Paediatrics Flashcards
1
Q
What is the most common congenital heart defect?
A
Ventricular septal defect
2
Q
Lithium use during pregnancy can cause what cardiac congenital malformation?
A
Ebstein’s anomaly
3
Q
Where in the foetal heart is the foramen ovale located? What type of blood is passed through this foramen?
A
Between the right and left atrium; oxygenated
4
Q
Where in the foetal heart is the ductus arteriosus located? What type of blood passes through this duct?
A
Between the pulmonary artery and aorta; oxygenated
5
Q
The ductus arteriosus is kept open by what during foetal life?
A
Prostaglandins
6
Q
The ductus venosus is located where in the foetus? What type of blood is shunted here?
A
Between the umbilical vein and inferior vena cava; oxygenated
7
Q
Name the 2 cyanotic congenital heart defects
A
Transposition of the great arteries and Tetralogy of Fallot
8
Q
What type of shunt does ventricular septal defect and atrial septal defect cause?
A
Left to right
9
Q
Name the congenital heart malformation described:
Harsh pansystolic murmur heard best at the left lower sternal edge
A
VSD
10
Q
Name the congenital heart malformation described:
Ejection systolic murmur heard best at upper left sternal edge with radiation to the back
A
Atrial septal defect
11
Q
Name the congenital heart malformation described:
Continuous machine like murmur + collapsing pulse
A
Patent ductus arteriosus
12
Q
Name the congenital heart malformation described:
Ventricular septal defect + overriding aorta + right ventricular hypertrophy + right outflow tract obstruction
A
Tetralogy of Fallot
13
Q
How long after birth will transposition of the great arteries present compared to Tetralogy of Fallot?
A
TGA - first few hours
TOF - first 1-2 months
14
Q
Coarctation of the aorta is most commonly associated with what genetic syndrome?
A
Turner’s syndrome - 45X
15
Q
What cardiac malformation is most associated with Trisomy 21?
A
Atrio-ventricular septal defect
16
Q
Supravalvular aortic stenosis is most commonly associated with genetic syndrome?
A
Williams syndrome
17
Q
22q11 deletion (Di-George syndrome) is most associated with which congenital cardiac malformation?
A
Tetralogy of Fallot
18
Q
Eisenmenger’s syndrome can result from lack of treatment of what cardiac congenital malformations?
A
ASVD, VSD, ASD, PDA
(Anything that causes a left to right shunt initially)
19
Q
What type of shunt is seen in Eisenmenger’s syndrome?
A
Right to left
20
Q
Name the syndrome:
VSD + cyanosis + polycythaemia + syncope
A
Eisenmenger’s syndrome
21
Q
Name the presenting cardiac congenital malformation:
Prolonged crying + increasing cyanosis + knees to chest + poor feeding
A
Tetralogy of Fallot
(Tet spells)
22
Q
Which medication can be given to encourage closure of a patent ductus arteriosus?
A
Indomethacin, ibuprofen
(Prostaglandin inhibitors)
23
Q
Pulmonary hypertension and congestion is a feature of which cardiac congenital malformations?
A
Any that cause left to right shunt - ASVD, VSD, ASD, PDA
24
Q
Patients with transposition of the great vessels should be given what until surgery can be performed?
A
Prostaglandin infusion to keep ductus arteriosus open
25
Name the cardiac congenital malformation:
Weak femoral pulse + harsh systolic murmur at left sternal edge with radiation to the back
Coarctation of the aorta
26
Chronic coarctation of the aorta can lead to what clinical sign?
Radio-femoral delay
27
Congenital heart diseases can cause which metabolic disturbance on blood gas in neonates?
Metabolic acidosis
28
Name the murmur:
Ejection systolic heard at upper right sternal border + radiation to carotids
Aortic stenosis
29
Name the murmur:
Ejection systolic heard at upper left sternal border + radiation to the back
Pulmonary stenosis
30
Name the murmur:
Varies with posture + no thrill + asymptomatic
Innocent murmur
31
Noonan’s syndrome is most commonly associated with which heart murmur?
