Paediatrics Flashcards
How should a patient with pharyngitis and a FeverPAIN score of 2-3 be managed?
Delayed prescription of phenoxymethylpenicillin
What is a congenital diaphragmatic hernia?
A rare congenital complication in which the abdominal contents herniate through a defect in the diaphragm and occupy space within the thoracic cavity. This applies pressure on the lungs, which often fail to fully develop. They are normally identified during antenatal ultrasound scans. Once the neonate is stabilised, surgical repair will be required.
How does necrotising enterocolitis present?
Poor feeding
Rectal bleeding
Unwell, premature neonate
How is necrotising enterocolitis without bowel perforation managed?
Drip and suck
Antibiotics
Parenteral feeding
How does infant respiratory distress syndrome manifest?
Respiratory distress immediately after birth in a premature newborn
Occurs due to a deficiency of surfactant in the lungs
How does alopecia areata present?
Patchy area(s) of complete hair loss
Usually not associated with any other symptoms and most cases resolve spontaneously within 1 year
What is the first step in the active management of alopecia areata?
Topical Corticosteroids
Which non-invasive test can be used to determine whether the cause of a patient’s chronic diarrhoea is likely to be inflammatory?
Faecal Calprotectin
What is the difference between gastroschisis and omphalocele?
Gastroschisis - Defect lateral to the umbilicus. Herniated contents are NOT covered in a peritoneal membrane.
Omphalocele - Defect at the umbilicus. Herniated contents are covered in a peritoneal membrane.
How are hypospadias usually managed?
Surgical correction at 12 months
How does Duchenne muscular dystrophy manifest?
Progressive weakness that usually manifests within the first 5 years of life
Patients may demonstrate delayed motor milestones
Patients often find it difficult to walk and to stand from a seated position
What is the difference in prognosis between Duchenne muscular dystrophy and Becker muscular dystrophy?
Duchenne muscular dystrophy: ~27 years
Becker muscular dystrophy: ~45 years
How does chondromalacia patellae present?
Anterior knee pain
Generally worse when climbing the stairs or when standing from a seated position
How does osteochondritis dissecans normally present?
Pain, swelling and locking following exercise
Usually occurs in active young people
Until what age do the majority of boys have physiological phimosis?
50% at 2 years of age
10% at 11 years of age
1% at 14 years of age
What is gastro-oesophageal reflux in infants?
Condition that typically presents with frequent regurgitation within 8 weeks of birth
Caused by functional immaturity of the lower oesophageal sphincter
What is the first-line step in the management of a breastfed infant with gastro-oesophageal reflux?
Breastfeeding assessment (often a change in frequency of feeds and positioning can help resolve symptoms)
What is osteogenesis imperfecta?
Genetic condition caused by a defect in type 1 collagen
Results in the formation of very brittle bones that are at high risk of fracture
Describe the difference between diplegia, hemiplegia and quadriplegia.
Diplegia: both lower limbs affected
Hemiplegia: one upper limb and one lower limb on the same side affected
Quadriplegia: all four limbs affected
How are IQ scores interpreted in patients with learning disabilities?
Borderline Mild 70-79
Mild 50-69
Moderate 35-49
Severe 20-34
Profound < 20
How is pityriasis rosea managed?
No treatment required in the first instance (self-limiting)
Describe the presentation of mesenteric adenitis.
Non-specific abdominal pain that may localise to the right iliac fossa (thereby mimicking appendicitis)
Often preceded by an upper respiratory tract infection
Describe the presenting symptoms of Crohn’s disease
Intermittent flares of diarrhoea (may or may not be associated with bleeding) and abdominal pain
Generally unwell during these episodes
Extra-GI manifestations include oral ulcers, perianal skin tags, uveitis, arthralgia and erythema nodosum
What is the treatment of choice for Hirschsprung disease?
Anorectal Pull-Through
What test is performed next in a baby who is noted as having an abnormal newborn hearing screen result?
Auditory brainstem testing
Which rules govern which method is used to quantify hyperbilirubinaemia in babies with neonatal jaundice?
