Paediatrics Flashcards
What method of chest compressions is correct to use in infants?
Two-thumb circling technique
What are the most common clinical signs associated with neonatal sepsis?
Grunting and other signs of respiratory distress
At what age would the average child acquire the ability to sit without support?
6-8 months
What are the clinical signs of pyloric stenosis?
Projectile vomiting after every feed in a young baby
What investigation is diagnostic for pyloric stenosis?
Abdominal ultrasound
What is the most likely cause of ambiguous genitalia in a newborn?
Congenital adrenal hyperplasia
Describe the clinical features of idiopathic thrmbocytopenic purpura
Petechial rash in an otherwise well child
When might a bone marrow biopsy be indicated in a child presenting with idiopathic immune thrombocytopenia?
If the child is presenting with atypical signs e.g. splenomegaly, bone pain, diffuse lymphadenopathy - may suggest an underlying myoproliferative malignancy
A mother comes to surgery with her 6-year-old son. During the MMR scare she decided not to have her son immunised. However, due to a recent measles outbreak she asks if he can still receive the MMR vaccine. What is the most appropriate action?
Give MMR with repeat dose in 3 months
Describe the clinical presentation of epiglottitis
- Abrupt onset and rapid progression (within hours) of dysphagia, drooling, and distress
- Patients frequently adopt the ‘tripod’ position to maximise airway opening - patient leaning forward and extending their neck when seated
When reviewing a child with suspected bronchiolitis, what features would make you consider another diagnosis?
According to NICE, you should consider pneumonia if the child has a high fever (over 39°C) and/or persistently focal crackles
A 12-year-old female presents to her GP with bilateral knee pain, swelling and stiffness. On examination, a salmon-pink rash is noted on the legs.
What is the most likely diagnosis?
Juvanile idiopathic arthritis
What are some of the risk factors for neonatal sepsis?
- GBS infection - mother with prev. baby with GBS, colonisation identified on screening, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
- Premature (>37 weeks)
- Low birth weight (<2.5kg)
- Evidence of maternal chorioamnionitis
Name 4 common causes of constipation in children
- Dehydration
- Anal fissure
- Hirschsprung’s disease
- Hypercalcaemia
What is the most appropriate management plan for a child with suspected whooping cough?
Prescribe azithromycin and report to Public Health (notifiable disease)
When can a child with rubella return to school?
5 days from onset of rash
When can a child with scarlet fever return to school?
24 hours after commencing antibiotics
When can a child with hand, foot and mouth return to school?
No exclusion required
What feature of tetralogy of falloy determines severity?
Degree of pulmonary stenosis (right ventricular outflow obstruction)
What is the peak incidence of bronchiolitis?
3-6 months of age
What is the rate of compressions to breaths in paediatric life support?
15:2
Describe the clinical features of Turner’s syndrome
- Short stature
- Shield chest, widely spaced nipples
- Webbed neck
- Bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
- Primary amenorrhoea
- Lymphoedema in neonates (especially feet)
- Gonadotrophin levels will be elevated
Name the cardiac murmur associated with Turner’s syndrome
Ejection systolic due to bicuspod aortic valve
What is the investigation of choice to look for renal scarring in a child with vesicoureteric reflux?
Radionuclide scan using dimercaptosuccinic acid (DMSA)
Describe the clinical features of chickenpox
- Fever initially
- Itchy, rash starting on head/trunk before spreading - initially macular then papular then vesicular
- Systemic upset is usually mild
Describe the clinical features of measles
- Prodrome: irritable, conjunctivitis, fever
- Koplik spots: white spots (‘grain of salt’) on buccal mucosa
- Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Describe the clinical features of mumps
- Fever, malaise, muscular pain
- Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Describe the clinical features of rubella
- Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
- Lymphadenopathy: suboccipital and postauricular
Describe the clinical features of erythema infectiosum
- Also known as fifth disease or ‘slapped-cheek syndrome’
- Caused by parvovirus B19
- Lethargy, fever, headache
- ‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Describe the clinical features of Scarlet fever
- Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
- Fever, malaise, tonsillitis
- ‘Strawberry’ tongue
- Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Describe the clinical features of hand, foot and mouth disease
- Caused by the coxsackie A16 virus
- Mild systemic upset: sore throat, fever
- Vesicles in the mouth and on the palms and soles of the feet
Name one condition that children with VSD are at increased risk of
Endocarditis
What are the features of a life-threatening asthma attack?
