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Paediatrics Flashcards

1
Q

When is jaundice in babies always pathological

A

In the first 24 hours

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2
Q

What are the causes of jaundice in the 24 hours?

A
  • Rhesus haemolytic disease
  • ABO haemolytic disease
  • hereditary spherocytosis
  • glucose-6-phosphodehydrogenase
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3
Q

What are the causes of jaundice in babies aged 2-14 days?

A
  • usually physiological
  • combination of factors including more red blood cells and more fragile red blood cells, and less developed liver function
  • seen more commonly in breast fed babies
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4
Q

Screen for prolonged jaundice

A
  • conjugated and unconjugated bilirubin
  • direct antiglobulin test (coomb’s)
  • TFTs
  • FBC and blood film
  • urine and MC&S and reducing sugars
  • U+Es and LFTs
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5
Q

What are the causes of a prolonged jaundice (post 14 days)

A
  • biliary atresia
  • hypothyroidism
  • galactosaemia
  • urinary tract infection
  • breast milk jaundice
  • prematurity (due to immature liver function)
  • congenital infections e.g. CMV, toxoplasmosis
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6
Q

What is biliary atresia?

A

Obliteration or discontinuation within the extrahepatic biliary system, resulting in the obstruction of bile flow

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7
Q

Type 1 biliary atresia

A

Proximal ducts are patent, common duct is obliterated

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8
Q

Type 2 biliary atresia

A

Atresia of the cystic duct and cystic structures are ofund in the porta hepatis

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9
Q

Type 3 biliary atresia

A

Atresia of the left and right ducts to the level of the porta hepatis

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10
Q

Signs of biliary atresia

A
  • jaundice beyond 2 weeks
  • hepatomegaly with splenomegaly
  • abnormal growth
  • cardiac murmurs
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11
Q

Presentation of biliary atresia

A
  • jaundice
  • appetite and growth disturbance
  • dark urine and pale stools
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12
Q

Investigations for biliary atresia

A
  • serum bilirubin: conjugated bilirubin abnormally high
  • LFTs
  • sweat chloride test to exclude CF as a cause
  • ultrasound of the biliary tree and liver
  • serum alpha 1 antitrypsin
  • percutaneous liver biopsy with intraoperative cholangioscopy
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13
Q

What is the management of biliary atresia?

A
  • surgical intervention
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14
Q

What are the complications of biliary atresia?

A
  • unsuccessful anastamosis formation
  • progressive liver disease
  • cirrhosis with eventual hepatocellular carcinoma
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15
Q

What is neonatal sepsis?

A
  • sepsis within the first 28 days
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16
Q

What are the most common causes of neonatal sepsis?

A
  • group B streptococcus (main cause of early onset sepsis)
  • escherichia coli
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17
Q

What are the risk factors of neonatal sepsis?

A
  • mother who has had a baby with GBS infection, who has current GBS colonisation, current bacteruria, intrapartum tmep of ≥38, membrane rupture of ≥18 hours, or current infection throughout pregnancy
  • prematurity
  • low birth weight
  • maternal chorioamnionitis
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18
Q

Presentation of neonatal sepsis

A
  • respiratory distress (grunting, nasal flaring, use of accessory respiratory muscles, tachypnoea)
  • tachycardia
  • apnoea
  • lethargy/change in mental state
  • jaundice
  • seizure
  • poor/reduced feeding
  • abdominal distension
  • vomiting
  • temperature
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19
Q

Investigations suspected neonatal sepsis

A
  • blood culture
  • FBC
  • CRP
  • blood gases (metabolic acidosis is particularly concerning)
  • urine microscopy, culture and sensitivity
  • lumbar puncture
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20
Q

What is the management of neonatal sepsis?

A
  • IV benzypenicillin with gentamicin
  • re-measure CRP after 18-24 hours after presentation if given antibiotics
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21
Q

Simple febrile convulsion

A
  • <15 minutes
  • generalised seizure
  • typically no recurrence within 24 hours
  • should be a complete recovery within an hour
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22
Q

Complex febrile seizure

A
  • 15-30 minutes
  • focal seizure
  • may have repeat seizure within 24 hours
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23
Q

Febrile status epilepticus

A

> 30 minutes

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24
Q

Presentation of febrile convulsion

A
  • usually occur early in viral infection as the temperature rises rapidly
  • seizures are usually breig, last less than 5 minutes
  • more commonly tonic clonic
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25
Q

What ages do febrile seizures typically occur?

A

Between the ages of 6 months and 5 years

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26
Q

What is the management of febrile seizure?

A
  • first seizure or any complex seizure should be admitted

Ongoing management:
- phone ambulance if lasts >5 minutes
- if recurrent then benzodiazepine rescue medication may be considered

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27
Q

What are the risk factors for developing epilepsy from febrile convulsion?

A
  • age of onset <18 months
  • fever <39
  • shorter duration of fever before the seizure
  • family history of febrile convulsions
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28
Q

What is cystic fibrosis

A
  • autosomal recessive disorder
  • increased viscosity of secretions
  • due to defect in CFTR
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29
Q

What causes a false positive sweat test

A
  • malnutrition
  • adrenal insufficiency
  • glycogen storage disease
  • nephrogenic diabetes insipidus
  • hypothyroidism, hypoparathyroidism
  • G6PD
  • ectodermal dysplasia
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30
Q

What is the most common cause of a false positive sweat test

A

Skin oedema

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31
Q

Diagnosis of CF

A
  • sweat test
  • high sweat chloride
  • normal is less than 40, CF indicated if >60
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32
Q

Neonatal presentation of CF

A
  • meconium ileus
  • prolonged jaundice
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33
Q

Presentation of CF in children

A
  • recurrent chest infection
  • malabsorption: steatorrhoea, failure to thrive
  • liver disease

Short, diabetes, delayed puberty, rectal prolpase, nasal polyps, male infertility, female subfertility

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34
Q

Management of cystic fibrosis

A
  • twice daily chest physio and postural drainage
  • high calorie, high fat intake
  • vitamin supplementation
  • pancreatic enzyme replacement
  • lung transplant
  • lumacraftor/ivacaftor if homozygous for delta F508 mutation
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35
Q

What is a contra indication for a lung transplant in someone with CF?

