Paediatrics Flashcards
Neonate with VSD, overriding aorta and infundibular stenosis
Tetralogy of Fallot
CXR: reticulonodular shadowing in neonate
Bacterial pneumonia
Widespread blanching maculopapular rash with spots of different sizes sparing the head and neck
Meningococcal sepsis
Intermittent high fever
Widespread evanescent salmon-pink rash
Can’t weight bear
JIA (systemic arthritis)
Quiet systolic murmur best heard at the upper left sternal edge.
The second heart sound is widely split
Atrial septal defect
Increased pigmentation of the areolar and nipples bilaterally
Congenital adrenal hyperplasia
Most common cause of failure to pass meconium
Meconium Plug Syndrome = transient immaturity of gut –> can’t move a plug of meconium along
-Treatment: anal stimulation with glycerine chip
Lactose intolerance caused by deficiency in which enzyme?
Lactose dehydrogenase
Puffy feet at birth (with widely-spaced nipples and absent femoral pulses)
Turner’s Syndrome
Caused by deficiency in galactose-1-phosphate uridyl transferase
Galactosaemia
Ill after drink lactose-containing milks –> recurrent E. coli sepsis and cataracts
Urine-reducing substances in urine
Galactosaemia
Dizziness, SOB and fainting –> ECG shows delta wave
Wolff-Parkinson-White Syndrome (spontaneous re-entry tachycardia/SVT)
Brain MRI shows subependymal calcifications and hypointense white matter lesions
Tuberous Sclerosis
Brain MRI shows many hyperintense, inflammatory white matter lesions
MS
Sandpaper skin, erythematous rash
Red tongue
Scarlet Fever
Single transverse palmar crease
Almond-shaped eyes
Protruding tongue
Down’s Syndrome
Tight Achilles tendon –> clonus
Clasp-knife response (resistance when flex arm, until it suddenly gives way)
Spastic Cerebral Palsy
Tiptoe walk
Unilateral (hemiplegic) Cerebral Palsy
Scissoring gait
Bilateral (quadriplegic) Cerebral Palsy
Formula for mid-parental height
Mean of parents height –> +7 for boy/-7 for girl
Short legs, normal torso
Skeletal Dysplasia (achondroplasia) -->calculate Subischial Leg Length = Total Height - Sitting Height
Commonest cause of delayed puberty
Constitutional Delay
Crescent Sign on Abdo X-Ray
Target Sign on Abdo US
Intussusception
Appendicitis with generalised guarding
Perforation
Colicky abdominal pain – pale around mouth during pain
Redcurrant jelly stool
Intussusception
Gram -ve bacillus which causes mesenteric adenitis
Yersinia enterocolitica
Olive-like mass in RUQ
Pyloric Stenosis
Constipation then diarrhoea –> pass loose, smelly stools without child realising
“Overflow soiling” in faecal impaction
Down Syndrome associated with which large bowel disease?
Hirschsprung Disease
Main cause of encopresis (soil yourself)
Chronic constipation
Cry during defecation
Anal fissure
Periumbilical abdo pain – relieved by pooing
Alternate between constipation and diarrhoea
Feeling of incomplete defecation
IBS
Epigastric pain wakes them at night and radiates through back
Peptic Ulcers
Main diagnostic test for peptic ulcers
Carbon-13 urea breath test (swallow urea labelled with 13C–> wait 30 mins –> detected 13CO2 in breath = shows that H. pylori is present, making urease)
Also do stool antigen for H. pylori
Connects right and left atria during pregnancy
Foramen ovale
Connects pulmonary artery to aorta during pregnancy
Ductus arteriosus
- Ejection systolic murmur at left sternal edge
- Widely-split S2
Atrial Septal Defect
- Pansystolic murmur at left sternal edge
Ventricular Septal Defect
- Continuous murmur beneath left clavicle
- Bounding pulse (pulse pressure increased)
Persistent Ductus Arteriosus
- Hypercyanotic spells: severe SOB, pallor, crying
- Clubbing in fingers and toes in older kids
- Harsh ejection systolic murmur at left sternal
Tetralogy of Fallot
- Cyanosis from day 2 (ductal closure = less mixing)
- Loud 2nd heart sound
- CXR: narrow upper mediastinum, with “egg on string” appearance of cardiac shadow
Transposition of Great Arteries
- Cyanosis at birth –> heart failure at 2 weeks
- Superior axis on ECG
- Common in Down Syndrome
Atrioventricular Septal Defect
- Ejection systolic + click at upper left sternal edge
Pulmonary Stenosis
- Absent femoral pulses
- Shock/cyanosis at 2 days when duct closes
Coarctation of Aorta
Strawberry tongue
Peeling skin
Cervical lymphadenopathy
Kawasaki Disease
Causes testicular torsion
“Clapper Bell” Testis = undescended testis lying transversely
Cottage-cheese discharge on penis glans
Smegma
Phimosis (pathologically non-retractile foreskin) caused by?