Transcutaneous Bilirubin: Jaundice develops after 24 hours of life and the baby who was born at more than 35 weeks’ gestation.
Serum Bilirubin: Jaundice develops within 24 hours of life or the baby was born at less than 35 weeks’ gestation.
How is ophthalmia neonatorum caused by chlamydia treated?
Oral erythromycin for 14 days
Which triad of features is associated with nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
(Thrombosis)
What is the investigation of choice for suspected pyloric stenosis?
Abdominal Ultrasound
How is mild croup managed?
0.15 mg/kg PO Dexamethasone STAT
How is intussusception managed?
Rectal air insufflation
Describe the presenting symptoms of epiglottitis.
Very unwell with high temperature
Worsens over hours
Intensely painful throat
Soft, inspiratory stridor and rapidly increasing respiratory difficulty
Drooling
Children often sit upright, immobile and with their mouths open to maintain their airways
What is the first-line antiepileptic treatment in a male patient with generalised tonic clonic epilepsy?
Valproate
What imaging modality is usually used in the first instance for a patient with a suspected Wilms’ tumour?
Abdominal Ultrasound
How does bronchiolitis present?
Dry cough
Breathlessness
Preceding coryzal illness
Rhinitis and nasal obstruction
Sore throat
Fine-end inspiratory crackles and wheeze on auscultation
What is the initial investigation of choice for suspected Perthes disease?
X-ray of both hips (including anteroposterior and frog leg lateral views)
How is talipes equinovarus treated?
Ponseti Method
What are the features of achondroplasia?
Short stature
Short limbs
Large head
Frontal bossing
Depression of nasal bridge
Marked lumbar lordosis
Outline the aspects of managing a sickle cell crisis.
Analgesia (usually opioids)
Oxygen
Fluids
Exchange transfusion (for acute chest syndrome, stroke and priapism)
How is idiopathic constipation with faecal impaction treated in children?
Disimpaction regimen of polyethylene glycol and electrolytes (Movicol®)
What school exclusion advice should be given to the parents of a child with mumps?
Exclude from school until 5 days after the onset of the parotid swellings
What are the main features of a candida nappy rash?
Widespread erythematous rash that involves the skin folds
May have a well-demarcated scaly border with satellite lesions
Which antibiotics are usually used in the management of meconium aspiration?
Ampicillin and Gentamicin
How should a neonate identified as having a unilateral undescended testicle during newborn examination be managed?
Re-examine at the 6-week check up
If still undescended at 4-5 months, a referral should be made to paediatric urology
How does coeliac disease tend to present in children?
Chronic diarrhoea
Failure to thrive
Fatigue
What triad of features defines nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
Which procedure is used to definitively manage biliary atresia?
Kasai Procedure
How can IgA nephropathy and post-streptococcal glomerulonephritis be clinically distinguished?
The urinary changes in IgA nephropathy occur within days of an upper respiratory tract infection whereas in post-streptococcal glomerulonephritis it happens several weeks afterwards.
How does whooping cough present?
Severe bouts of coughing with an inspiratory gasp
Bouts of coughing may be bad enough to cause vomiting
How does otitis externa present?
Ear pain (otalgia)
Red and itchy outer ear which may have some dry skin
What is the best investigation for diagnosing asthma?
Spirometry (in particular, looking at the FEV1 and the FEV1/FVC ratio)
List some clinical signs associated with pyloric stenosis
Hypochloraemic, hypokalaemia metabolic alkalosis
Visible peristalsis from left to right
Olive-like mass in the right upper quadrant
List some clinical features that are associated with ulcerative colitis more than Crohn’s disease.
Continuous lesions starting distally and progressing proximally
Rectal bleeding
Pseudopolyps
Crypt damage
What is a kerion and how does it manifest?
Area of scarring alopecia resulting from the inflammatory response to a fungal skin infection (ringworm)
The area of skin may appear boggy and inflamed.
How does Still’s disease present?
Salmon-pink rash
Arthritis
Uveitis
Systemic features (e.g. fever)
Weight loss
Myalgia
When are cleft palates usually surgically repaired?