A

Chronic infeciton with burkholderia cepacia

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36
Q

What is the main cause of croup

A

PArainfluenze viruses

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37
Q

What is the peak age incidence of croup

A

6 months to 3 years

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38
Q

Presentation of croup

A
  • cough: seal bark, worse at night
  • stridor
  • fever
  • coryzal symptoms
  • increased work of breathing
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39
Q

When should you admit a child with croup

A
  • moderate or severe croup
  • <3 months
  • uncertainty about diagnosis
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40
Q

Diagnosis of croup

A
  • clinical diagnosis
  • can consider a chest Xray: steeple sign and thumb sign
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41
Q

Management of croup

A
  • single dose of dexamethasone
  • emergency treatment: high flow oxygen, nebulised adrenaline
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42
Q

Severe croup

A
  • frequent barking cough
  • prominent inspiratory stridor at rest
  • marked sternal wall retractions
  • significant distress, agitation, lethargy or restlessness
  • tachycardia
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43
Q

What is the cause of bronchiloitis?

A

Respiratory syncytial virus

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44
Q

What is the peak incidence age of bronchiolitis?

A
  • 3-6 months
  • 90% are 1-9 months
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45
Q

What are the features of bronchiolitis?

A
  • coryzal symptoms
  • dry cough
  • increasing brethlessness
  • wheeze, fine inspiratory crackles
  • feeding difficulties associated with dyspnoea
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46
Q

When should you admit a child with bronchiolitis?

A
  • resp rate of over 60
  • difficulty breastfeeding or inadequate oral fluid intake (50-75% usual volume)
  • clinical dehydration
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47
Q

What is the management of bronchiolitis?

A
  • humidified oxygen
  • nasogastric feeding may be needed if children cant take enough fluid/feed by mouth
  • suction is sometimes used for excessive upper airway secretions
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48
Q

Severe asthma attack

A
  • spo2 <92%
  • PEF 33-50% best or predicted
  • too breathless to talk or feed
  • HR: >125 if over 5, >140 if 1-5
  • RR: >30 if over 5, >40 if 1-5
  • Use of accessory neck muscles
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49
Q

Life threatening

A
  • sp02 <92%
  • PEF <33% best or predicted
  • silent chest
  • poor respiratory effort
  • agitation
  • altered consciousness
  • cyanosis
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50
Q

What is the management of moderate acute asthma in children?

A
  • beta 2 agonist via a spacer
  • give 1 puff every 30-60 seconds up to a maximum of 10 puffs
  • if symptoms are not controlled then repeat beta 2 agonist and refer to hospital
  • steroid for 3-5 days
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51
Q

stepwise approach for asthma in children

A
  • SABA
  • SABA + ICS
  • SABA + ICS + LTRA
  • SABA + ICS + LABA
  • SABA + MART
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52
Q

In which cases should you start an ICS for asthma at presentation?

A

symptoms ≥3 times a week or night time waking

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53
Q

What are the most commonly affected joints in septic arthritis?

A
  • hip
  • knee
  • ankle
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54
Q

What are the symptoms of septic arthritis?

A
  • joint pain
  • limp
  • fever
  • systemically unwell: lethargy
  • swollen, red joint
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55
Q

Investigations for septic arthritis

A
  • joint aspiration
  • raised inflammatory markers
  • blood cultures
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56
Q

Kocher criteria

A

septic arthritis:
- fever>38.5
- non weight bearing
- raised ESR
- raised WCC

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57
Q

What are the types of osteomyelitis?

A
  • haematogenous osteomyelitis
  • non-haematogenous
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58
Q

Which type of osteomyelitis is most common in children?

A

Haematogenous

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59
Q

What is the most common cause of osteomyelitis?

A

staph aureus

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60
Q

investigation osteomyelitis

A

MRI

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61
Q

management of osteomyelitis

A

flucloxacillin for 6 weeks, clindamycin if penicillin allergic

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62
Q

What is the management of viral wheeze?

A

Episodic:
- symptomatic treatment
- salbutamol via a spacer

multiple trigger wheeze:
- corticosteroid trial for 4-8 weeks

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63
Q

What is the most common cause of pneumonia in children?

A

s.pneumoniae

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64
Q

Treatment of pneumonia

A
  • amoxicillin
  • macrolides can be added if no response to first line, or if chlamydia or mycoplasma is suspected
  • if influenza associated then co-amoxiclav
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65
Q

Risk factors for GORD in kids

A
  • preterm
  • neurological disorder
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66
Q

Features of GORD

A
  • typically develops before 8 weeks
  • vomiting/regurgitation
  • excessive crying, especially whilst feeding
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67
Q

Management of GORD

A
  • 30 degree head up position for feeds
  • sleep on back
  • ensure no overfeeding, can trial more frequent, smaller feeds
  • can trial thickened formula
  • trial alginate therapy e.g. Gaviscon
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68
Q

Diagnosis of constipation in children under 1

A

Fewer than 3 complete stools per week (type 3 or 4) , hard large stool, rabbit droppings (type 1)

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69
Q

Diagnosis of constipation in children over 1

A

fewer than 3 complete stools per week (type 3 or 4)
- overflow soiling
- rabbit droppings
- large, infrequent stools that can block the toilet

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70
Q

Causes of constipation in children

A
  • idiopathic
  • dehydration
  • low fibre diet
  • anal fissure
  • hypothyroidism
  • hirschprungs
  • hypercalcaemia
  • learning difficulties
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71
Q

Red flag symptoms in constipation

A
  • symptoms from birth or first few weeks of life
  • > 48 hours
  • ribbon stools
  • faltering growth = amber
  • abdomen distension
  • previously unknown or undiagnosed weakness in the legs or locomotor delay
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72
Q