Balanitis Xerotica Obliterans (BSO) = lichen sclerosus in penis!
Treatment: topical betamethasone
Dark patch on armpit of diabetic
Acanthosis Nigrans (shows insulin resistance)
Commonest cause of congenital hypothyroidism in UK
Maldescent of thyroid
Overlapping fingers
“Rocker-bottom” feet (like rocking chair)
Small chin
Edwards Syndrome (Trisomy 18)
Clitoral hypertrophy and fusion of labia
Congenital Adrenal Hyperplasia
Faltering growth, large tongue and goitre
Congenital hypothyroidism
Polydactyly (extra fingers)
Cleft lip and palate
Small eyes
Patau Syndrome (Trisomy 13)
Small testicles
Gynaecomastia
Tall and weak
Klinefelter Syndrome (47, XXY)
Prader-Willi affects which chromosome?
Chr 15 (imprinting = uniparental disomy)
Diagnostic test for Prader-Willi
DNA-methylation testing = absence of paternal PWS region
Wide-spaced and down-slanting eyes
Short stature
Pectus excavatum
Noonan Syndrome
Heart murmur in Noonan Syndrome
Pulmonary stenosis
- Most common all-cause of death <5yrs
2. Most common infectious cause of death <5yrs
- Prematurity
2. Pneumonia
When would you use electronic thermometer in axilla?
<4 weeks (use tympanic for older)
Causes of early-onset sepsis
Group B Strep and E. coli
Bulging fontanelle and opisthotonos (hyperextension of neck/back) in neonate
Neonatal Meningitis
Treatment of early-onset sepsis
IV benzylpenicillin + gentamicin
Add cefotaxime if Gram -ve sepsis
Causes of late-onset sepsis
Staph epidermis (coagulase-negative staph)
Treatment of late-onset sepsis
Flucloxacillin + gentamicin
add vancomycin for staph epidermis
What is Brudzinski Sign?
In meningitis: child supine – neck flexion causes hip/knees flexion
What is Kernig Sign?
In meningitis: child supine and hips/knees flexed – back pain when extend knee
Main cause of viral meningitis
90% enterovirus (Coxsackie Group B)
Treatment of encephalitis
IV aciclovir
Painful white pustules on fingers (esp on broken skin)
Herpetic Whitlow
When can kids go back to school after chickenpox
5 days after rash onset (infectious until all lesions dry and crusted)
GP gives abx for the fever –> generalised macular rash appears –> he mistakenly thinks it is an allergic reaction
Roseola Infantum (Exanthema Subitum) - caused by HHV6 -get rash after fever subsides, it's nothing to do with the abx!
Lace-like rash on trunk/limbs
Erythema Infectiosum (“Slapped-Cheek Syndrome”) = Human Parvovirus B19
- Maculopapular rash: face –> spreads centrifugally across body
- Suboccipital and postauricular lymphadenopathy
- Mild prodrome: fever <39, headache, malaise
Rubella
1st-line management of iron-deficiency anaemia
Dietary advice and oral iron
• Sytron (sodium iron edetate) or Niferex (polysaccharide iron complex)
–> continue for 3 months after Hb normal – should rise by 10 a week
Genetics of Sickle Cell
Mutation in codon 6 of β-globin gene = glutamate to valine
Drug given to kids with recurrent vaso-occlusive crises
Hydroxycarbamide (increases HbF)
Easy bruising/bleeding after viral infection
Immune Thrombocytopenic Purpura (ITP)
–> most self-resolve within 8 weeks
Adrenaline doses for anaphylaxis
IM Adrenaline 1:1000
0-6yrs: 0.15mL
6-12yrs: 0.30mL
12+yrs: 0.5mL
Lactose intolerance caused by deficiency in which enzyme?
