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Paediatrics Flashcards

1
Q

What is the management of inguinal hernias in newborns?

A

Needs surgical management asap

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2
Q

What side are inguinal hernias most common in in newborns?

A

Right sided

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3
Q

Treatment of labial adhesions in children? (symptomatic)

A

Topical oestrogen

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4
Q

How does ITP present in children?

A

Petechial rash, isolated thombroytopeania (low platelets), bruising.

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5
Q

What is the management of GORD in neonates?

A
  1. Trial of Gaviscon
  2. Trial of PPI
  3. Referral to paeds.
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6
Q

Treatment of infectious mononucleosis?

A

(EBV infection) Tx is reassurance and supportive. Viral infection.

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7
Q

What are the features of Edwards syndrome? What trisomy is it?

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

Edwards is trisomy 18

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8
Q

What are the features of Patau syndrome?

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

Patau is trisomy 13

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9
Q

What is the first sign of puberty in girls?

A

Breast development

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10
Q

What is caput seccundum?

A

Scalp oedema that DOES cross suture lines

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11
Q

What are the features of Noonan syndrome?

A

Pectus exacatum, webbed neck, pulmonary stenosis, short stature

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12
Q

What age will a child respond to their own name?

A

12 months

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13
Q

What age will a child have a vocabulary of 2-6 words?

A

12-18 months

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14
Q

What age can a child talk in short sentences?

A

2.5-3 years

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15
Q

What is the treatment of threadworms?

A

Single dose of mebendazole for child and family. STAT dose.

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16
Q

What is the management of hypospadius?

A

Corrective surgery at 12 months and not to be circumcised prior as may need foreskin for surgery.

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17
Q

What is the management of croup?

A

Single dose of dexamethasone

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18
Q

What is the management of whooping cough?

A

Oral Azithromycin if onset of cough is less than 21 days previously.

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19
Q

Scarlet fever is caused by what?

A

Group A strep

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20
Q

Epiglottitis is caused by?

A

Haemophillis influenza B

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21
Q

How does Roseola infantum present?

A

Infants
Fever FOLLOWED BY the rash
febrile seizures are common
Blanching erythematous rash

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22
Q

What causes croup?

A

Para influenza virus

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23
Q

What causes bronchitis?

A

RSV

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24
Q

What is the school advice for a diagnosis of mumps?

A

5 days off school

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25
Q

How is precocious puberty defined in girls and boys?

A

Boys aged 9
Girls aged 8

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26
Q

What is the emergency dosing for a child >10 with suspected meningitis in the community?

A

1200 mg of Benzypenicillin

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27
Q

How does HUS present?

A

Normocytic anaemia, thrombocytopaenia and AKI- can be 2ndary to infection with E-coli

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28
Q

What age would you refer if a child could not sit without support at this age?

A

12 months.
At 12 months should be cruising

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29
Q

What are each of these tests? Barlow and Ortolani?

A

Barlow manoeuvre is an attempted dislocation of a newborns femoral head. After performing this the Ortolani manoeuvre is used to attempt to relocate a dislocated femoral head.

‘ottelengi is good so he is relocating hips’

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30
Q

What age would a child squat to pick up a ball?

A

18 months

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31
Q

Perthes- what is it?

A

Avascular necrosis of femoral head. It is a degenerative conditon

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32
Q

What is the presentation of Perthes?

A

Age 4-8. More common in boys
Limp and stiffness
Xray-widening of joint space

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33
Q

What are the features of fragile X?

A

Large testicles, large low set ears, autism

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34
Q

How would a glue ear present?

A

Otitis media with effusion. Presents with hearing loss.
Retracted tympanic membrane

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35
Q

How would a congential diaphragmatic hernia present in the newborn?

A

Concave chest, reduced breath sounds and heart sounds displaced.

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36
Q

How does Roseola Infantum present?

A

Fever followed by rash 3 days after.

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37
Q

What organism causes Roseola Infantum?

A

Herpes 6

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38
Q

Polydactyl in the newborn would indicate which chromosomal abnormality?