Factors suggesting faecal impaction

A
  • symptoms of severe constipation
  • overflow soiling
  • faecal mass palpable in the abdomen
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73
Q

Management of constipation if faecal impaction is present

A
  • polyethylene glycol 3350 + electrolytes
  • add stimulant laxatives if doesn’t lead to disimpaction after 2 weeks
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74
Q

Features of coeliac disease

A
  • failure to thrive
  • diarrhoea
  • abdominal distension
  • anaemia if older
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75
Q

Diagnosis of coeliac

A
  • jejunal biopsy showing subtotal villous atrophy
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76
Q

Features of cows milk protein intolerance/allergy

A
  • regurgitation/vomiting
  • diarrhoea
  • urticaria, atopic eczema
  • colic symptoms: irritable, crying
  • wheeze, chronic cough
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77
Q

Diagnosis of cows milk protein intolerance

A
  • skin prick/patch test
  • total IgE and specific IgE
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78
Q

Management of cows milk protein intolerance if breast fed

A
  • continue breast feeding
  • eliminate cows milk protein from maternal diet
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79
Q

Management of cows milk protein intolerance if formula fed

A
  • extensive hydrolysed formula (eHF) if mild/moderate symptoms
  • amino acid based formula if severe or if no response
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80
Q

Prognosis of cows milk protein intolerance

A
  • IgE mediated, around 55% tolerant by age 5
  • non- IgE mediated, most tolerant by age of 3
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81
Q

What is intussusception?

A

Invagination of one portion of the bowel into the lumen of the adjacent bowel, most commonly around the ileocaecal region

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82
Q

most common age intussusception

A

between 6 and 18 months

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83
Q

Features of intussusception

A
  • intermittent, crampy, severe, progressive abdo pain
  • inconsolable crying
  • draw knees up to chest and turn pale
  • vomiting
  • bloodstained stool, red currant jelly as late sign
  • sausage shaped mass in the right upper quadrant
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84
Q

Investigation intussusception

A

USS- target like mass

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85
Q

Management of intussusception

A

Reduction by air insufflation under radiological control

If this fails/peritonitis then surgery

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86
Q

Presentation of meckels diverticulum

A
  • abdominal pain mimicking appendicitis
  • rectal bleeding
  • intestinal obstruction
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87
Q

What is meckels diverticulum?

A
  • congenital diverticulum of the small intestine
  • remnant of the omphalomesenteric duct
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88
Q

investigation meckels diverticulum

A
  • meckels scan
  • mesenteric ateriography in more severe cases
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89
Q

Management of meckels diverticulum

A
  • removal if narrow neck or symptomatic: wedge excision or formal small bowel resection and anastomosis
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90
Q

Features of necrotising enterocolitis

A
  • feeding intolerance
  • abdominal distension
  • bloody stools
  • abdominal discolouration, perforation, peritonitis
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91
Q

Abdominal X ray necrotising enterocolitis

A
  • dilated bowel loops
  • bowel wall oedema
  • pneumatosis intestinalis (intramural gas)
  • portal venous gas
  • pneumoperitoneum resulting from perforation
  • air both inside and outside of the bowel wall (rigler sign)
  • air outlining the falciform ligament (football sign)
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92
Q

Diagnosis of malrotation

A

upper GI contrast study and USS

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93
Q

Treatment of malrotation

A
  • laparotomy
  • Ladd’s procedure if volvulus is present or at high risk of recurrence
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94
Q

Meconium ileus on x ray

A

no fluid level

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95
Q

Management of necrotising enterocolitis

A

total gut rest and TPN, babies with perforation require laparotomy

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96
Q

What is hirschprungs?

A

aganglionic segment of bowel due to developmental failure of the parasympathetic auerbach and meissner plexuses leading to uncoordinated peristalsis

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97
Q

Associations of hirschprungs

A

down’s syndrome

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98
Q

Presentation of hirschprungs

A
  • failure or delay to pass meconium
  • in older children: constipation, abdominal distension
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99
Q

Investigation for hirschprungs

A
  • abdominal X ray
  • rectal biopsy: gold standard for diagnosis
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100
Q

Management of hirschprungs

A
  • rectal washout/bowel irrigation
  • definitive management to the affected segment of the colom
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101
Q

What are the complications of undescended testis?

A
  • infertility
  • torsion
  • testicular cancer
  • psychological impacts
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102
Q

Management of undescended testis

A

Unilateral:
- referral from 3 months of age, uroglogical surgeon before 6 months
- orchidoplexy at around 1 year

Bilateral
- reviewed by a senior paesiatrician within 24 hours as child may need ugent endocrine or genetic investigation

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103
Q

Features of testicular torsion

A
  • pain is usually severe and sudden onset
  • pain may be referred to the lower abdomen
  • nausea and vomiting
  • swollen, tender testis, retracted upwards
  • loss of the cremasteric reflex
  • elevation of the testis does not ease the pain (prehns sign)
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104
Q

Management of testicular torsion

A

Urgent surgical exploration, both testis should be fixed

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105
Q

cause of measles

A

RNA paramyxovirus, aerosol transmission

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106
Q

Features of measles

A
  • prodrome: irritable, conjuncitvitis, fever
  • koplik spots, typically develop before the rash, white spots on the buccal mucosa
  • rash: starts behind the ears then whole body, maculopapular rash becoming blotchy
  • diarrhoea in 10%
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107
Q

Investigation measles

A

IgM antibodies

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108
Q

Management measles

A
  • supportive
  • admission in immunosuppressed or pregnant
  • inform public health
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109
Q

Complication of measles

A
  • otitis media
  • pneumonia
  • encephalitis
  • subacute sclerosing panencephalitis 5-10 years after
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110
Q

Managment of contacts: measles

A
  • MMR vaccine within 72 hours if not immunized
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111
Q

