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Paediatrics Flashcards

1
Q

What is involved in newborn life support?

A

DAFT MC 3:1

Dry the baby
Assess tone, breathing and heart rate
Five inflation breaths
Tilt head

Monitoring
Chest compressions 3:1

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2
Q

What is the APGAR score?

A

Appearance
Pulse
Grimace
Activity
Resp rate

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3
Q

What is the newborn life support algorithm?

A
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4
Q

What is correct for the newborn life support in terms of chest compressions to breaths?

A

3:1

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5
Q

How many inflation breaths are given?

A

5 breaths

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6
Q

What is the basic life support for children?

A
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7
Q

Where can IO access be achieved?

A

1-2cm medial and 1-2cm distal from tibial tuberosity

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8
Q

How is weight calculated for a child?

A

Age + 4 x 2

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9
Q

What is considered with anaphylaxis?

A

Doses
Refractory - not responsive to two
Biphasic
Tryptases
Autoinjector

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10
Q

Where should a baby be placed when being checked?

A

Resuscitaire

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11
Q

When is the only indication for checking the oropharynx?

A

If the baby is covered in a thick meconium which may cause an aspiration

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12
Q

What is the use of therapeutic cooling?

A

For patients at risk of hypoxic induced encephalopathy cooling may be done within 6 hours of birth

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13
Q

What is a normal HR in children?

A

Separate
<1
1-2
2-5
5-12
>12

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14
Q

What does a septic screen involve in a child <3 months old?

A

Urine, FBCs, blood cultures, stool culture, NPA, and LP septic screen

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15
Q

What is the main concern and worry for a child with fever?

A

Dehydration
Ensure the parents are giving plenty of fluids
Oral antibiotics if no known source of infection
Anti-pyretics if needed

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16
Q

How should children with amber on the traffic light system be managed?

A

Perform a septic screen, FBC, CRP, blood cultures, urine and LP if <1 year

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17
Q

How should children with red features be treated?

A

Life threatening and requires urgent treatment.
Urine, FBC, CRP, blood culture, LP, CXR, blood gas, U and E’s, NPA, throat swab
Fluid 20ml/kg
3rd generation cephalosporin
Ceftriaxone or cefotaxime
If >3 months you can give steroids
>5 days assess for Kawasaki disease
Safety netting

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18
Q

T or F, it is not possible to age a bruise based on physical appearance?

A

T

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19
Q

What are some signs of child abuse with burns?

A

Contact burns not on the hands or feet

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20
Q

What are some examples of physical abuse in children?

A

Oral injuries such as a torn frenulum
bruising on face, buttocks, abdomen, ears, hands and arm

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21
Q

What needs to be checked with physical abuse?

A

Retinal haemorrhages
skeletal survey
subdural haematomas

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22
Q

What are some differentials for NAI?

A

OI, ITP, leukemia, HSP, coagulation disorder, congenital dermal melanocytosis

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23
Q

How should suspected child abuse be managed?

A

A senior community paediatrician
Document appropriately

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24
Q

What are the guidelines for CSA?

A

Inform social services.
Sexual activity is illegal <13 years
Foreign bodies or sexual injuries
Forensic investigation must be done within 7 days from vaginal intercourse
Vaginal discharge or vulvovaginitis should be indicative

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25
Q

What is triple therapy for encephalitis?

A

Ceftriaxone, clarithromycin and aciclovir

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26
Q

What are some signs of meningitis?

A

Fever, lethargy, irritability, headache, myalgia,
Meningeal signs - photophobia, neck stiffness, Kernings sign, Brudinski’s sign, opisthotonus

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27
Q

What is opisthotonus?

A

Opisthotonus or opisthotonos is a state of severe hyperextension and spasticity in which an individual’s head,

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28
Q

What are the contraindications to LP?

A
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29
Q

How should meningitis be treated?

A

Benzylpenicillin in a pre hospital setting
Give IV cefotaxime if <3 months
Give IV ceftriaxone if >3 months
Give dexamethasone is >3 months and not meningiococcal
Mannitol if raised ICP and avoid LP if raised ICP
Treat cryptoccus if HIV positive

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30
Q

What does Cushing’s triad a sign of?

A

Suggests coning

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31
Q

What are some signs of raised ICP?