A

Pataus- Chromosome 13

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39
Q

How does pyloric stenosis present?

A

Projectile vomiting at 2-12 weeks

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40
Q

How does meconium ileus present and what is it a/w with?

A

Meconium ileus- a/w cystic fibrosis. Presents in first 24-48 hours of life without opening bowels.

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41
Q

Rocker bottom feet indicates which conditon?

A

Edwards trisomy 18

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42
Q

Epiglottitis is caused by?

A

Haemophilis Influenza

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43
Q

When is the HPV vaccine given?

A

Aged 12-13 boys and girls.

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44
Q

What are the cyanotic congential heart diseases?

A

Transposition of great arteries, tetralogy of fallot, tricuspid atresia

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45
Q

What are the ACYANTOIC congenital heart diseases?

A

VSD, ASD, PSA, Coarchtation, aortic valve stenosis.

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46
Q

What is chondromalacia patellae and how does it present?

A

Anterior knee pain with pain when walking up/down stairs.

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47
Q

What is the cardiac malformation seen in downs syndrome? (most common)?

A

AVSD

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48
Q

What is the treatment of Molluscum contagium and caused by which virsus?

A

Caused by Poxvirus
No specific treatment- self limiting

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49
Q

What antibiotics are given for children with meningitis?

A

Less than 3 months- IV Cefotaxime and amoxicillin
Over 3 months- Iv cefotaxime

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50
Q

What cardiac abnormality is most commonly seen in Turners?

A

Bicuspid aortic valvue- systolic mumur

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51
Q

What is the triad with shaken baby syndrome?

A

Retinal haemorrhages, subdural haematoma and encephalopathy

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52
Q

What is physiological genu varum and what is the management?

A

“Bow legs” in children. Management- nothing if under 3

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53
Q

Rubella requires what school exclusion?

A

5 days

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54
Q

Scarlet Fever requires which school exclusion?

A

24 hours after commencing antibiotics can return to school

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55
Q

Hand, foot and mouth requires which school exclusion?

A

No exclusion

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56
Q

When would palivizumab be used?

A

To prevent RSV in high risk children given as an IM injection in RSV season to high risk children such as congenital health disease.

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57
Q

What are the features of Williams syndrome?

A

Small chin, aortic stenosis, small up turned nose

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58
Q

Scarlet fever- what is the presentation and caused by which organism?

A

Group A streptococci
Strawberry tongue
Punctuate rash that spares the mouth

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59
Q

Rubella- what is the classical presentation?

A

Rash that starts on the face and then works down the body. AND lymphadenopathy

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60
Q

Slapped cheek aka ‘erythema infectiosum’- what organism and what presentation?

A

Parvovirus B19. Rash on cheeks/ lethargy/ headache

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61
Q

When would you expect to be able to sit without support?

A

7-8 months

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62
Q

How many doses of the tetanus jab give lifelong protection?

A

5 doses

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63
Q

Painful tibial tubercle in sporty teenagers.. dx is?

A

Osgood schlatter - self resolving

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64
Q

What are the doses of IM benzypenicillin in the community for under 1s, 1-10 and over 10?

A

Under 1= 300mg
1-10yo= 600mg
>10 yo= 1200mg

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65
Q

When is the Men B vaccine given to children?

A

2 months
4 months
12-13 months

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66
Q

What is the difference in presentation between nephritic and nephrotic syndrome?

A

Nephrotic- odema/ proteinuria
Nephritic- proteinuria and haematuria

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67
Q

What is an example of nephrotic disease in children?

A

Minimal change most common nephrotic disease in children.

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68
Q

What is Sildenafil used for in neonates?

A

Treating pulmonary hypertension

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69
Q

What is the management of Bronchiolitis in children?

A

Supportive

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70
Q

What organism causes bronchiolitis?

A

RSV

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71
Q

If under 3 months and suspecting meningitis what are the antibiotics and how does this differ if over 3 months?

A

Under 3 months = Iv Cef + Amoxicillin
Over 3 months=Iv Cef

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72
Q

What organism causes croup?