Pulmonary stenosis
32
Developmental dysplasia of the hip can be elicited with what tests?
Barlow’s or Ortolani’s
33
Name the orthopaedic complaint:
Easily dislocation of the hip + positive Ortolani’s test + breech presentation at birth
DDH
34
Name the orthopaedic complaint:
Limp + limited movement of hip joint + xray findings of sclerotic epiphysis
Perthes disease
35
Name the orthopaedic complaint:
Displacement of femoral head on neck + obese child + altered gait
Slipped upper femoral epiphysis
36
Spasticity in cerebral palsy can be managed by what medications?
Baclofen or diazepam
37
Significant talipes can increase the risk of what other orthopaedic complaint in children?
DDH
38
For how many hours a day should scoliosis braces be worn?
23-24 hours a day
39
Name the orthopaedic complaint:
Pain and limited movement of the hip + low grade fever + bilateral effusion on USS
Transient synovitis
40
Name the orthopaedic complaint:
Morning stiffness + fatigue + 3 joints affected
Pauciarticular juvenile idiopathic arthritis
41
Which type of JIA is most commonly associated with uveitis?
Pauciarticular
42
Which type of JIA is most commonly associated with constitutional symptoms?
Polyarticular RF-ve
43
Name the orthopaedic complaint:
Arthritis symptoms + salmon pink erythematous rash + high CRP and ESR
Systemic onset JIA
44
A child with JIA has poor response to intra-articular steroids. What treatment should be initiated?
DMARDs - methotrexate SC injection
45
Name the presentation:
Arthritis + red eyes + headache
Uveitis
46
Name the orthopaedic complaint:
Fever + joint swelling + elevated CRP and WCC
Septic arthritis
47
How should a child with septic arthritis be managed?
Immediate referral, IV antibiotics, joint aspiration
48
The nephron receives how much of cardiac output?
25%
49
What is the GFR in a neonate?
20-30ml/min/1.73m^2
50
Frothy urine indicates the presence of what?
Protein in the urine
51
Name the renal complaint:
Facial swelling + normal light microscopy + proteinuria +++
Minimal change disease
52
What is the gold standard for diagnosing minimal change disease?
24 hour urine protein collection
53
What treatment should be given to this child:
Facial swelling + preceding viral URTI + normal BP
8 weeks of prednisolone
54
Steroid resistance in minimal change disease would indicate a change in diagnosis to what?
Focal segmented glomerulosclerosis
55
What should this child be treated with:
Steroid resistant minimal change disease
Cyclophosphamide or ciclosporin
56
Name the renal complaint:
Hypertension + 2 day history of URTI + frank haematuria
IgA nephropathy
57
What type of vasculitis is associated with IgA nephropathy?
Henoch-Schonlein IgA small vessel vasculitis
58
Name the renal complaint:
Frank haematuria + hypertension + 1 week history of URTI
Post infectious glomerulonephritis
59
What increase in serum creatinine is seen in AKI level 1 in children?
Over to or equal to 1.5x
60
What happens to calcium and phosphate levels in AKI?
Calcium drops, phosphate rises
61
Which drugs should be held in AKI?
DAMN drugs:
Diuretics, ACE inhibitors, metformin, NSAIDs
62
Name the renal complaint:
Haemolytic anaemia + thrombocytopenia + AKI
Haemolytic uraemic syndrome
63
Name the renal complaint:
History of bloody diarrhoea + AKI
Haemolytic uraemic syndrome
64
Name the renal complaint:
Oliguria + hypertension + rising creatinine
AKI
65
What percentage of kidney function needs to be lost before GFR is impaired?
40%
66
What affect does kidney disease have on sodium and potassium levels?
Sodium decreases (hyponatraemia)
Potassium increases (hyperkalaemia)
67
In what age group should we not use urine dipstick testing in?
Under 2
68
How many colony forming units per millilitre of culture is diagnostic in UTI?
10^5
69
What is the gold standard for diagnosing vescico-ureteric reflux in children?