A
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32
Q

What are some late signs of menigitis?

A

Bulging fontanelles

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33
Q

What are the features of measles?

A

SSPE
ADEM
Morbiliform rash
and
5C’s
Koplik spots, conjunctivitis, coryza, cranky, cough

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34
Q

What are the features of mumps, measles and rubella?

A

Mumps - MOP - myocarditis, orchitis, pancreatitis + 5 c’s
Measles - SAM - SSPE, ADEM, morbiliform rash
Rubella - DICE - Deadness, intraarticular, cardiac, eyes

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35
Q

What causes hand foot and mouth?
What causes roseola infantum?

A

Coxsackie A16
HHV6

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36
Q

What are some features of roseola infantum?

A

Nagayama spots
Exanthem subitum, fourth disease
3-5 days fever

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37
Q

How is chickenpox managed?

A

Calamine lotion
No NSAIDs
Associated with VZV and with group A strep cellulitis, leads to necrotising fascitis

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38
Q

How should neonates be managed with HIV?

A

PEP for 4 weeks starting <4h from birth: zidovudine monotherapy and co-trimoxole pcp treatment

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39
Q

What is 90-90-90 by 20?

A

A goal set up for 90% of people to know their status, 90% treatment and 90% U=U

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40
Q

What are some differentials for stridor?

A

Laryngomalacia
Bacterial tracheitis
Croup
Foreign body

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41
Q

What is the scoring system used for croup?

A
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42
Q

What are the treatments for croup?

A

Dexamethasone and nebulised adrenaline

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43
Q

Compare croup, tracheitis and epiglossitis

A
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44
Q

How is epiglossitis managed?

A

Call the anaethetist
Ceftriaxone IV

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45
Q

What are the URTI infections in children?

A

Tonsilitis
Acute epiglossitis
Bacterial tracheitis
Croup

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46
Q

What are the LRTI in children?

A

Pneumonia
Bronchiolitis
Whooping cough

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47
Q

How is bronchiolitis managed?

A

Pavlizumab
Oxygen therapy
Bronchodilators

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48
Q

How is whooping cough managed?

A

Clarithromycin

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49
Q

What is the treatment for children with asthma?

A

Inhalers and spacer

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50
Q

What is needed for asthma discharge?

A

5 rules
1. Watch - 3-4 hours with good control
2. Peak flow - 75% or more of predicted
3. Tick - good inhaler use
4. Management plan
5. Appointments with GP 2 days later

Give 5 days prednisolone

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51
Q

What is the classification of asthma?

A

Moderate - 50-70%, increasing symptoms
Severe - cant complete sentences, 110, 25
Life threatneing - <92%, <33%, CHEST symptoms

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52
Q

What does CHEST stand for?

A

Cyanosis
Hypotension
Exhaustion
Silent chest
Tiring

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53
Q

What is seen on spirometry tested?

A

<70% fev1/fvc
>12% bronchodilator therapy

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54
Q

What should be asked about asthma?

A

Night symptoms.
Inhaler use > 3 times a week
Hospital
Admissions

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55
Q

What are the treatments for asthma?

A

SABA
SABA + ICS
SABA + ICS + monteleukast OR LABA
MART
Referral

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56
Q

How is meconium ileus treated?

A

Stabilise with NG tube and use hyperosmolar enemas

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57
Q

What are some complications of CF?

A

Bronchiectasis
Infections
Pancreatic insufficiency
Malabsorption
Faltering growth
Distal intestinal obstruction syndrome
Impaired glucose tolerance

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58
Q

How is CF managed?

A

Dornase alfa
Ivacaftor
Abidec
Pancrex
Creon
Physiotherapy - teach parents to percuss and postural drainage. Older children expiration techniques
Lung transplantation
Gene therapies

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59
Q

What is tested in babies for CF?

A

Immunoreactive trypsinogen

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60
Q

What is tested in older children with suspected CF?

A

Pilocarpine sweat test

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61
Q

What is the mean age for people with CF?

A

Median age is 47

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62
Q

What are some differentials for abdominal pain in children?

