Paediatrics Flashcards
Give 4 clinical signs of bronchiolitis
Coryzal symptoms preceding:
Dyspnoea with feeding difficulties
Auscultation findings include widespread harsh breath sounds, wheezes and fine inspiratory crackles
Mild fever (under 39ºC)
Commonest cause of bronchiolitis
respiratory syncytial virus
Investigation for bronchiolitis
Immunofluorescence of nasopharyngeal secretions may show RSV
NICE immediate referral criteria for bronchiolitis
Apnoea
Child looks seriously unwell to a healthcare professional
Severe respiratory distress (grunting, marked chest recession, RR >70)
Central cyanosis
Hypoxia <92% on air
Except for difficulty breathing, what other symptoms are associated with croup?
Barking cough, worse at night
Hoarseness
Stridor (laryngeal oedema + secretions) - DO NOT EXAMINE THROAT
Fever
Corzyal symptoms
Other than croup, give 2 other causes of developing stridor in a 4 year old
Epiglottis
Foreign body
Anaphylaxis
Name the virus most commonly responsible for causing croup
Parainfluenza virus
Treatment prescribed for croup
Single dose of dexamethasone regardless of severity
Emergency:
High flow O2
Nebulised adrenaline
Name the most likely finding upon palpation of the abdomen in pyloric stenosis and where in the
abdomen you would expect to find it?
Olive-shaped mass in the RUQ
What acid-base disturbance would you expect to find in pyloric stenosis?
hypochloraemic, hypokalaemic metabolic alkalosis - from vomiting
Name the four sections of the stomach
cardia
fundus
pylorus
body
Typical SUFE patient
obese boy aged 10-15
What cartilage makes up the epiphyseal plate?
Hyaline cartilage
SUFE 3 features
Hip, groin, medial thigh or knee pain
Loss of internal rotation of the leg in flexion
Bilateral in 20%
Name 3 differential diagnoses for hip pain in a child
SUFE
Perthes
Acute transient synovitis
Septic arthritis
Give 2 causes of jaundice within the first 24 hours of life
JAUNDICE IN THE FIRST 24H IS ALWAYS PATHOLOGICAL
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD
Most common cause of jaundice 2-14 days
Physiological (more RBC, fragile RBC, less developed liver) - more common in breastfed babies
Give 2 investigations (other than bilirubin) for jaundice in first 24h
Rhesus status
ultrasound?
Pale stools and raised conjugated bilirubin
Cause of prolonged jaundice in a baby?
Obstructive picture: biliary atresia
What complication may occur if raised levels of unconjugated bilirubin remain untreated?
Kernicterus
Give 1 methods of treating neonatal jaundice?
Phototherapy
What prenatal investigation can be used to detect congenital heart diseases?
Echocardiography
In which direction is blood flowing in the heart in acyanotic congenital heart disease?
Left to right
Give 2 causes of acyanotic congenital heart disease
Ventricular septal defect
Atrial septal defect
In which direction is blood flowing in cyanotic heart disease?
Right to left
Give 2 causes of cyanotic congenital heart disease?
Tetralogy of fallot
Transposition of the great arteries
In decompensated congenital heart disease, give 2 clinical features
Poor feeding
Tachycardia
Cold peripheries
Hepatomegaly
Engorged neck veins
What is Eisenmenger’s syndrome?
Left to right shunt causes pulmonary hypertension which leads to shunt reversal (acyanotic to cyanotic)
Apart from prematurity, give 2 risk factors for IRDS
Maternal diabetes
C-section
What substance is deficient in the lungs of premature babies (<32w), giving rise to IRDS?
Surfactant produced by mature alveoli
Lack of it leads to high surface tension within alveoli which leads to lung collapse
What prenatal medication can be given to mothers with suspected preterm labour to prevent respiratory distress syndrome?
Dexamethasone
Increases production of surfactant
Give 2 signs of IRDS
Tachypnoea
Cyanosis
Inspiratory recession
Grunting
Nasal flaring
What is seen on a chest X-ray in a baby with IRDS?
Ground glass appearance
In what age range do febrile convulsions typically occur?