Micturating cysto-urethrogram
70
How many days should we administer antibiotics in children with lower tract UTI symptoms?
3 days
71
How many days should we administer antibiotics for in children with pyelonephritis/upper tract UTI?
7-10 days; oral if systemically well, IV if not
72
Which GI symptom may predispose children to UTI?
Constipation
73
What happens to phosphate levels in kidney disease?
Increases
74
Increased phosphate in kidney disease leads to the increase of what hormone? This can lead to damage to which part of the body?
PTH; damage to bones - metabolic bone disease
75
A child presenting with a groin swelling is most likely what?
Inguinal hernia
76
At what age should we urgently refer children with inguinal hernia?
Under 1 year old
77
Name the urological complaint:
Painless scrotal swelling which transilluminates
Hydrocele
78
Non retractile foreskin will require what treatment?
Circumcision
79
How many hours do we have to save testicles in testicular torsion?
6 hours
80
Name the urological complaint present:
Blue dot sign
Torsion appendix testis
81
Name the urological complaint:
Urethral meatus on ventral aspect of penis
Hypospadias
82
Nuchal thickening seen on USS is an indication for what test?
Amniocentesis
83
Foetal macrosomia can predispose to what foetal complication during labour?
Shoulder dystocia
84
What is important to carry out for neonates born to diabetics?
Feeding early
85
Acute chorioamnionitis can predispose to what condition later in life for the child if not treated successfully?
Cerebral palsy
86
Cocaine use can predispose to what placental disorder?
Placental abruption
87
Name the neurological complaint:
Hemicranial pain + vomiting + abdominal pain
Childhood migraine
88
What medication would we use for migraine prophylaxis in children without AND with asthma?
Without - propranolol
With - amitriptyline
89
Name the neurological complaint:
Band like headache + constant ache
Tension headache
90
What medication can we use for tension headache prophylaxis?
Amitriptyline
91
Up rolling of the eyes and blinking indicates what type of epileptic seizure?
Absence
92
Do GABA and glutamate levels increase or decrease during epileptic seizures?
GABA - decrease
Glutamate - increase
93
What medication would we use for generalised seizures in boys?
Sodium valproate
94
What medication would we use for generalised seizures in girls?
Levetiracetam
95
What medication would we use for focal seizures in children?
Carbamazepine
96
What diet may be implicated in drug refractory epilepsy?
Ketogenic
97
At what age is febrile convulsion most common?
3 months to 5 years
98
Name the neurological complaint:
X linked + proximal muscle weakness + Gowers sign positive
Duchenne Muscular Dystrophy
99
Gowers sign positive indicates what?
Pelvic girdle weakness
100
Which blood test parameter would be significantly elevated in Duchenne muscular dystrophy?
Creatinine kinase
101
Name the neurological complaint:
Distal muscle weakness + high arched foot
Charcot-Marie tooth disease
102
Which gene is implicated in Duchenne muscular dystrophy?
Dystrophin gene
103
Name the neurological complaint:
Headache worse on coughing + vomiting
Raised ICP headache
104
Which chromosome and gene is affected in cystic fibrosis?
Chromosome 7 CFTR gene
105
Meconium ileus in neonates is a sign of which disease?
Cystic fibrosis
106
Children with cystic fibrosis are vulnerable to deficiency’s in what vitamins?
Fat soluble vitamins - A, D, E, K
107
What is the gold standard for diagnosing cystic fibrosis?
Sweat testing
108
What level of chloride in sweat testing would be highly suggestive of a diagnosis of cystic fibrosis?
Over 60mm/l
109
Neonatal heel prick testing will show elevated levels of what in cystic fibrosis?
Immunoreactive trypsinogen
110
What is the most common infectious agent in cystic fibrosis exacerbations?
Pseudomonas aeruginosa
111
Name the complaint:
Red currant jelly stools + dying spells + abdominal colic
Intussusception
112
What is the first line treatment for intussusception?