- SpO2 <92%
- PEF <33% best or predicted
- Silent chest
- Poor respiratory effort
- Agitation
- Altered consciousness
- Cyanosis
When should you immediately refer a child with bronchiolitis for observation and oxygen therapy?
- Apnoea (observed or reported)
- Persistent oxygen saturation of <92% in air
- Inadequate oral fluid intake (<50% of normal fluid intake)
- Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
What features make up the triad of ‘shaken baby syndrome’?
Retinal haemorrhages, subdural haematoma and encephalopathy
Describe the clinical features of an umbilical granuloma
- Consist of cherry red lesions surrounding the umbilicus, they may bleed on contact and be a site of seropurulent discharge
- Infection is unusual and they will often respond favourably to chemical cautery with topically applied silver nitrate
In cases of patients with recurrent febrile seizures, what may be prescribed to be administered during febrile episodes to abort or reduce the duration of seizures?
Benzodiazepine rescue medication for recurrent febrile seizures (rectal diazepam or buccal midazolam)
What is the most common complication of measles?
Otitis media
What immunisations are given at birth?
BCG if risk factors
What immunisations are given at 2 months?
- ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
- Oral rotavirus vaccine
- Men B
What vaccinations are givenat 3 months?
- ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
- Oral rotavirus vaccine
- PCV
What vaccinations are given at 4 months?
- ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
- Men B
What vaccinations are given at 12-13 months?
- Hib/Men C
- MMR
- PCV
- Men B
What vaccinations are given between 2-8 years?
Flu vaccine (annual)
What vaccinations are given between 3-4 years?
- 4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
- MMR
What vaccination is given 12-13 years?
HPV vaccination
What vaccinations are given 13-18 years?
- ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
- Men ACWY
What is a common complication of chickenpox?
Secondary bacterial infection of the lesion:
- Risk may be increased by NSAIDs
- Commonly manifests as a single infected lesion or small area of cellulitis, but in small number of patients invasive group A strep soft tissue infections may occur resulting in necrotizing fasciitis
What is the term used to describe the mode of inheritance for Prader-Willi syndrome?
Imprinting - phenotype depends on whether the deletion occurs on a gene inherited from the mother or father
What is the most common cause of death associated with measles?
Pneumonia
What age should a child be able to crawl?
9 months
What age should a child be able to walk unsupported? At what age would you refer a child who was unable to do this?
- Should be able to walk unsupported 13-15 months
- Should refer at 18 months
When should a child be able to hold objects in palmar grasp?
6 months
When should a child be able to point with their finger?
9 months
At what time of year is croup the most common?
Autumn months
What is a CF-specific contraindication to lung transplantation?
Chronic infection with Burkholderia cepacia
What results from a blood gas
are associated with pyloric stenosis?
Hypochloraemic, hypokalaemic alkalosis
Why is ibuprofen not recommended in chickenpox?
NSAIDs can increase the necrotising fasciitis
What is the first line management for viral-induced wheeze (episodic viral wheeze)?
Oral montelukast or inhaled corticosteroid
How is Duchenne muscular dystrophy usually diagnosed?
Genetic analysis (rather than muscle biopsy)
At what ages is the oral rotavirus vaccine given?
2 months + 3 months
What are the red flags regarding colour for the NICE paediatric system?
- Pale/mottled/ashen/blue
What are the red flags regarding activity for the NICE paediatric system?
- No response to social cues
- Appears ill to a healthcare professional
- Does not wake or if roused does not stay awake
- Weak, high-pitched or continuous cry
What are the respiratory red flags for the NICE paediatric system?
- Grunting
- Tachypnoea: respiratory rate >60 breaths/minute
- Moderate or severe chest indrawing
What are the red flags regarding hydration for the NICE paediatric system?
Reduced skin turgor
Under what age is a fever >=38°C a red flag in paeds?
< 3 months
What is the first line investigation for development dyplasia of the hip in children > 4.5 months?
X-ray
What is the most common cause of respiratory distress in the newborn? What causes this?
- Transient tachypnoea of the newborn - caused by delayed resorption of fluid in the lungs
- More common in caesarean sections
Describe the management of transient tachpnoea of the newborn
Observation and supportive care +/- oxygen
What is the cutoff for height centile which warrants a paediatric referral?
Children below 0.4th centile for height
What is a cephalhaematoma?
Swelling on the newborns head due to bleeding between the periosteum and the skull
Describe the clinical features of a cephalohaematoma
- Typically develops several hours after birth
- Most commonly in the parietal region, doesn’t cross suture lines
- May take months to resolve
What is caput succedaneum?