Cause of chicken pox

A

Varicella zoster

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112
Q

Features of chicken pox

A
  • fever initially
  • itchy rash, starting on head/trunk before spreading
  • initally macular then papular then vesicular rash
  • systemic upset normally mild
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113
Q

Management of chicken pox

A
  • keep cool, trim nails
  • calamine lotion
  • keep off school until all lesions are dry and crusted over (5 days after onset of rash)
  • if immunosuppressed then varicella zoster immunoglobulin, if chicken pox develops then consider IV aciclovir
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114
Q

Complication of chicken pox

A

secondary bacterial infection of lesions

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115
Q

features of mumps

A
  • fever
  • malaise
  • muscular pain
  • parotitis (ear ache/pain on eating)
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116
Q

Management of mumps

A
  • rest
  • paracetamol for high fever/discomfort
  • notifiable disease
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117
Q

Complications of mumps

A
  • orchitis
  • hearing loss
  • meningoencephalitis
  • pancreatitis
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118
Q

What causes slapped cheek?

A

Parvovirus B19

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119
Q

What causes rubella?

A

Togavirus

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120
Q

Features of rubella

A
  • prodrome e.g. low grade fever
  • rash: maculopapular, initially on the face before spreading to the whole body, usually fades by day 3-5
  • lymphadenopathy: suboccipital and postauricular
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121
Q

Complications of rubella

A
  • arthritis
  • thrombocytopenia
  • encephalitis
  • myocarditis
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122
Q

What causes sixth disease?

A

Human herpes virus 6

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123
Q

Features of sixth disease

A
  • high fever lasting a few days then maculopapular rash
  • nagayama spots on the uvula and soft palate
  • febrile convulsion
  • diarrhoea and cough
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124
Q

What causes whooping cough?

A

Bordetella pertussis

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125
Q

Features of whooping cough

A
  • catarrhal phase: similar to URTI
  • paroxysmal phase: cough increases in severity, central cyanosis, post tussive vomiting, inspiratory whoops, may have spells of apnoea, lasts between 2-8 weeks
  • convalescent phase: cough subsides over weeks to months
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126
Q

Investigation for whooping cough

A
  • nasal swab for bordetella pertussis
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127
Q

Management of whooping cough

A
  • if under 6 months then admit
  • notifiable disease
  • oral macrolide if onset of cough is within the last 21 days
  • household contacts offered antibiotic prophylaxis
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128
Q

What are the complications of whooping cough?

A
  • subconjunctival haemorrhage
  • pneumonia
  • bronchiectasis
  • seizures
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129
Q

what are the contraindications to lumbar puncture?

A
  • focal neurological signs
  • papilloedema
  • significant bulging of the fontanelle
  • disseminated intravascular coagulation
  • signs of cerebral herniation
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130
Q

What is the management of meningitis in under 3mnth old

A
  • IV amoxicillin + IV cefotaxime
  • fluids
  • cerebral monitoring
  • public health notification and antibiotic prophylaxis (ciprofloxacin)
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131
Q

What is the management of meningitis in over 3mnth olds

A
  • IV cefotaxime or ceftriaxone
  • fluids
  • cerebral monitoring
  • public health notification and antibiotic prophylaxis (ciprofloxacin)
  • consider steroids
132
Q

Meningitis neonatal causes

A
  • Group B streptococcus
  • E.coli
  • lsiteria monocytogenes
133
Q

Meningitis 1 month to 6 years causes

A
  • neisseria meningitidis
  • streptococcus pneumoniae
  • haemophilus influenzae
134
Q

Diagnosis of epiglottitis

A
  • direct visualisation
134
Q

Meningitis causes older than 6

A
  • neisseria meningitidis
  • streptococcus penumoniae
134
Q

What causes acute epiglottitis?

A

Haemolphilus influenzae type B

134
Q

Features of acute epiglottitis

A
  • rapid onset
  • high temperature
  • generally unwell
  • stridor
  • drooling of saliva
  • tripod position
134
Q

X ray epiglottitis

A
  • thumb sign: swelling of epiglottis
  • steeple sign: subglottic narrowing
135
Q

management of epiglottitis

A
  • immediate senior involvement (endotracheal intubation may be needed to protect the airway )
  • if suspected dont examine the throat
  • oxygen
  • IV antibiotics
136
Q

Symptoms of uti in babies

A
  • fever
  • lethargy
    -irritability
  • vomiting
  • poor feeding
  • urinary frequency
137
Q

Symptoms of UTI in children

A
  • fever
  • abdominal pain
  • vomiting
  • dysuria
  • urinary frequemcy
  • incontinence
138
Q

When is a diagnosis of acute pyelonephritis made?

A
  • temperature over 38
  • loin pain or tenderness
139
Q

Who should get an ultrasound when presenting with a UTI

A
  • all children under 6 months with their 1st UTI (scan within 6 weeks)
  • children with recurrent UTIs
  • Children with atypical UTI
140
Q

When should DMSA scans be used?

A
  • used 4-6 months after illness to assess for damage after reucrrent or atypical UTI
  • if dye not taken up by part of the kidney suggests scarring
141
Q

What is vesico-ureteric reflux?

A
  • urine has a tendency to flow from the bladder back into the ureters
142
Q

How do you diagnose vesico-ureteric reflux?

A

Micturating cystourethrogram

143
Q

What is the management of vesico-ureteric reflux?

A
  • avoid constipation
  • avoid an excessively full bladder
  • prophylactic antibiotics
  • surgical input from paediatric urology
144
Q

Triad of nephrotic syndrome

A
  • low serum albumin
  • high protein content
  • oedema
145
Q

Most common cause of nephrotic syndrome in kids

A

minimal change disease

146
Q

Kidney disease causes of nephrotic syndrome

A
  • focal segmental glomerulosclerosis
  • membranoproliferative glomerulonephritis
147
Q

What systemic illnesses can cause nephrotic syndrome?