Air enema
113
Name the complaint:
Fever + strawberry tongue
Scarlet fever
114
Otitis externa is associated with what sport?
Swimming
115
Acute otitis media can be complicated by what?
Mastoiditis
116
Name the complaint:
Chronic hearing loss + foul smelling discharge from ear
Cholesteatoma
117
Glue ear causes what type of hear loss?
Conductive
- bone conduction exceeds air conduction on Rinne’s, Weber’s lateralises to affected ear
118
Which antibiotic should be avoided in EBV and why?
Amoxicillin - can cause an itchy maculopapular rash
119
Name the complaint:
Coryzal symptoms + buccal mucosa spots + fever
Measles
120
What is the most common complication associated with measles?
Acute otitis media
121
Erythema infectiosum is caused by what virus?
Parvovirus B19
122
What treatment should be given to all children presenting with barking cough and stridor?
Oral dexamethasone 0.15mg/kg
123
What bacteria causes whooping cough?
Bordatella pertussis
124
Where is the vomiting centre in the brain located?
Medulla oblongata
125
Retching plus early morning vomiting is associated with what type of pathology?
Intracranial
126
Bilious vomiting is what until proven otherwise?
Intestinal obstruction
127
Vomiting will show what abnormality on ABG?
Hypokalaemia hypochloraemia metabolic alkalosis
128
Name the complaint:
Non bilious projectile vomiting after feeds + dehydration + hypokalaemic hypochloraemic metabolic alkalosis
Pyloric stenosis
129
What is the management for patients presenting with pyloric stenosis?
Fluid resus to correct ABG value followed by pyloromyotomy
130
Around what age should most cases of reflux resolve spontaneously?
6 months old
131
Sandifer syndrome is associated with what?
Gastro-oesophageal reflux
132
What pH in the oesophagus suggests significant reflux?
Below 4
133
What is the surgical procedure carried out in reflux?
Nissen’s fundoplication
134
Bloating, dumping syndrome and retching after surgery are all side effects of which surgical procedure?
Nissen’s fundoplication
135
Steatorrhoea is common in what respiratory condition?
Cystic fibrosis
136
Secretory diarrhoea is associated with what levels of sodium, potassium, chloride and pH?
All high
137
Osmotic diarrhoea is associated with what values of sodium, potassium, chloride, pH and osmolarity?
All low apart from osmolarity which is high
138
Gene HLADQ2/8 is associated with what disease?
Coeliac disease
139
Which serological tests should be carried out on suspicion of coeliac disease?
Anti-TTG + IgA
140
Which test should be carried out on suspicion of coeliac disease when anti-TTG is positive?
Anti-endomysial antibodies
141
What is the gold standard for diagnosing coeliac disease?
Duodenal biopsy
142
There is increased risk of what if coeliac disease goes untreated?
Small bowel lymphoma
143
What is the first line treatment for faecal disempaction in children?
Movicol
144
Megarectum can lead to what infectious complication?
Urinary tract infections
145
Name the complaint:
Growth failure + diarrhoea + oral ulcers
Crohn’s disease
146
Which medication is used to induce remission in Crohn’s?
Prednisolone
147
Which medication is used to maintain remission in Crohn’s?
Azathioprine or methotrexate
148
Which medication is used to induce remission in ulcerative colitis?
Mesalazine
149
Which medication is used to maintain remission in ulcerative colitis?
Prednisolone
150
Acute flares of Crohn’s and ulcerative colitis can be managed with what?
IV hydrocortisone
151
What are the first vaccines given at 2 months old?
6 in 1, rotavirus, men B, pneumococcal
152
When are the first, second and third doses of 6 in 1 given?
First - 2 months
Second - 3 months
Third - 4 months
153
When is the first dose of the pneumococcal vaccine given?
2 months
154
When is the second dose of the rotavirus vaccine given?
3 months
155
When is the second dose of the meningitis B vaccine given?
4 months
156
When is the first dose of the MMR vaccine given?
1 year old
157
When is the first dose of the meningitis C vaccine given?
1 year old
158
Which ONE of the 6 in 1 is given as a booster at 1 year old?