A

Parainfluenza

73
Q

How does intersusseption present?

A

Knees drawing up, redcurrent jelly, 9 months old, sausage shaped mass in abdomen. Intermittent pain

74
Q

What investigation does intersusseption require?

75
Q

Acute management of migraines in children

A

Ibuprofen for acute migraine mx in children

76
Q

When can nasal triptans be used in children?

A

Over 12 years old.

77
Q

What are the cyanotic heart diseases ?

A

Tetralogy of fallot
Transpositon of great arteries

78
Q

What is the most common complication of meales?

A

Otits media

79
Q

Treatment of migranes in children?

A

Paracetamol/ Ibuprofen.

80
Q

Dosing of ibuprofen in children- eg what dose for age 7-9?

A

Age 7-9 = 200mg PO TDS

81
Q

What are the LIVE vaccines?

A

MMR/ Yellow fever/ BCG/ Typhoid/ Varicella/ Rotovirus and Influenza nasal.

82
Q

How does JIA present?

A

Joint pain, SALMON PINK RASH and anaemia

83
Q

Dose of adrenaline for children for anaphylaxis?

A

Under 6= 150 micrograms
6-12= 300 micrograms
Over 12 and adults= 500 micrograms

84
Q

Neonates are subject to risk of hypo/ hypercalcaemia?

A

HYPOcalcaemia

85
Q

Feature of neurofibromatosis type 1?

A

Cafe au lait spots, squint ( optic giloma), axillary freckles, lisch nodules, sunken chest (pectus exavatum)

86
Q

Acute lymphoblastic leukemia presents how?

A

Short (acute) presentation, days to weeks. Most common childhood malignancy.

87
Q

First line for absent seizures

A

1st line: Ethosuximide
2nd line: males- valporate. females- lamotrigine.

88
Q

How does DiGeorge present?

A

Cardiac abnormalities, cleft palate, thymic hypoplasia, facial deformities, hypocalcemia.

Immune defiency as lacking T cells from thymus

(Failure of development of 3rd/4th pharyngeal pouches)

89
Q

What are the features of Williams syndrome?

A

Aortic stenosis, short stature, learning difficulties, friendly personality.

90
Q

How does larngotrachiomalacia present?

A

Stridor in first year of life- common after feeding or with crying

91
Q

How does developmental dysplasia of the hip present? Age, pain, gender

A

0-5 year old
Painless
More common in GIRLS

92
Q

How does Perthes present? Age, presentation, gender

A

5-10 year old
Slow developing into chronic pain
More common in BOYS

93
Q

How does SUFE present?

A

10-15 year old
Obese children in puberty
More common in BOYS

94
Q

Children with a UTI need to be followed up how?

A

If less than 6 months need a USS at 6 weeks.
If over 6 months- no follow up unless atypical UTI

95
Q

When is the MMR vaccine given?

A

12 months and then again at 3-4 years.

96
Q

What is the EDWARDS mnemonic?

A

Eighteen
Digit overlapping
Wide head
Absent intellect
Rocker bottom feet
Diseased heart
Small lower jaw

97
Q

Features of Patau ?

A

Midline facial defects (cleft palate)
Triosomy 13
Polydactyl

98
Q

Meningitis antibiotics in children;
Primary care:
Secondary care:

A

Primary care- IM Benzypenicillin
Secondary care- under 3 months cefotaxamine and amoxicillin
Over 3 months- ceftriaxone

99
Q

Benign rolandic epilepsy- how does it present?

A

At night
Centrotemporal spikes on EEG
Focal epilepsy

100
Q

What is Charcot Marie tooth and how would it present?

A

Example of a peripheral neuropathy.
Motor and sensory
(predominately motor)
Example: child falling over lots, atrophy of distal muscles

101
Q

What is the presentation in congenital CMV?

A

Sensioneural hearing loss
Microcephaly
Jaundice
Heptaosplenomegaly
Intracranial calcification

102
Q

What are the features of Alport syndrome?

A

Lens dislocation
Haematuria
SNHL
End stage renal failure (common in males)

103
Q

What are the features of Pendred syndrome?