A

Acute
Hepatitis
Biliary atresia
Gastritis
Gastroenteritis
Mesenteric adenitis
Hirshsprung’s
Intersusseption
Appendicitis
Torsion
IBD
Pneumonia

Recurrent
Lactose intolerance
PICA
Coeliac
Stress

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63
Q

How should children with abdominal pain always be investigated?

A

Urine dip
FBC, U and E’s, amylase/ lipase, TTG +iGA level
If functional avoid over investigation

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64
Q

What are the causes of abdominal distension?

A

F: fat
F: fluid
F: flatus
F: faeces
F: fetus
F: fulminant mass

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65
Q

What are the causes of hepatomegaly?

A

Infections like CMV, malaria, EBV
Malignancy like leukemia, lymphoma and neuroblastoma
Metabolic disease like Gaucher’s disease

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66
Q

What needs to be measured in coleiac patients with IgA deficiency?

A

igG gliadin

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67
Q

What us coeliac?

A

An enteriopathy induced by gluten
Presents aged 6-24 months with diarrohea, abdo distension, pain and faltering growth as well as anemia. Faltering growth, short stature are some features of coleiac
Features are:
Distension
Abdo pain
Delayed growth
Anorexia
Diarrohea
Anaemia

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68
Q

What is appendicitis and how does in present in children?

A

Less likely on <5 years, but more chance of rupture
Use the ALVARDO score - MANTRELS
Rovsing’s sign, obturator and psoas sign, fetor hepatis

69
Q

What is seen in intusseption?

A

Inconsolable crying
Drawing up of legs
Red currant jam stool
Target sign on US
Air enema
Laparatomy

69
Q

What are the features of pyloric stenosis?

A

Hypochloremic hypokalaemic metabolic alkalosis
Non-billious vomiting
Olive shaped mass

69
Q

What are the features of VUR?

A

Vesicouteric reflux can be as high as up to 35% of cases of recurrent UTI and many may have renal scarring
Grades 1 - incomplete filling
Grade 2 - complete filling + some dilation
Grade 3 - ballooning calyces
Grade 4 - Megaureter
Grade 5 - megaureter + hydropnephorsis
DMSA testing and MCUG testing
Antibiotics prophylaxis - case by case

69
Q

What is a mictruating cystourethrogram?

A
70
Q

What is DMSA?

A
71
Q

What are the features of nephrotic syndrome?

A

Triad of proteinuria, oedema, hypoalbuminemia.
Frothy urine, protein >3
Corticosteroid therapy required
60mg/m2/ day for 4 weeks, then 40mg/m2/day for another 4 weeks
Diuretics and albumin may considered

72
Q

What are the features of nephritic syndrome?

A

Haematuria, oedema, Blood pressure
IgA nephropathy and PSGN

73
Q

What are some of the causes of bladder obstruction?

A

Posterior urethral valves
Hypospadias, epispadias

74
Q

What are the RIFLE grades for AKI?

A
75
Q

What are the KDIGO staging for AKI?

A
76
Q

What are the types of AKI?

A
77
Q

How is AKI managed in children?

A

Strict input/ output twice daily weights
Minimise nephrotic drugs
Assess hyperkalemia, uraemia, metabolic acidosis, pulmonary oedema
if BP is high use sodium nitroprusside
Refer for dialysis if any HUMP symptoms

78
Q

What is HUS?

A
79
Q

What are the features of HUS?

A

Neurological
Uraemia
Haemolytic anaemia
Thrombocytopenia
ADAM 13
Fever

Not Unless He Takes A Fire
NUHTF

80
Q

What are the causes of thrombocytopenia?

A

HIT or HUS
ITP
TTP
Chemotherapy
Hereditary
Infection
Neoplasm
Splenomegaly

81
Q

How is HUS managed?

A

Supportive management

82
Q

How is ITP managed?

A

Oral corticosteroids
IV immune globulin (IVIG)
IV anti-D immune globulin
Sometimes, splenectomy
Thrombopoietin receptor agonists (TPO-RA)
Rituximab
Fostamatinib
Other immunosuppressants
For severe bleeding, IVIG, IV anti-D immune globulin, IV corticosteroids, and/or platelet transfusions
2019 guidelines are now available (1,2). Asymptomatic patients with a platelet count > 30,000/mcL (> 30 × 109/L) and no bleeding do not require treatment and can monitored.