Haemophilus influenzae type B
159
When is the meningitis ACWY vaccine given?
14 years old
160
Which vaccine is given alongside the second dose of MMR at 3 years + 4 months old?
4 in 1 booster - diphtheria, tetanus, polio, whooping cough
161
When is the HPV vaccine given?
12-13 years
162
Which vaccine is contraindicated in immunosuppressed patients?
MMR
- due to being a live vaccine
163
At what age do we expect crawling?
9 months
164
At what age should we refer children if they are not walking?
18 months
165
What is the mean age that children begin to walk?
12 months
166
At what age do we expect the pincer grip?
9 months
167
At what age can children draw - a line, circle, square
Line - 2 years
Circle - 3 years
Square - 4 years
168
At what age do children begin building with bricks?
18 months
169
At what age would we expect children to laugh and vocalise?
4 months
170
Polysyllabic babble is typically present by what age?
6 months
171
At what age would we expect to see a social smile?
6 weeks
172
At what age do infants put food in their mouth?
6 months
173
At what age do children wave bye bye?
9 months
174
Isolated thrombocytopenia + recent viral illness + purpuric rash is indicative of what?
Immune thrombocytopenia purpura
175
Which 2 LFTs are raised in hepatocellular damage?
ALT & AST
176
Which 2 LFTs are raised in biliary disease?
ALP and GGT
177
Stercobilin is the faecal pigment version of what?
Bilirubin
178
Early infant jaundice occurs when?
Within first 24 hours of life
- ALWAYS PATHOLOGICAL
179
Which form of neonatal jaundice is always pathological?
Early infant jaundice
180
Late infant jaundice appears at what age?
2 weeks
181
What is the normal haemoglobin range for an infant?
180-200
182
Breast milk jaundice typically occurs at what age?
24 hours to 2 weeks
183
What type of jaundice is breast milk jaundice?
Unconjugated
184
Kernicterus occurs in what type of jaundice only?
Unconjugated
185
Kernicterus occurs as bilirubin crosses what?
The blood brain barrier
186
How can we prevent kernicterus from developing?
Phototherapy with 450nm wavelength
187
Neonatal hepatitis causes what type of jaundice?
Conjugated
188
What is the best investigation to show reversible airway obstruction in asthma?
Peak flow
189
An FeNO reading of over what is a positive test?
35ppb
190
After initiating very low dose ICS and SABA when needed in under 5s, what should be administered next if symptoms are still bothersome?
LTRA - montelukast
191
After initiating very low dose ICS and SABA when needed in over 5s, what should be administered next if symptoms are still bothersome?
LABA
192
Acute asthma is what type of hypersensitive reaction?
Type 1
193
A peak flow reading of under what percentage is indicative of a life threatening asthma attack?
33%
194
Oxygen saturations below what are indicative of a life threatening asthma attack?
92%
195
What 3 things should be administered on presentation of an acute asthma attack?
Oxygen + salbutamol + oral prednisolone
196
What sats should we aim for in children having an acute asthma attack?
94-98%
197
If initial management of an acute asthma attack does not relieve symptoms, what can we add?
Ipratropium bromide
198
If ipratropium bromide is not successful in alleviating symptoms in an acute asthma attack, what can we administer next?
Magnesium sulfate
199
Name the complaint:
Dilation of bronchi + purulent sputum + inspiratory creps
Bronchiectasis
200
Bronchiolitis typically presents at what age?
1-12 months
201
Bronchiolitis is most typically caused by what virus?
Respiratory syncytial virus
202
Management for bronchiolitis is mainly what?
Supportive
203
The CENTOR criteria is used to determine what?
If tonsillitis is bacterial
204
What is the first line treatment for bacterial tonsillitis?
Penicillin V
- clarithromycin or erythromycin if penicillin allergic
205
Bacterial tracheitis presents the same as what other infection, but with the addition of what?
Presents the same as croup with the addition of a high fever
206
Glandular fever is most commonly caused by what?
