Symmetrical.
Edges scaly.
132
What is the cause of pityriasis rosea?
Unclear cause.
Some links to viruses.
133
How do you treat pityriasis rosea?
Self limiting.
Resolves in 12 weeks.
No treatment indicated.
No complications.
Itchy= consider emollients, topical corticosteroids or antihistamines
134
How do you treat pityriasis rosea?
Self limiting.
Resolves in 12 weeks.
No treatment indicated.
No complications.
Itchy= consider emollients, topical corticosteroids or antihistamines
135
In who does eczema usually present in?
Presents before the age of 2.
Clears in 50% of kids by 5yo.
Clears in 75% of kids by 10yo.
136
What are the features of eczema?
Itchy, erythematous rash.
137
What is the distribution of eczema in different age groups?
Infants: face & trunk
Young children: extensor surfaces
Older children: typical distribution (flexor surfaces and creases)
138
How do you treat eczema?
Avoid irritants.
Simple emollients. (Use pump rather than dipping finger in as it can be contaminated by bacteria)
Topical corticosteroids (emollient before then wait 30 mins to dry).
Wet wrapping (emollient under wet bandages).
Oral cyclosporin in severe cases.
139
What are flat feet?
Absent medial arch on standing.
Resolves by 2-8 years.
Reassurance.
Do not recommend orthotics.
140
What is in-toeing caused by?
Internal tibial torsion.
Metatarus adductus.
Femoral anteversion.
Usually resolves.
141
What causes out toeing?
External tibial torsion
142
Does out toeing need to be treated?
Usually resolves at around 2 yo.
Intervention may be required if it doesn't resolve due to increased risk of patellofemoral pain.
143
What is bow legs?
Increased intercondylar distance.
Resolves by ages 4-5.
144
What is knock knees?
Increased intermalleolar distance.
Typically resolves spontaneously.
145
What are the Fraser Guidelines regarding contraception?
- Young person understands professional advice
- Young person cannot be persuaded to tell their parents
- They are likely to begin or continue having sex without contraception
- Unless they receive treatment their physical/mental health is likely to suffer
- Young person's best interest requires them to receive treatment with or without parental consent
145
What are the Fraser Guidelines regarding contraception?
- Young person understands professional advice
- Young person cannot be persuaded to tell their parents
- They are likely to begin or continue having sex without contraception
- Unless they receive treatment their physical/mental health is likely to suffer
- Young person's best interest requires them to receive treatment with or without parental consent
146
How do you resuscitate a newborn?
3:1 (compressions:ventilation)
120-150 bpm
147
What are the risk factors for SIDS?
- Bed sharing (more significant RF)
- Prone sleeping
- Hyperthermia
- Prematurity
- Head covering
- Parental smoking