83
Q

How is ITP managed if platelets <30,000 and active bleeding?

A

Adults with newly diagnosed ITP with bleeding and a platelet count < 30,000/mcL (< 30 × 109/L) are usually given an oral corticosteroid (eg, prednisone 1 mg/kg orally once a day) initially.

84
Q

What are the features of HSP?

A

Pain
Abdominal pain
Renal disease
Petechiae

85
Q

What are some differentials for a seizure in children?

A

Generalised seizure: tonic clonic, tonic, atonic, myoclonic, absence, infantile spasms

Focal seizure

BRUE - brief resolved unexplained event

electrolyte disturbance

encephalitis, meningitis

Febrile convulsions

Reflex anoxic spells

Breath holding spells

86
Q

What is Todd’s paresis?

A

Weakness for >48 h of muscles involved in seizure

87
Q

What are febrile convulsions?

A

A single tonic clonic, generalised, bilateral, last less than 15 minutes, from about 6 months to 6 years preceeded by fever

Treat with oxygen, put in recovery position, check glucose, test CXR, MSU, ENT swabs. Avoid LP in post ictal period

<3% chance of epilepsy

88
Q

Which epilepsy is associated with hypassrythrmia?

A

West syndrome

89
Q

Which epilepsy is assoictaed with centrotemporal spikes?

A

Rolandic seizures

90
Q

Apart from medication what else can be advised in epilepsy?

A

Ketogenic diet

91
Q

What is the most common tumours in children and what are the features?

A

2/3rds in posterior fossa
Astrocytomas of the brainstem (glioblastoma in adults)
Medulloblastomas

2 weeks headaches
2 weeks vomiting
Visual changes
Subtle motor weakness

Discuss with specialist on the same day

92
Q

Compare and contrast VSD and ASD

A

VSD more common - 30% of heart defects
Pan systolic murmur
Cardiomegaly
Ventricular hypertrophy
Mild symptoms
May need surgery

ASD (17%)
Split S2 sounds
Cardiomegaly
Right ventricular hypertrophy
RBBB
May need surgery

93
Q

What are the 5 cyanotic heart disease?

A

R–> L shunt as by passes lungs
ToF
Great transposition of arteries
Truncus arteriosis
Triscupid artresia
Total anomalous pulmonary venous drain
All require prostaglandns to keep dutus arteriosus open

94
Q

What happens in Eisemenger?

A

Left to Right shunt
which later changes

95
Q

What tests should be done in a newborn with congenital heart disease?

A

FBC, CXR, Po2, pre-ductal and post ductal sats
Echo

96
Q

What is a feature of PDA?

A

Machinery like murmur below left clavicle
Can use ibuprofen

97
Q

How is coarctation treated?

A

Treat with stent or surgery before 5 years to reduce HTN and HF

98
Q

How are tet spells managed?

A

Bring knees to chest and give oxygen, morphine, beta blockers and phenylephrine

99
Q

What are signs of tetralogy of fallot?

A

Clubbing, harsh ESM, LSE

100
Q

What are features of coarctation?

A

Difference in femoral pulses
Ejection systolic

101
Q

What is Still’s murmur?

A

Musical murmur
Heard in 4th intercostal space on left sternum border

102
Q

What are the types of innocent murmurs?

A

Flow murmur ULSE
Venous hum
Still’s murmur LLSE

103
Q

What are the signs of HSP?

A

Petechiae on buttocks
Arthralgia
Renal disease - haemturia
Pain in abdomen

104
Q

How is HSP treated?

A

Steroids and analgesia

105
Q

What is tested in HSP?

A

Skin exam
Urinalysis
BP

FBC may be normal, especially platelets
U and E’s if proteinuria +2 (kidney function)

Might admit if poor kidney function or in pain

106
Q

How is ITP managed and tested?

A

Steroids and IVIG
Chronic management may be rituximab and splenectomy
RISS

107
Q

T or F, platelets are normal in HSP?

A

T

108
Q

What are the causes of bruising in young children?

A

ITP
TTP
DIC
ALL
VWF
Haemophilia
+
HUS
ITP
TTP
Chemo
Hereditary
Infection
Neoplasm
Splenomegaly

109
Q

What is the main presentation of ALL?