EBV
207
Why should we advise glandular fever patients to avoid contact sports or heavy lifting?
Minimise risk of splenic rupture
208
It is important not to administer which antibiotic in glandular fever?
Amoxicillin
- causes a rash
209
Whooping cough is caused by which bacteria?
Bordetella pertussis
210
Name the complaint:
Spasmodic cough followed by inspiratory whoop + post cough vomiting
Whooping cough/pertussis
211
How do we manage whooping cough?
Macrolide antibiotics
- azithromycin, clarithromycin, erythromycin
212
Epiglottitis is caused by what?
Haemophilus B
213
Name the complaint:
Soft inspiratory stridor + drooling + high fever
Epiglottitis
214
Which antibiotic is most commonly used for epiglottitis?
Ceftriaxone
215
Which mediation can be prescribed to alleviate muscle spasticity in cerebral palsy?
Baclofen
216
Early onset neonatal sepsis is most commonly caused by what organism?
Group B strep
217
Is group B strep gram negative or positive?
Positive
218
Brudzinski’s and Kernig’s sign can be elicited in presentation of what disease?
Meningitis
219
What is the most common cause of meningitis in children?
Viral
220
High protein + low glucose on lumbar puncture is indicative of what type of meningitis?
Bacterial
221
High lymphocytes + normal glucose on lumbar puncture is indicative of what type of meningitis?
Viral
- high neutrophils not lymphocytes on bacterial
222
Gram positive and negative bacteria are treated by what antibiotic in paediatric meningitis?
IV ceftriaxone
223
Listeria meningitis is treated via which 2 antibiotics?
Amoxicillin + gentamicin
224
Group B strep meningitis is treated by which 2 antibiotics?
IV benzylpenicillin + gentamicin
225
Staph scalded skin syndrome can be managed by what antibiotic?
IV flucloxacillin
226
Scarlet fever is managed by what antibiotic?
Penicillin V (phenoxymethylpenicillin)
227
What equation can we use to calculate an child’s approximate weight?
2 x (age in years + 4)
228
What equation can we use to approximately calculate a child’s systolic BP?
80 + (age in years x 2)
229
What dose of adrenaline should be administered to a 4 year old child experiencing anaphylaxis?
150mcg
230
What dose of adrenaline should be given to an 8 year old child experiencing anaphylaxis?
300mcg
231
What dose of adrenaline should be given to a 14 year old child experiencing anaphylaxis?
500mcg
232
PPROM is associated with neonatal infection with what?
Group B strep
233
Transient synovitis usually follows what?
Viral infection
234
SIDS can occur up to what age?
1 year
235
What is the most common age for SIDS to occur?
10-20 weeks
236
What is the most common causation of SIDS?
Unknown
237
Cleft palate and polydactyly are associated with which Trisomy?
Patau syndrome - trisomy 13
238
Elevated calcium is associated with which genetic condition?
Williams syndrome
239
Fragile X is due to what abnormality at genetic level?
Trinucleotide repeat
240
Constant insatiable hunger is associated with what genetic condition?
Prader-Willi syndrome
241
Long fingers and thumbs are associated with what genetic condition?
Marfan syndrome
242
47-XXY is the genetic component of what syndrome?
Klinefelter’s
243
Unusual fascination with water is associated with what syndrome?
Angelman syndrome
244
Children have a circulating blood volume of how many ml per kg?
70-80
245
On finding a child unresponsive, what it the first most important thing to administer?
5 rescue breaths
246
What is the correct compression to rescue breath ratio in children?
15:2
247
What rate should CPR be delivered in children in bpm?
100-120
248
Which pulse should be felt for for signs of life in under 1s and over 1s?
Under 1s - brachial or femoral
Over 1s - carotid
249
Where is the ductus venosus found?
Between umbilical vein and IVC
250
Which vessel delivers oxygenated blood to the foetus?
Umbilical vein
251
Newborn babies produce heat via what?
Brown fat lipolysis
252
Irregular breathing in neonates can be managed by administering what?
Caffeine