A

Goitre, SNHL

104
Q

What is the HUS triad?

A

Thrombocytopenia, haemolytic anaemia and renal failure.

105
Q

Neonatal jaundice after 24 hours, which. 2 conditions cause a raise in conjugated bilirubin?

A

Neonatal hepatits
Bilary Atresia

106
Q

Breast milk jaundice- is the bilirubin conjugated or unconjugated?

A

Can show a raised unconjugated bilirubin.

107
Q

What is a complication of exchange transfusion for neonatal jaundice?

A

Hearing loss/ damage

108
Q

What is the treatment for headlice?

A

Malathion (chemical insecticide)

109
Q

What are the features of Hirschsprungs disease? and what is the gold standard ix ?

A

Boys
Associated with downs syndrome
In the neonates- delayed passage of meconium

Gold standard ix= rectal biopsy (other ix= abdominal X-ray)

110
Q

Intussusseption presentation

A

Drawing legs up
Recurrent jelly
Cramping
Crying
Sausage shaped mass

111
Q

What is seen on USS for intussusception?

A

Target-like mass on USS

112
Q

What vaccination is given at birth?

A

BCG if at risk

113
Q

What vaccination is given at 2 months ?

A

6 in 1
Oral rotavirus
Men B

114
Q

What vaccination is given at 3 months?

A

6 in 1
Oral Rotovirus
PCV (pnuemococcus)

115
Q

What vaccination is given at 4 months?

A

6 in 1
Men B

116
Q

What vaccination is given at 12 months?

A

Hib/Men C
MMR
PCV
Men B

117
Q

What vaccination is given at 3-4 years?

A

4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR

118
Q

What vaccination aged 13-18?

A

‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY

119
Q

What is the management for cows milk protein allergy/ intolerance?

A

extensive hydrolysed formula (eHF)
Second line- Amino acid based formula.

If breastfeeding- continue breastfeeding but cut out maternal cows milk protein

120
Q

How does Pyloric stenosis present?

A

Projectile vomiting
Olive shaped mass in the RUQ
First couple weeks of life.

121
Q

Management of atypical UTI in children?

A

If atypical organism then USS during acute phase.

122
Q

What are the USS guidelines and UTI in children?

A

Any atypical= USS in acute phase
Less than 6 months and typical= USS in 6 weeks
Recurrent UTIs any age= USS

123
Q

Neonatal resus- what is the compression to breath ratio? How does this compare to paediatric resus?

A

3:1
(After 5 rescue breaths initially)

Paeds 15:2

124
Q

What are the features of DKA?

A

HyPER glycaemia
Ketones
Acidosis

125
Q

What are the components of the APGAR score?

A

Appearance
Pulse
Grimace
Activity
Respiration

126
Q

What are the points for APGAR?

A

Appearance- Blue (0). Blue peripheries (1). Pink (2)

Pulse- Absent (0), Less 100 (1), Over 100 (2)

Grimace No response (0), Weak cry (1), Strong cry (2)

Activity No movement (0), Flexion (1), Wriggly (2)

Respiration Nil (0), Weak (1), Strong (2)

127
Q

What age would you refer a child if they weren’t walking?

128
Q

What is the limit age for sitting without support (referral limit)

129
Q

What are the guidelines for first febrile seizure in a child?

A

Immediate hopsital assessment for first febrile seizure of any age.
OR
(And if child is under 18 months and diagnostic uncertainty)

130
Q

What things warrant a very urgent specialist referral (less 48 hours) in investigating children for lymphoma/ leukaemia?

A

Night sweats + splenomegaly
Night sweats + lymphadenopathy
Unexplained lymphadenopathy
Fever with splenomegaly
Fever with lymphadenopathy

131
Q

How does Rheumatic Fever present?

A

Sore throat
‘JONES’
Joint Pain
O- carditis
N- Nodules
E- erythema marginatum
S ydneham chorea

132
Q

If a baby is born to a HIV pos mum when would you test for antibodies for seroconversion?