A

Bone pain due to bone marrow invasion
Splenomegaly and hepatomegaly due to reticuloendothelial infiltration
Bruising, petichiae and bleeding

Reticuloendothelial invasion
Invasion of bone marrow
Petechiae and pain

110
Q

What is the treatment of ALL?

A

Induction
Consolidation
Maintenance

111
Q

Discuss the primary immunodefencies.

A

SCID
IgA deficiency
Treatment hypogammaglobulinemia
Common variable immunodeficiency
Bruton’s X linked aggamaglobulinemia
IgG subclass deficiency
Chronic granulomatous disease
Di-George

112
Q

What are the features of Di George syndrome?

A
113
Q

What is the most common type of MODY?

A

MODY 3 HIF-alpha, treat with gliclazide

114
Q

What are the symptoms of diabetes type 1?

A

Polydispsia, polyuria, lethargy, weight loss

115
Q

What is involved in the diagnosis of diabetes?

A

Blood sugars + symptomatic 11.1 > for eating and >7 (fasting)

116
Q

When is glucose added for DKA?

A

When blood glucose <14

117
Q

What is a complication of treating a patient with DKA?

A

Cerebral oedema
If this occurs call a senior
Mannitol
Restrict IV maintenance
fluid

118
Q

What are the causes of primary hypothyroidism in children?

A

Hashimito’s
Iodine deficiency
Amiodarone or lithium exposure

119
Q

What are the causes of secondary hypothyroidism in children?

A

Intracranial tumour, radiotherapy and surgery

120
Q

What are the symptoms and signs of hypothyroidism?

A

Dry skin, coarse hair, poor growth, low IQ, hypotonia, tongue protrusion
Cretinisim is an old fashioned term

121
Q

What might babies of mother’s with Grave’s acquire?

A

Transient neonatal thyrotoxicosis

122
Q

What is a cause of precocious puberty?

A

Between 8 in girls and 9 in boys

123
Q

What is delayed puberty?

A

No findings in a girl of 13 or no progression in characteristics aged 15

124
Q

What is the healthy start programme?

A

Antenatal testing
Mother and child bonding
Nutritional needs and breastfeeding
Hearing and seeing
Starting school
Immunisations
Reading and bookstart

125
Q

What is the vaccination schedule in the UK?

A

2m - 6-in-1 - MenB - rotavirus (3)
3m - 6-in-1, PCV and rotavirus (3)
4m - 6-in-1, MenB (2)
1y - MMR, Hib/MenC, PCV, MenB (4)
3y - 4 in 1, MMR
12-13 - HPV
14 - 3 in 1, MenACWY

126
Q

What are the causes of delayed speech?

A

Hearing impairment
Familial family history of language delay
Environmental, deprivation, poor social interaction
Neuropsychological - autism spectrum disorder, global developmental delay

127
Q

What is a concern for vocab at 3 years?

A

<50 years suspect deafness

128
Q

What are some signs of cerebral palsy?

A

Weakness, paralysis, hand dominance or other motor asymmetry, delayed milestones,

129
Q

What are the types of cerebral palsy?

A

Spastic
Ataxic
Dyskinetic

130
Q

What is the Gross Motor Function Classification System?

A
131
Q

What are the treatments for cerebral palsy?

A

Intrathecal baclofen
Deep brain electrostimulation
Botulinum toxin

132
Q

How is enuresis treated?

A

Reward chart
Enuresis alarms
Desmopressin

133
Q

What are the causes of faltering growth in children?

A

Fed - abuse/ neglect
Feeding - suckling, atresia, pyloric stenosis, cleft palate
Malabsorption - coeliac disease, CF, CMPA

Short stature = height <2nd centile. Causes: growth hormone deficiency, hypothyroidism, Cushings

134
Q

What are the different IQ parameters for learning disability?

A

<70 mild
<50 moderate
<35 severe
<20 profound

135
Q

What is R14 testing?

A

R14 is a genetic test for acutely unwell children with a likely monogenic disorder1

136
Q

Who should be admitted for paracetamol poisoning vs who can be treated at home?

A

If you are certain that a patient has had less than 75mg/kg then they may be treated at home. If more than 75mg/kg in children they should be admitted and tests should be done 4 hours post ingestion. If presenting less than 1 hour and more than 150 mg/kg give activated charcoal. Use n acetylcysteine.