6-12 months
How does dyskinetic cerebral palsy manifest?
Dystonia (abnormal muscle tone)
Chorea (dance-like, irregular movements)
Athetosis (slow, writing movements)
What is a caput succedaneum?
Localised, soft tissue oedema of the scalp that occurs following pressure applied on the baby’s head by the cervix during delivery
It crosses suture lines and resolves within days.
What is Ewing sarcoma and how does it present?
Rare cancer that most commonly arises in the pelvis and long bones
Patients present with severe bone pain and may suffer from pathological fractures
An X-ray may reveal an ‘onion skin’ appearance due to a multilayered periosteal reaction
What is the first step in the management of eczema?
Liberal use of emollients
Which autoantibodies are associated with coeliac disease?
Anti-tissue transglutaminase antibody
Anti-endomysial antibody
What is the first-line investigation for suspected bowel obstruction secondary to intestinal malrotation?
Upper GI Contrast Study with US Scan
How do congenital hydroceles present?
Painless, soft and fluctuant swelling around a testicle
It is possible to get above the swelling and the swelling cannot be separated from the testicle
List some clinical features that warrant immediate in-hospital review for children with bronchiolitis.
Apnoea
Central Cyanosis
Oxygen Saturation < 92%
Severe Respiratory Distress
Respiratory Rate > 70/minute
What is a useful intervention to treat malabsorption and diarrhoea in cystic fibrosis?
Pancreatic enzyme supplementation
How does acute appendicitis classically present?
Umbilical pain that moves to the right iliac fossa
Nausea and vomiting
Loss of appetite
Fever
Diarrhoea
Which gene mutation causes achondroplasia?
Fibroblast Growth Factor 3 Gene (FGFR-3) Mutation
What would you expect haemoglobin electrophoresis in a newborn with sickle cell disease to show?
HbS and HbF
Which test is useful to confirm whether a patient has had an anaphylactic reaction?
Mast Cell Tryptase
What is infant torticollis and how does it present?
Condition that is usually caused by a tumour of the sternocleidomastoid muscle.
Reduced range of neck motion
Struggle to turn head in one direction (may manifest with preferring to feed from one breast)
Palpable, non-tender nodule on sternocleidomastoid
Which vaccines are administered at 3 months?
6-in-1 (whooping cough, hepatitis B, tetanus, diphtheria, Hib, polio)
Rotavirus
Pneumococcal conjugate vaccine
How long does a child with chickenpox need to be excluded from school?
Until the vesicles have crusted over
Outline the developmental milestones that an 18-month old child should have reached.
Social, Emotional and Behavioural: Feed themselves with a spoon, drink from a cup, try to play alone and try to help with dressing
Gross Motor: Walks steadily and independently and may be able to squat
Vision and Fine Motor: Pincer grip, build a tower of 3 blocks, look at and ‘palm hit’ books, draw a scribble
Hearing, Speech and Language: 6-10 words, can follow simple instructions, points to 2-4 body parts
What is the first-line pharmacological management option for ADHD?
Methylphenidate
What is transient tachypnoea of the newborn?
Benign condition caused by a delay in the resorption of fluid from the lungs which, in turn, leads to some respiratory distress.
It usually resolves within a few hours. It is more common in infants born by C-section.
List some complications of mumps
Pancreatitis
Orchitis
CNS involvement (meningitis or encephalitis)
What important diagnosis must you consider if a child is noted to have a loss of red reflex in one eye?
Retinoblastoma
How does patellar dislocation tend to present?
Severe knee pain after trauma
Associated with sudden knee swellingand an inability to straighten the leg or walk
Patients may describe the knee ‘popping’
Describe how growing pains manifest
Bilateral pain that is present throughout the day and is worst at night
Patients are able to continue all usual activities
No limp
What is the inheritance pattern of Becker Muscular Dystrophy?
X-Linked Recessive
List some conditions that are associated with club foot.
Spina Bifida
Edward Syndrome
Oligohydramnios
Arthrogryposis Multiplex Congenita
Cerebral Palsy
What is the first-line management option for a 4-year-old child with nocturnal enuresis?