LACTOSE dehydrogenase
Commonest cause of viral conjunctivitis
Adenovirus = 80%
Conjunctivitis with lots of discharge
Gonorrhoae
White pupillary reflex (leukocoria) and squint
Retinoblastoma
Mutation associated with retinoblastoma
RB1 mutation (chr 13)
Difference between Barlow and Ortolani tests?
o Barlow Test: push hip forward and in–> it dislocates
o Ortolani Test: pull hip back and out–> it relocates
Asymmetrical skin folds around hip
Developmental Dysplasia of the Hip
Osteomyelitis is infection of which part of bone?
Metaphysis
Knee pain after exercise in sporty adolescent
Osgood-Schlatter Disease = osteochondritis of the patellar tendon’s insertion into knee
Persistent knee pain + local tenderness over femoral condyles in very sporty adolescent
Osteochondritis Dissecans = avascular necrosis –> piece of bone and cartilage separates from medial femoral condyle in femur
Blue sclera and bones easily break
Oteogenesis imperfecta
How to differentiate between transient synovitis and septic arthritis?
Kocher Criteria o Non weight-bearing on affected side o ESR>40 o Fever >38.5 o WCC>12,000
Most common cause of joint pain in kids
Reactive Arthritis (Reiter’s Syndrome)
Joint pain and salmon-pink macular rash
JIA (Systemic Arthritis)
Key diagnostic test for Hypoxic-Ischaemic Encephalopathy
Amplitude-integrated EEG
CXR in neonate shows diffuse “ground-glass” appearance
Respiratory Distress Syndrome
CXR in neonate shows “widespread opacification”
Bronchopulmonary Dysplasia
Antibiotics used in necrotizing enterocolitis
Amoxicillin, gentamicin and metronidazole
CXR in neonate shows fluid in horizontal fissure. Baby is term born
Transient Tachypnoea of Newborn (TTN)
Central cyanosis in otherwise well baby
Congenital Heart Disease
Which type of seizure gives EEG with 3 spike waves per second in all leads?
Absence seizure
Epilepsy drug which induces liver enzymes
Carbamazepine
Infantile spasms have what EEG appearance?
Hypsarrhythmia = chaotic brain activity
Waddling gait, calves very big
Duchenne Muscular Dystrophy (big calves = pseudohypertrophy)
What is genetic mechanism underlying Duchenne?
Deletion of dystrophin gene (connects cytoskeleton of muscle fibre to surrounding ECM)
Newborn born with hypotonia
Club foot/talipes (feet point down and in, soles face back)
Myotonic Muscular Dystrophy
Head trauma –> lose consciousness, have lucid interval, then lose consciousness again
Extradural Haemorrhage
Type of brain haemorrhage with retinal haemorrhages
Subdural Haemorrhage
LP shows xanthochromia (yellow CSF)
Intraventricular Hamorrhage
Setting-Sun Sign (eyes deviate down)
Hydrocephalus
Lisch Nodule
Neurofibromatosis Type 1
Lisch Nodule = haemoatoma of iris
Depigmented ash-leaf patches
Tuberous Sclerosis
MRI brain shows subependymal calcified nodules
Tuberous Sclerosis
Skull X-Ray shows railroad track calcification of gyri
Sturge-Weber Syndrome
Neurological disease causing panda eyes
Neuroblastoma
CXR shows bowel loops in chest
Diaphragmatic Hernia
Important complication of Diaphragmatic Hernia
Pulmonary hypoplasia = herniated abdo organs compress lungs during pregnancy –> lung have not developed
Drug class causing cleft lip/palate
Anticonvulsants (phenytoin)
Confirmatory diagnostic test of oesophageal atresia
Birth: pass wide-calibre feeding tube –> X-Ray shows it doesn’t reach stomach
Down Syndrome associated with which congenital GI abnormality?
Duodenal Atresia
Confirmatory diagnostic test of biliary atresia
ERCP: abnormal biliary tree
First-line management of biliary atresia
Kasai hepatoportoenterostomy (HPE): attach loop of jejunum to porta hepatis (area of liver from which bile drains)
Organism causing UTI in structural abnormality/catheter
Pseudomonas
Management of UTI in <3 months/septic
Hospital ASAP
o IV co-amoxiclav for 7 days
o Then oral prophylaxis
Periorbital swelling and puffy face on waking
Nephrotic Syndrome (also ask for frothy urine!)