A
  • henoch schonlein
  • diabetes
  • infection: HIV hepatitis malaria
148
Q

Management of minimal change disease

A
  • corticosteroids
149
Q

Urinalysis of minimal change

A
  • small molecular weight proteins
  • hyaline casts
150
Q

Management of nephrotic syndrome

A
  • high dose steroids for 4 weeks then wean for 8
  • low salt diet
  • diuretics for oedema
  • albumin infusion
  • antibiotic prophylaxis in severe cases
151
Q

Complications of minimal change disease

A
  • hypovolaemia
  • thrombosis
  • infection
  • acute or chronic renal failure
  • relapse
152
Q

Nephritic syndrome

A
  • haematuria
  • protein uria
153
Q

What are the most common causes of nephritic syndrome in children?

A
  • post streptococcal
  • IgA (bergers)
154
Q

Presentation of post streptococcal glomerulonephritis

A
  • 1-3 weeks after a beta haemolytic streptococcus e.g. tonsilitis
155
Q

Management of post streptococcal glomerulonephritis

A

-supportive
- may need help managing if there is a worsening of renal function e.g. antihypertensive or diuretics

156
Q

Biopsy of IgA nephropathy

A
  • IgA deposits
  • glomerular mesangial proliferation
157
Q

Management of IgA nephropathy

A
  • supportive treatment of renal failure
  • immunosuppressant medications e.g. steroids, cyclophosphamide to slow the progression
158
Q

What are the causes of UTI in children?

A
  • e. coli
  • proteus
  • pseudomonas
159
Q

What are the factors that predispose to UTI

A
  • incomplete bladder emptying (infrequent voiding,
    hurried micturition,
    obstruction by full rectum due to constipation,
    neuropathic bladder)
  • poor hygiene
  • vesico-ureteric reflux
160
Q

Other features of nephrotic syndrome

A

hyperlipidaemia, a hypercoagulable state (due to loss of antithrombin III) and a predisposition to infection (due to loss of immunoglobulins)

161
Q

What is the most common cause of gastroenteritis in children?

A

Rotavirus

162
Q

Signs of clinical dehydration in children

A
  • Appears to be unwell or deteriorating
  • Decreased urine output
  • Altered responsiveness (for example, irritable, lethargic)
  • Sunken eyes
  • Dry mucous membranes
  • Tachycardia
  • Tachypnoea
  • Reduced skin turgor
  • Skin colour unchanged
  • Warm extremities
  • Normal peripheral pulses
  • Normal capillary refill time
  • Normal blood pressure
163
Q

Signs of clinical shock in children (dehydration)

A
  • Decreased level of consciousness
  • Cold extremities
  • Pale or mottled skin
  • Tachycardia
  • Tachypnoea
  • Weak peripheral pulses
  • Prolonged capillary refill time
  • Hypotension
164
Q

Features of hypernatraemic dehydration

A
  • jittery movements
  • increased muscle tone
  • hyperreflexia
  • convulsions
  • drowsiness or coma
165
Q

What is the most common age of SIDs?

A

3 months

166
Q

What are the major risk factors of SIDs?

A
  • putting the baby to sleep prone
  • parental smoking
  • prematurity
  • bed sharing
  • hyperthermia or head covering
167
Q

What are the protective factors against SIDs

A
  • breastfeeding
  • room sharing (but not bed)
  • use of dummies
168
Q

What should happen following a cot death?

A
  • siblings screened for potential sepsis and inborn errors of metabolism
169
Q

Management of eczema

A
  • avoid irritants
  • emollients
  • topical steroids
  • wet wrappings
170
Q

Management of eczema herpeticum

A

Aciclovir oral or IV if severe

171
Q

Presentation of eczema herpeticum

A
  • widespread painful vesicular rash
  • systemic symptoms
  • lymphadenopathy
172
Q

Virus eczema herpeticum

A

Herpes simplex virus 1 or VZV

173
Q

Management of urticaria

A
  • fexofenadine
  • oral steorids can be considered for a severe flare
174
Q

Cause of impetigo

A

Stpahy aureus

175
Q

non bullous vs bullous impetigo

A

non bullous: golden crust, no systemic symtpoms, bullous: fluid filled vesicles

176
Q

Management of non bullous impetigo

A
  • topical fusidic acid or hydrogen peroxide cream
  • oral flucloxacillin if more wide spread
  • need to be off school until all the lesions have healed over or they have been treated with antibiotics for at least 48 hours
177
Q

Describe molluscum contagiosum

A

Small, flesh coloured papules that have a central dimple

178
Q

Management of molluscum contagiosum

A
  • heal by themselves
  • avoid sharing towels, scratching
179
Q

Presentation of scabies

A
  • very itchy
  • small red spots
  • finger webs
180
Q

Management of scabies

A

Permethrin cream left for 8-12 hours then washed off then repeated a week later

Oral ivermectin for difficult to treat or crusted scabies

Wash all clothes/bedsheet on a hot wash

181
Q

What are the cyanotic heart diseases?

A
  • Tetralogy of fallot
  • transposition of the great arteries
    tricuspid atresia
182
Q

What are the acyanotic heart diseases?

A
  • ASD
  • VSD
  • Coarctation of the aorta
  • Patent ductus arteriosus
  • Aortic valve stenosis
183
Q

Auscultation of ASD

A

Fixed split second heart sound

Mid systolic, crescendo-decrescendo

184
Q

Auscultation of VSD

A

Pan-systolic murmur best heard at L lower sternal edge

185
Q

Auscultation of coarctation of the aorta

A

Systolic murmur

186
Q

Auscultation of aortic valve stenosis

A

Ejection systolic, radiates to the carotids

187
Q

Eisenmenger syndrome

A

Reversal of a L to R shunt as pulmonary pressure rises to a level above that of the systemic pressure. Resulting in cyanosis

188
Q

When does the ductus arteriosus normally close?

A

2-3 weeks after birth

189
Q

What keeps ductus arteriosus open?