Positive reward system (e.g. star chart)
Which combinations of signs would you expect to see in testicular torsion?
Absent cremasteric reflex
Negative Prehn’s sign (no pain relief on elevation of testes)
Positive Ger sign (pitting at the testicular base)
Negative blue-dot sign (no nodule)
Positive Deming sign (abnormally elevated testes)
Positive Brunzel sign (horizontal lie of the affected testis)
What is omphalitis?
Infection and inflammation of the umbilicus and stump that is usually caused by Staphylococcal or Streptococcal organisms.
It warrants further investigation and prompt treatment because it can progress to cause more widespread tissue damage (e.g. necrotising fasciitis).
What is a secondary lesion in the context of acne?
Those that occur as a result of the primary lesion healing (e.g. excoriations from spots that have been picked)
What is Ebstein’s anomaly?
Ebstein’s anomaly is a congenital defect which involves the downward displacement of an abnormal tricuspid valve which causes the atrium to increase in size and the right ventricle to become smaller or ‘atrialise’. It is commonly associated with maternal lithium use.
What is the first-line treatment option for balanitis?
Hygiene (including under the foreskin) with saline washes and a short-course of topical 1% hydrocortisone cream is recommended.
What is the histological hallmark of a pilocytic astrocytoma?
Rosenthal Fibres
What is the most common cause of congenital adrenal hyperplasia?
21-Hydroxylase Deficiency
How should a 2.3 cm primary spontaneous pneumothorax be managed in a patient who is breathless?
Needle Aspiration (with 16-18G cannula)
What are the four types of female genital mutilation?
1: Clitoroidectomy
2: Excision
3: Infibulation
4: Other forms of genital mutilation
How should a pregnant woman who has never had chickenpox before be managed once they have had significant exposure to chickenpox?
Aciclovir
Alternative: VZIG can be given if aciclovir is poorly tolerated/contraindicated
Ref: https://assets.publishing.service.gov.uk/media/63e230638fa8f50e86ff1ae4/UKHSA-guidelines-on-VZ-post-exposure-prophylaxis-january-2023.pdf
What is the incubation period of rubella?
14-21 days
List some of the features associated with neurofibromatosis type 2.
Acoustic Neuromas
Meningiomas
Ependymomas
What biochemical results would you expect to see in osteogenesis imperfecta?
Normal Calcium, Phosphate, PTH and ALP
What is the mainstay of treating mild proctitis associated with ulcerative colitis?
Per Rectal 5-ASAs (e.g. mesalazine)
What are the presenting features of an abdominal migraine?
Paroxysmal episodes of intense acute umbilical pain which interferes with daily activities. They occur more than twice in 12 months and are associated with more than two of anorexia, vomiting, photophobia, nausea, headache and pallor.
How does intestinal malrotation present?
Often asymptomatic but can present due to internal hernias and midgut volvulus.
Volvulus can present with signs of intestinal obstruction often in the first few weeks of life and is considered a surgical emergency.
What are some of the main associated features of gastro-oesophageal reflux disease in infants?
Presenting up to 1 year of age
Crying or posturing whilst feeding
Hoarseness and/or chronic cough
Single episode of pneumonia
Unexplained feeding difficulties (e.g. refusing, gagging, choking or faltering growth)
How should infantile colic be managed?
Advice on soothing the child and parental wellbeing
What histological features would you expect to see on a full-thickness rectal biopsy in a patient with Hirschsprung disease?
Absence of ganglion cells
What are the presenting symptoms of croup?
Coryzal symptoms
Seal-like barking cough
Stridor
How is epiglottitis treated?
Urgent anaesthetic review (for consideration of intubation)
IV 3rd generation cephalosporin (e.g. ceftriaxone)
According to the NICE guidelines, what frequency of tonsillitis would warrant referral to an ENT specialist for consideration of tonsillectomy?
More than 7 episodes per year for 1 year, 5 episodes per year for 2 years or 3 episodes per year for 3 years.
What should be done first when reviewing the control of a patient’s asthma?
Review inhaler technique and compliance