137
Q

How is salicylate poisoning managed?

A

Urinary alkalisation with iv sodium bicarbonate and haemodialysis

138
Q

What is a risk of forceps delivery?

A

Facial nerve palsy

139
Q

What is the new name for a Mongolian blue spot?

A

Congenital dermal melanocytosis

140
Q

What is TTN?

A

Starts around 4h after delivery and it is mainly cause by c section where there is slow clearance of fluid. CXR shows pulmonary oedema normally resolves in 24 h

141
Q

What is an example of hydrolysed milk?

A

Nutramigen

142
Q

What is colic?

A

Paroxysmal crying with pulling up of the legs for >3h on >3 days

143
Q

What are the causes of vomiting in babies?

A

Posseting
Gord
Gastritis
Over feeding
Pyloric stenosis
Infection
CMPA
Adverse food reaction
Infective gastroenteritis

144
Q

What is CMPA?

A

Non ige mediated
Reflux, vomiting, blood or mucus in stools
Exclude cows milk in diet
Hydrolyzed milk

145
Q

What are the early causes of jaundice?

A

Sepsis
Rhesus incomptability
ABO incompatibility
Hemolytic disease of new born

<24 h pathological

146
Q

What type of jaundice is always pathological?

A

Conjugated

147
Q

Physiological jaundice is always….

A

Unconjugated

148
Q

Which jaundice causes encephalopathy?

A

Unconjugated

149
Q

What are causes of physiological jaundice?

A

Increased breakdown of rbc
Absence of gut flora
Exclusive breastfeeding

150
Q

Define haemolytic disease of the newborn.

A

Incompatibility between maternal and fetal blood groups –> production of IgG which crosses the placenta –> haemolysis in the fetus and neonate and severe anaemia.

151
Q

What is the physiology behind haemolytic disease of the newborn?

A

When a rhesus positive baby is born to a rhesus negative mother some of the blood can escape into the mother’s circulation which can cause her to make anti-D antibodies (isoimmunisation)

152
Q

What is erythroblastosis fetalis?

A

Another name for haemolytic disease of the newborn.

153
Q

What is the most common cause of hydrops fetalis?

A

Haemolytic disease of the newborn.

154
Q

When is anti-D normally give?

A

Week 28 and week 32

155
Q

What are three causes of SGA babies?

A

Pre-eclampsia
Chromosomal
Constitutionally small

156
Q

What are the long term effects of SGA?

A

90% of babies catch up in 2 years
Increased risk of fetal death
CHD
HTN
Obesity
Hypoglycaemia
Hypothermia
Polycythaemia

Cold, hungry and red as a child
Old and fat as an adult.

157
Q

What is shown here?

A

Coloboma

158
Q

What are the features of foetal alcohol syndrome?

A

Microcephaly
Short palpebral fissures
Hypoplastic upper lip
Absent philtrum
Small eyes
Low IQ
Cardiac malformations

159
Q

What is the commonest cause of ambigious genitalia?

A

CAH

160
Q

What are the causes of CAH?

A

Defiency of 21 hydroxylase
11-hydroxylase
17 alpha hydroxylase
Cortisol is inadequately produced, leading to a rise in ACTH
Testosterone increase

161
Q

What are the features of CAH?

A

Vomiting, dehydration and ambiguous genitalia

162
Q

How is CAH managed?

A

Glucocorticoid replacement
Mineralocorticoid replacement
Clitorial reduction and vaginoplasty

163
Q

How can an addisonian crisis be treated?

A

IV fluids
Glucose 10%
Hydrocortisone

(I get high)

164
Q

What are the signs of respiratory distress syndrome?

A

Increased work of breathing after birth, tachyponoea, grunting, nasal flaring, intercostal recession, ground glass appearance
Linked to low surfactant

165
Q

What should be given in respiratory distress syndrome?

A

Glucocorticoids
CPAP
NIPPV
Mechanical ventilation

166
Q

What are the risks of pre-term labour?

A

Retinopathy of prematurity
Apnoea
NEC
Intraventricular haemorrhage
Anaemia

Finals (24 decks)

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