6 months to 5 years
Give 2 features that mean febrile seizures are classified as complex febrile convulsions
15 to 30 minutes
Repeated seizures within 24 hours
Focal seizure
Give 3 investigations in febrile convulsions
FBC
Blood culture
U&E
Glucose
Throat swab
Give 1 pieces of information to give to parents prior to child being discharged after febrile seizure
Advise to phone for an ambulance if seizure lasts >5 minutes
Medication for recurrent febrile convulsions
Benzodiazepine rescue medication
Define cerebral palsy
Disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain
Give 2 of the subtypes of cerebral palsy, using the classification system based on movement disorder
Spastic (70%) - increased muscle tone due to UMN lesion
Dyskinetic - basal ganglia and substania nigra cause athetoid movements
Ataxic - damage to cerebellum
Mixed
Apart from motor complications, give 2 other clinical features that a child with cerebral palsy may have
Learning difficulties
Epilepsy
Squint
Hearing impairment
Give 3 a cause of cerebral palsy from each category
a) antenatal
b) intrapartum
c) postnatal
a) Congenital infection e.g. rubella
b) Birth asphyxia
c) Meningitis
Name 2 medications a child with cerebral palsy may be prescribed to help with muscle spasm
Diazepam
Baclofen
In which gender are intussusceptions more common
Male
Describe the pathogenesis of intussusception
Invagination of one portion of the bowel into the lumen of the adjacent bowel, usually the ileo-caecal region
Investigation of choice for intusseception and sign seen
Ultrasound
Target-like mass
1st line treatment for intussuception
Air insufflation under radiological control
What are 2 indications for laparotomy in intussuception
Failed air insufflation
Signs of peritonitis
3 month old baby with episodes in which he becomes irritable, struggles with his
breathing, and his lips turn blue - name?
Tet spells
*Tetralogy of fallot
Anatomical abnormalities that occur in Tetralogy of Fallot
Pulmonary stenosis
RVH
VSD
Overriding aorta
Investigations to identify cause in suspected NAI
FBC
Coagulation screen
LFTs
Cranial CT
Skeletal survey
Cranial ultrasound
3 professionals outside of hospital involved in NAI
Social workers
Health visitors
GP
Police
2 clinical signs of infectious mono
Splenomegaly
Petechial haemorrhages of soft palate
White exudate covering tonsils
Lymphadenopathy
Hepatosplenomegaly
Fever
2 complications of infectious mono
Chronic fatigue syndrome
Splenic rupture
GBS
Encephalitis
Meningitis
Name 2 notifiable diseases
Acute meningitis
Botulism
COVID-19
Diptheria
Enteric fever
Pyloric stenosis pathophysiology
Hypertrophy of the pylorus prevents food travelling from the stomach into the
duodenum as normal
After feeding, there is powerful peristalsis against the narrow pylorus causing food to
be ejected into the oesophagus leading to projectile vomiting
Investigation of choice pyloric stenosis
Abdo ultrasound
Definitive management pyloric stenosis
Laparoscopic pyloromyotomy (Ramstedt’s)
2 of the 6 in 1 vaccine components
Diphtheria
Hep B
Whooping cough
Tetanus
Polio
H. influenzae B
8 week vaccinations
6 in 1
Rotavirus
Men B
When is jaundice pathological
first 24h of life
3 examples of prolonged jaundice
Biliary atresia
Hypothyroidism
Breast milk jaundice
What is the serious complication of untreated neonatal jaundice that parents should be warned about?
Kernicterus
Which special tests in the NIPE can detect signs of hip pathology?
Follow up imaging?
Ortolani and Barlow tests
Ultrasound
What condition are ortolani/barlow/US looking for
Developmental dysplasia of the hip
Name 2 criteria of Wilson and Junger screening test criteria
Important
Cost-effective
Simple and safe screening test
Acceptable to population
Agreed diagnostic investigation for positive test results
Epididymo-orchitis presentation
gradual onset, over minutes to hours, with unilateral:
Testicular pain
Dragging or heavy sensation
Swelling of testicle and epididymis
Tenderness on palpation, particularly over epididymis
Urethral discharge (should make you think of chlamydia or gonorrhoea)
Systemic symptoms such as fever and potentially sepsis
Examination findings in testicular torsion
Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position
Explain why trismus occurs in quinsy
The inflammation and swelling associated with the abscess can cause pain and spasm of the muscles involved in opening the mouth (masticator muscles)
Lymph node enlarged in quinsy
Jugulodigastric lymph node
What test on an ABG could help decide the urgency of treatment for pneumonia
Lactate
2 management options for bronchiolitis
Oxygen
NG feeding
Investigation for SUFE
AP and lateral (typically frog-leg) views are diagnostic
Management of SUFE
Internal fixation (single cannulated screw in centre of epiphysis)
4 complications of SUFE
Osteoarthritis
Avascular necrosis of the femoral head
Chrondrolysis
Leg length discrepancy