A

Prostaglandins

190
Q

Sign of coarctation of the aorta

A

Weak femoral pulses

191
Q

Sign of aortic valve stenosis

A

Slow rising pulse and narrow pulse pressure

192
Q

What are the risk factors of tetralogy of fallot?

A
  • maternal diabetes
  • alcohol consumption during pregnancy
  • rubella
  • maternal age over 40
193
Q

What to give in tet spell

A
  • oxygen
  • beta blocker
  • morphine
  • sodium bicarbonate
  • phenylephrine
  • IV fluids
194
Q

What are the features of tetralogy of fallot?

A
  • over riding aorta
  • right ventricular hypertrophy
  • pulmonary valve stenosis
  • ventricular septal defect
195
Q

Management of transposition of the great arteries

A
  • prostaglandins to keep ductus arteriosus open
  • balloon septostomy into foramen ovale
  • open heart surgery = definitive
196
Q

Auscultation of tricuspid atresia

A

single s2 with pan-systolic murmur

197
Q

association of coarctation of the aorta

A

turner’s

198
Q

innocent murmurs

A
  • soft
  • short
  • systolic
  • symptomless
  • situation dependent
199
Q

Presentation of type 1 diabetes

A
  • DKA
  • triad of hyperglycaemia: polyuria, polydipsia, weight loss
200
Q

What should you check if someone has just been diagnosed with type 1 diabetes?

A
  • FBC
  • glucose
  • UEs
  • HbA1c
  • TFTs and TPO antibodies
  • anti TTG
  • Insulin antibodies, anti GAD, islet cell antibodies
201
Q

Why should you cycle insulin injection sites?

A

Lipodystrophy

202
Q

Symptoms of hypoglycaemia

A
  • hunger
  • tremor
  • sweating
  • irritability
  • dizziness
  • pallor
203
Q

Long term complications of type 1 diabetes

A
  1. Macrovascular
    - coronary artery disease
    - peripheral ischaemia
    - stroke
    - hypertension
  2. Microvascular
    - peripheral neuropathy
    - retinopathy
    - kidney disease especially glomerulosclerosis
  3. Infection related:
    - UTI
    - pneumonia
    - skin/soft tissue
    - fungal
204
Q

What is haemolytic disease of the newborn

A

Destruction of fetal erythrocytes by maternal antibodies

205
Q

What are the causes of haemolytic disease of the newborn

A
  • ABO incompatibility: O mother with A/B antibodies, baby with group A or B blood group
  • Rhesus incompatibility (Rh negative mother, Rh positive baby)
206
Q

What are the sensitisation events?

A
  • normal delivery
  • abortion or stillbirth
  • chorionic villus sampling
  • amniocentesis
  • antenatal haemorrhage
  • maternal trauma
  • idiopathic
207
Q

What are the antenatal causes of cerebral palsy?

A
  • maternal infection
  • trauma during pregnancy
208
Q

What are the perinatal causes of cerebral palsy?

A
  • birth asphyxia
  • pre term
209
Q

What are the post natal causes of cerebral palsy?

A
  • meningitis
  • severe neonatal jaundice
  • head injury
210
Q

What are the types of cerebral palsy?

A
  • spastic: UMN, increased tone
  • Dyskinetic: basal ganglia, increased and reduced tone
  • ataxic: cerebellum, unco-ordinated movement
  • mixed
211
Q

cerebral palsy one limb affected

A

monoplegia

212
Q

cerebral palsy one side of body

A

hemiplegia

213
Q

cerebral palsy, all 4 limbs but legs worse

A

diplegia

214
Q

What are the signs/symptoms of cerebral palsy?

A
  • failure to meet milestones
  • hand preference before 18 months
  • increased or reduced tone
  • difficulty with co-ordination, speech, walking, swallowing
215
Q

what can be used to help spasticity in cerebral palsy?

A

Baclofen (muscle relaxant)

216
Q

What can be used to help with drooling in cerebral palsy?

A

glycopyrronium bromide

217
Q

How can you grade fractures at the growth plate?

A

Salter harris

218
Q

Salter harris grades

A

Type 1: Straight across
Type 2: Above
Type 3: beLow
Type 4: Through
Type 5: cRush

219
Q

Greenstick fracture

A

One side of the bone breaks but other side stays intact

220
Q

Presentation of transient synovitis

A
  • limp
  • refusal to weight bear
  • mild fever
  • groin or hip pain
221
Q

What is Perthes disease?

A

Avascular necrosis of the femoral head

222
Q

Presentation of Perthes disease

A
  • limp
  • pain in the hip or groin that may radiate to the knee
  • restricted hip movement
  • no history of trauma
223
Q

What is the management of perthes disease?

A
  • bed rest
  • traction
  • crutches
  • analgesia
  • physiotherapy
224
Q

What is SUFE?

A
  • slipped upper femoral epiphysis
  • head of the femur is displaced along the growth plate
225
Q

age SUFE

A

8-15

226
Q

Presentation of SUFE

A
  • hip, groin, thigh, or knee pain
  • restricted internal rotation
  • painful limp
  • restricted hip movmement
227
Q

Management of SUFE

A

Surgery

228
Q

What are the risk factors for Developmental Dysplasia of the Hip?

A
  • first degree family history
  • breech
  • multiple pregnancy
229
Q

Tests to check for DDH

A
  • ortolani: abduct hip and try to displace it anteriorly
  • barlow test: hips abducted and flexed at 90 degrees, press down on the knee to try to displace the hip posteriorly
230
Q

investigation for DDH

A

Ultrasound

231
Q

Management of DDH

A
  • palvik harness - removed after 6-8 weeks
  • surgery if harness fails, or if diagnosed after 6 months
232
Q

Treatment of vulvovaginitis

A
  • Avoid washing with soap and chemicals
  • Avoid perfumed or antiseptic products
  • Good toilet hygiene, wipe from front to back
  • Keeping the area dry
  • Emollients
  • Loose cotton clothing
  • Treating constipation and worms where applicable
  • Avoiding activities that exacerbate the problem
233
Q

Symptoms of vulvovaginitis

A
  • soreness
  • itching
  • erythema around the labia
  • vaginal discharge
  • dysuria
  • constipation
234
Q

What is otitis media?