An extraperiosteal collection of blood present on the head of a newborn
Describe the clinical features of caput succedaneum
- Present at birth
- Typically forms over the vertex and crosses over the suture lines
- Resolves within days
Describe the clinical features of Kawasaki disease
- High fever lasting >5 days
- Red palms with desquamation
- Strawberry tongue
Describe the clinical features of roseola infantum
- Characteristic 3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever
- The fever is typically rapid onset and can often predispose to febrile convulsions
- The rash typically starts on the trunk and limbs
- HHV6 is neurotropic (attacks the nervous system) and thus a rare complication is encephalitis and febrile fits (after cessation of the fever)
Name the organism which causes roseola infantum
Human herpes virus 6
Describe the clinical features of fragile X syndrome in males
- Learning difficulties
- Large low set ears, long thin face, high arched palate
- Macroorchidism
- Hypotonia
- Autism is more common
- Mitral valve prolapse
- Macrocephaly
A child with a UTI at what age warants an immediate paediatric referral?
> 3 months
What is the difference between oligoarticular and systemic-onset juvenile idiopathic arthritis?
- Oligoarticular JIA is the most common presentation and is characterised by pain and stiffness in up to 4 (usually larger) joints, with fever and fatigue
- Other associated symptoms include rash, fever, dry or gritty eyes
- Systemic-onset juvenile idiopathic arthritis is a subset of JIA that requires the onset of joint symptoms accompanied by regular and intermittent fevers for diagnosis
What are the Kocher criteria for the diagnosis of septic arthritis?
- Fever >38.5 ℃
- Non-weight bearing
- Raised ESR (> 40 mm/hr)
- Raised WCC (> 12 10^9/L)
Each parameter is worth 1 point; estimates probability of septic arthritis (0 = very low risk, 4 = 99% probability)
At what age would the average child start to play alongside, but not interacting with, other children?
2 years
A 14-month-old girl is diagnosed as having roseola infantum. What is the most common complication of this disease?
Febrile convulsions
At what ages is the routine Men B vaccine given?
2, 4 and 12-13 months
A baby is born at term via vaginal delivery with no complications, however he is still not showing signs of breathing at one minute. Heart rate is >100bpm, but he is floppy and cyanosed. What is the most appropriate next step in management?
5 breaths of air via face mask
The mother of a 6-week-old baby girl born at 32 weeks gestation asks for advice about immunisation. What should happen regarding the first set of vaccines?
Give as per normal timetable
What is the usual management for bronchiolitis?
Supportive management only (ensuring to discharge with safety netting)
If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance, what method of feeding should be tried?
Extensive hydrolysed formula
If fails - amino acid-based formula
If a formula-fed baby is suspected of having severe (e.g. failure to thrive) cow’s milk protein intolerance, what method of feeding should be tried?
Amino acid-based formula (+ referral to paediatrician)
At what age would a child be expected to ask ‘what’ and ‘who’ questions?
3 years
At what age would a child be expected to combine two words?
2 years
At what age would a child be able to ask ‘why’, ‘when’ and ‘how’ questions?
4 years
Name 2 cardiac conditions associated with Turner’s syndrome
- Coarctation of the aorta
- Bicuspid aortic valve
When should you consider referring a child with bronchiolitis to hospital?
- A respiratory rate of over 60 breaths/minute
- Difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
- Clinical dehydration
What is the investigation of choice for stable children with suspected Meckel’s diverticulum?
Technetium scan
Describe the clinical features of Patau syndrome
- Microcephalic, small eyes
- Cleft lip/palate
- Polydactyly
- Scalp lesions
Describe the clinical features of Edward’s syndrome
- Micrognathia
- Low-set ears
- Rocker bottom feet
- Overlapping of fingers
Describe the clinical features of Noonan syndrome
- Webbed neck
- Pectus excavatum
- Short stature
- Pulmonary stenosis
Describe the clinical features of Pierre-Robin syndrome
- Micrognathia
- Posterior displacement of the tongue (may result in upper airway obstruction)
- Cleft palate
Describe the clinical features of William’s syndrome
- Short stature
- Learning difficulties
- Friendly, extrovert personality
- Elfin facies
- Transient neonatal hypercalcaemia
- Supravalvular aortic stenosis
Describe the clinical features of Prader-Willi syndrome
- Hypotonia
- Hypogonadism
- Obesity