A

18-24 months

133
Q

Paeds infections- what are these caused by:

Bronchiolitis
Croup
Whooping Cough
Rubella
Roseola Infantum
Scarlet Fever
Slapped Cheek
Hand/ Foot/ Mouth
Mumps
Chickenpox

A

Bronchiolitis- RSV
Croup- Parainfluenza virus
Whooping Cough - Bortedella pertussus
Rubella - Toga Virus
Roseola Infantum - Human herpes 6
Scarlet Fever- Strep Progenies - Group A haemolytic
Slapped Cheek - Parvovirus B19
Hand/ Foot/ Mouth - Coxsackie A16
Mumps - Paramyoxvirus
Chickenpox - Varicella Zoster

134
Q

Scarlet Fever
- Organism
- Characteristics
- Treatment
- School exclusion

A

Strep pyogenes (Group A haemolytic streptococci)
Sandpaper rash and strawberry tongue
Treatment- pen V
School exclusion from 24 hours after ABx start.

135
Q

What is the triad of DiGeorges syndrome?

A

Congenital heart defects
Immune deficiency due to thymic hypoplasia
Hypocalcaemia due to small parathyroid glands

136
Q

What are the 5 causes of jaundice in the first 24 hours?

A

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
CMV infection

137
Q

What are the causes of prolonged jaundice with elevated CONJUGATED bilirubin?

A

Bilary atresia
Neonatal hepatitis

138
Q

G6PD
- Characteristic patient
- Diagnostic test
- Blood film

A

Males from Northern African descent
Diagnostic test is enzyme activity in G6PD
Heinz bodies

139
Q

Features and inheritance of Fragile X?

A

X linked
Large testicles
ADHD
Learning difficulties

140
Q

Features and inheritance of Noonan’s?

A

Autosomal dominant

(male version of Turners)
Short stature
webbed neck
Undesended testes

141
Q

Features of Pierre Robin?

A

Small jaw
Posterior displacement of the tongue
Cleft palate

142
Q

Angleman and Prader Willi - what chromosome and features?

A

Chromosome 15
Angleman= friendly personality, ataxia, learning difficulty.
Prader Willi - Obesity/ Hypotonia/ Hypogonadism

143
Q

Friedreichs Ataxia- features

A

(Most common cause of inherited ataxia)
May first present with clumsiness
Scolosis
Ataxia
Diabetes**
Cardiomyopathy**

144
Q

Friedreichs Ataxia- inheritance?

A

Autosomal recessive

145
Q

What is the formula for calculating STAT fluids for children?

A

10mls/kg over 15 mins

146
Q

Roseola infantum is caused by what?

A

Human Herpes 6

147
Q

Small for Gestational Age refers to which centile?

148
Q

Collection of urine sample in children?

A

Need a clean catch specimen.
Not advised to use gauze/ cotton wool/ sanitary ware.

149
Q

What are the characteristics of an innocent murmur ?

A

Soft
Systolic
No palpable thrill
Position dependent
Splitting of S2

All diastolic murmurs are pathological

150
Q

When is the MMR vaccine given?

A

(2 doses)
12 months
Preschool booster aged 3/4

151
Q

Cystic Hygroma - where are they. Features?

A

Soft
Posterior triangle
TRANSILLUMIATE

152
Q

Branchial cyst - presentation

A

Solitary painless mass
May swell during LRTI

153
Q

Erythema Toxicicum neonatorum - how does it present?

A

Within first few days of life- up to 2 weeks
Flat red macules
Otherwise well
Newborns

154
Q

Kartagener’s syndrome- 4 features?

A

Dextrocardia
Bronchiestasis
Recurrent sinusitis
Sub fertility
(Deafness)

Presentation may be similar to CF: however deafness and dextrocardia make it different!

155
Q

What are the characteristic features of these surgical presentations in paeds:
Intussuseption
Pyloric stenosis
Midgut malrotation

A

Intussuseption: cherry red stools/ drawing legs up
Pyloric stenosis: olive shaped mass and projectile NON bilious vomiting
Midgut malrotation: Bilious vomiting/ PR blood and mucus.