A

Infection of the middle ear

235
Q

How does otitis media occur in children?

A

Through infection via the eustachian tube - often preceded by a viral URTI

236
Q

What is the most common bacterial cause of otitis media?

A

Streptococcus pneumoniae

237
Q

Presentation of otitis media

A
  • ear pain
  • reduced hearing
  • URTI symptoms
  • if affecting the vestibular system then can cause balance issues
238
Q

appearance of the tympanic membrane in otitis media

A

bulging red, inflamed looking membrane. May be a perforation

239
Q

Management of otitis media

A
  • if not very unwell then simple analgesia
  • can consider delayed antibiotics to be picked up after 3 days if there has been no improvement
240
Q

Antibiotic of choice for otitis media

A

amoxicillin

241
Q

What are the complications of otitis media?

A
  • otitis media with effusion
  • hearing loss
  • perforated ear drum
  • recurrent infection
  • mastoiditis
  • abscess
242
Q

What is the most common bacterial cause of tonsilitis?

A

Group A streptococcus

243
Q

What criteria can you use when diagnosing tonislitis?

A

Centor or feverPAIN

244
Q

Centor

A

Score of 3 or more: treat with antibiotics

  • fever over 38
  • exudate on tonsils
  • absence of cough
  • tender anterior cervical lymph nodes
245
Q

antibiotics for tonsilitis

A

Penicillin V for 10 days

246
Q

Complications of tonsillitis

A
  • chronic tonsilitis
  • peritonsillar abscess (quinsy)
  • otitis media
  • scarlet fever
  • rheumatic fever
  • post streptococcal glomerulonephritis or reactive arthritis
247
Q

What is hypoxic ischaemic encephalopathy

A

Lack of oxygen during birth resulting in ischaemia to the brain

248
Q

Causes of hypoxic ischaemic encephalopathy

A
  • maternal shock
  • intrapartum haemorrhage
  • prolasped cord
  • nuchal cord
249
Q

Mild hypoxic ischaemic encephalopathy

A
  • Poor feeding, generally irritability and hyper-alert
  • Resolves within 24 hours
  • Normal prognosis
250
Q

Moderate hypoxic encephalopathy

A
  • Poor feeding, lethargic, hypotonic and seizures
  • Can take weeks to resolve
  • Up to 40% develop cerebral palsy
251
Q

Severe hypoxic encephalopathy

A
  • Reduced consciousness, apnoeas, flaccid and reduced or absent reflexes
  • Up to 50% mortality
  • Up to 90% develop cerebral palsy
252
Q

Caput Succedaneum

A

Oedema collects on the outside of the scalp outside the periosteum

Able to cross the suture lines

253
Q

Cephalohaematoma

A

Blood between the skull and the periosteum
Below the periosteum so doesn’t cross the suture lines

254
Q

Management of cepahlohaematoma

A

Should resolve by itself

Monitor for jaundice and anaemia

255
Q

Nerves erbs palsy

A

C5/6

256
Q

Erbs palsy

A
  • weakness of shoulder abduction and external rotation, arm flexion and finger extension
  • waiter’s tip
  • internally rotated shoulder
  • extended elbow
  • flexed wrist facing back
  • lack of movement in the affected arm
257
Q

Signs of a fractured clavicle after birth

A
  • lack of movement in affected arm or asymmetry of movement
  • pain and distress on movement of the arm
258
Q

What is the most common cause of respiratory distress in the newborn?

A

Transient tachypnoea of the newborn

259
Q

TTP on x ray

A
  • hyperinflation
  • fluid in the horizontal fissure
260
Q

Management of Transient Tachypnoea of the newborn

A
  • observation
  • supplementary oxygen
  • normally settles in 1-2 days
261
Q

What is respiratory distress syndrome?

A
  • premature neonates (born before surfactant develops)
262
Q

Apnoea in baby

A

20 seconds no breathing or shorter periods with desaturation or bradycardia

262
Q

X ray of respiratory distress syndrome

A

Ground glass appearance

263
Q

Retinopathy of prematurity

A

Abnormal development of blood vessels in the retina

Can lead to scarring, retinal detachment and blindness

264
Q

Exomphalos

A

Abdominal wall defect - intestines outside of the body covered in amniotic sac (amniotic membrane and peritoneum)

265
Q

Exomphalos management

A
  • caesarean if picked up antenatally
  • staged repair
266
Q

Gastroschisis

A

Congenital defect in the anterior abdominal wall lateral to the umbilicus

267
Q

Gastroschisis management

A

Newborns should go to theatre straight after delivery

268
Q

Diaphragmatic hernia

A

Concave shape of the abdomen, intestines/abdominal contents in the chest

269
Q

What is rickets

A

Defective bone mineralisation causing soft and deformed bones

270
Q

What causes rikcets?

A

Deficiency in either vitamin D or calcium

271
Q

Bone deformity in rickets

A
  • bowing of the legs
  • knock knees
  • craniotabes (soft skull)
  • ribs expand at the costochondral joints
272
Q

Symptoms of retinoblastoma

A
  • absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
  • strabismus
  • visual problems
273
Q

Prognosis of retinoblastoma

A

> 90% make it to adulthood

274
Q

What is the most common malignancy affecting children?

A

Acute lymphoblastic leukaemia

275
Q

Features of acute lymphoblastic leukaemia

A
  • anaemia: lethargy pallor
  • neutropenia: frequent or severe infections
  • thrombocytopenia: easy bruising, petechiae
  • bone pain
    -splenomegaly and hepatomegaly
  • fever
  • testicular swelling
276
Q

Benign rolandic epilepsy

A
  • between age 4 and 12
  • seizures characteristically at night
  • typically partial seizures
277
Q

EEG benign rolandic epilepsy

A

Centrotemporal spikes

278
Q

Hypogonadotrophic hypogonadism (Kallman’s syndrome) LH and testosterone

A

Low LH, low testosterone

279
Q

Primary hypogonadism (Klinefelter’s syndrome) LH and testosterone

A

high LH, low testosterone

280
Q

Androgen insensitivity syndrome LH and testosterone

A

High LH, normal/high testosterone

281
Q

Klinefelters karyotype

A

47 XXY

282
Q

What is duchenne muscular dystrophy?

A

X linked recessive disorder in dystrophin genes

283
Q

Features of duchenne muscular dystophy

A
  • progressive proximal muscle weakness from 5 years
  • calf pseudo hypertrophy
  • Gower’s sign: child uses arms to stand up from squatted position
  • 30% have intellectual impairment
284
Q

Gower’s sign

A

Child uses their arms to stand from squatted position

285
Q

association duchenne muscular dystrophy

A

Dilated cardiomyopathy

286
Q

prognosis duchenne muscular dystophy

A

Cannot walk by aged 12, typically survive to age 25-30

287
Q

Features of growing pains

A
  • never present at the start of the day
  • no limp
  • no limitation of physical activity
  • systemically well
  • normal physical development
  • meeting all physical milestones on time
  • symptoms intermittent and more common after vigorous activity
288
Q

immunisation at birth

A

BCG if at risk

289
Q

Immunisation at 2 months

A

6 in 1, oral rotavirus, MENb

290
Q

What is included in the 6 in 1 vaccine?

A
  • diptheria
  • tetanus
  • whooping cough
  • polio
  • Hib
  • hep B
291
Q

Immunisation at 3 months

A
  • 6 in 1
  • oral rotavirus
  • PCV (pneumococcal)
292
Q

Immunisation at 4 months

A
  • 6 in 1
  • men b
293
Q

Immunisation at 12/13 months

A
  • hib/men C
  • MMR
  • PCV
  • Men B
294
Q

Immunisation 3-4 years

A
  • MMR
  • 4 in 1 booster: diptheria, whooping cough, polio, tetanus
295
Q

Features of kawasaki disease

A
  • high grade fever lasting over 5 days, classically resistant to anti-pyretics
  • conjunctival injection
  • bright red, cracked lips
  • strawberry tongue
  • cervical lymphadenopathy
  • red palms of the hands and soles of the feet
296
Q

Management of kawasaki disease

A
  • high dose aspirin
  • intravenous immunoglobulin
297
Q

Complication of kawasaki diseae

A

Coronary artery aneurysm

298
Q

What are the causes of a nappy/napkin rash?

A
  • irritant dermatitis |(most common due to urine+ faeces, creases spared)
  • candida dermatitis (satellite lesions)
  • seborrhoeic dermatitis
  • psoriasis
  • atopic eczema
299
Q

Management of nappy rash

A
  • disposable nappy
  • expose napkin area to air when possible
  • apply barrier cream
  • mild steroid cream
  • candida- topical imidazole cream
300
Q

When does blood spot screening take place?

A

5-9 days

301
Q

What does the neonatal blood spot test check for?

A
  • congenital hypothyroidism
  • cystic fibrosis
  • sickle cell disease
  • phenylketonuria
  • medium chain acyl-CoA dehydrogenase deficiency (MCADD)
  • maple syrup urine disease (MSUD)
  • isovaleric acidaemia (IVA)
  • glutaric aciduria type 1 (GA1)
  • homocystinuria (pyridoxine unresponsive) (HCU)
302
Q

Newborn resuscitation

A
  • dry baby
  • assess tone, resp rate and heart rate
  • If gasping or not breathing give 5 rescue breaths
  • reassess
  • If heart rate not improving and less than 60 start compressions and ventilation breaths at a rate of 3:1
303
Q

What are the causes of obesity in children?

A
  • growth hormone deficiency
  • hypothyroidism
  • Down’s syndrome
  • Cushing’s syndrome
  • Prader-Willi syndrome
304
Q

What are the consequences of childhood obesity?

A
  • orthopaedic problems: slipped upper femoral epiphyses, Blount’s disease (a development abnormality of the tibia resulting in bowing of the legs), musculoskeletal pains
  • psychological consequences: poor self-esteem, bullying
  • sleep apnoea
  • benign intracranial hypertension
  • long-term consequences: increased incidence of type 2 diabetes mellitus, hypertension and ischaemic heart disease
305
Q

Precocious puberty small testes

A

Adrenal cause

306
Q

precocious puberty enlarged testicles

A

astrocytoma

307
Q

sex cord-gonadal stromal tumour

A

unilateral enlargement of the testis

308
Q

What makes up the agpar score?

A
  • respiratory effort
  • colour
  • tone
  • heart rate
  • reflex irritability
309
Q

When is the agpar score assessed?

A
  • 1 minute
  • 5 minutes
  • 10 minutes if low
310
Q

good score for Agpar

A

7-10

311
Q

What is the compression ratio for a child?

A

15:2

312
Q

Compression type in child

A

Lower half of the sternum

313
Q

Compression type in infant

A

two thumb encircling technique

314
Q

Age to smile

A

6 weeks, refer if no smile by 10 weeks

315
Q

Age to laugh

A

3 months

316
Q

What is the most common cause of stridor in a neonate

A

Laryngomalacia

317
Q

What is a wilms tumour?

A
  • nephroblastoma
  • renal malignancy in children
318
Q

Presentation of wilms tumour

A
  • abdominal mass
  • painless haematuria
  • flank pain
319
Q

Presentation of congenital cytomegalovirus

A
  • hearing loss
  • low birth weight
  • petechial rash
  • microcephaly
  • fever
320
Q

How should you check for complication of kawasaki disease?

A

Echocardiogram

321
Q

What is the most common cause of billious vomiting on the first day?

A

Intestinal atresia

322
Q
A

Finals (37 decks)

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