156
Q

What are the features of fetal alcohol syndrome?

A

Thin Philtrum
Learning difficulties
IUGR

157
Q

ECHMO (Extra corporeal oxygenation) is used to treat what in neonates?

A

Used to treat primary pulmonary hypertension

158
Q

Diode laser therapy is used to treat what in neonates?

A

Retinopathy of prematurity

159
Q

What is Respiratory Distress Syndrome?

A

Premature neonates
Lack of surfactant!
Ground glass on CXR

160
Q

How is cystic fibrosis inherited?

A

Autosomal recessive

161
Q

What is the causative organism in Otitis Media?

A

Hib
Streptococcus pneumonia
Viral causes- RSV

162
Q

Newborn blood spot screening- what is screened for?

A

Parents Happy Smiles Might Comfort My Hysterical Grumpy Infant

Phenylketonuria
Hypothyroid
Sickle cell disease
MCADD
Cystic Fibrosis
Maple Syrup disease
Homocysteinuria
Glutamic academia type 1
Isovaleric academia

163
Q

Management of SUFE?

A

IM surgical fixation

164
Q

When can babies sit without support?

A

7-8 months
Refer at 12 months

165
Q

Haemorrhagic disease of the newborn- how does it present and in which infants?

A

Breastfed infants (deficient in vit K)
Presents with bleeding from gums/ bleeding from umbilicus

166
Q

Roll from front to back - what age??

167
Q

Jump on 2 feet - what age?
Hop on one leg- what age?

A

Jump on 2 feet- 2 years
Hop on one leg- 4 years

168
Q

What are the causes of neonatal jaundice?

A

First 24 hours (always pathological)
- CMV infection
- ABO incompatibility
- Rhesus disease (severe anaemia)
- G6DPH defiency - fava beans/oxidative stress
- Hereditary sperocytosis - osmotic fragility test

After 24 days- 14 days
- Bilary atresia- conjugated
-Neonatal hepatitis- conjugated
- Breast milk Jaundice

169
Q

What is seen on XR for Tetrology of fallot vs transposition of great arteries?

A

Both cyanotic
Tetralogy of fallot: Boot heart
Transposition of great arteries: Egg on a string

170
Q

Facioscapulohumeral muscular dystrophy - presents how?

A

Weakness of facial muscles
Winging of the scapula
Weakness progresses from face downwards

171
Q

What to remember about nasal influenza vaccine for children vs normal influenza vaccine?

A

Nasal influenza is LIVE
Normal flu vaccine is inactivated eg given to elderly

172
Q

How does cows milk protein allergy present?

A

Most commonly formula fed infants
Diarrhoea/ vomiting
Failure to thrive
Colic
Regurgitation
Associated with atopic eczema

Mx ) extensively hydrolysed formula
Or amino acid formula if severe.

173
Q

What age can you - kick a ball
- pass objects between 2 hands?

A

Kick a ball- 3 years
Pass objects between 2 hands - 9-12 months

174
Q

What would the bloods show for Kleinfelters?

A

Delayed puberty
LOW testosterone
Elevated gondadotrophins (elevated LH)

Other features eg gynaecomastia
Small firm testes
Infertile

175
Q

How is Kallmans different to Kleinfelters?

A

Kallmans - hypogonadotrophin hypogonadism
Low LH/Low testosterone
Delayed puberty and anosmia

(Different to Kleinfelters who have raised LH)

176
Q

How is chronic suppurative otitis media (CSOM) defined?

A

perforation of the tympanic membrane with otorrhoea for > 6 weeks
- presents with hearing loss
- and discharging ear ++

Need to be careful not to miss cholesteatoma

177
Q

HSP presents how? and what antibody?

A

HSP
Vasculitis that affects children
Rash on legs/ abdo pain

178
Q

What does the thumb sign on XR indicate?

A

Epiglottitis (HIB)

179
Q

Double bubble on XR indicates?

A

Duodenal atresia
High intestinal obstruction- vomiting in a newborn!

MSRA- my cards (15 decks)

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