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
2
Q
What is the APGAR score?
A
Appearance
Pulse
Grimace
Activity
Resp rate
3
Q
What is the newborn life support algorithm?
A
4
Q
What is correct for the newborn life support in terms of chest compressions to breaths?
A
3:1
5
Q
How many inflation breaths are given?
A
5 breaths
6
Q
What is the basic life support for children?
A
7
Q
Where can IO access be achieved?
A
1-2cm medial and 1-2cm distal from tibial tuberosity
8
Q
How is weight calculated for a child?
A
Age + 4 x 2
9
Q
What is considered with anaphylaxis?
A
Doses
Refractory - not responsive to two
Biphasic
Tryptases
Autoinjector
10
Q
Where should a baby be placed when being checked?
A
Resuscitaire
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
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
13
Q
What is a normal HR in children?
A
Separate
<1
1-2
2-5
5-12
>12
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
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
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
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
18
Q
T or F, it is not possible to age a bruise based on physical appearance?
A
T
19
Q
What are some signs of child abuse with burns?
A
Contact burns not on the hands or feet
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
21
Q
What needs to be checked with physical abuse?
A
Retinal haemorrhages
skeletal survey
subdural haematomas
22
Q
What are some differentials for NAI?
A
OI, ITP, leukemia, HSP, coagulation disorder, congenital dermal melanocytosis
23
Q
How should suspected child abuse be managed?
A
A senior community paediatrician
Document appropriately
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
25
What is triple therapy for encephalitis?
Ceftriaxone, clarithromycin and aciclovir
26
What are some signs of meningitis?
Fever, lethargy, irritability, headache, myalgia,
Meningeal signs - photophobia, neck stiffness, Kernings sign, Brudinski's sign, opisthotonus
27
What is opisthotonus?
Opisthotonus or opisthotonos is a state of severe hyperextension and spasticity in which an individual's head,
28
What are the contraindications to LP?
29
How should meningitis be treated?
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
30
What does Cushing's triad a sign of?
Suggests coning
31
What are some signs of raised ICP?
32
What are some late signs of menigitis?
Bulging fontanelles
33
What are the features of measles?
SSPE
ADEM
Morbiliform rash
and
5C's
Koplik spots, conjunctivitis, coryza, cranky, cough
34
What are the features of mumps, measles and rubella?
Mumps - MOP - myocarditis, orchitis, pancreatitis + 5 c's
Measles - SAM - SSPE, ADEM, morbiliform rash
Rubella - DICE - Deadness, intraarticular, cardiac, eyes
35
What causes hand foot and mouth?
What causes roseola infantum?
Coxsackie A16
HHV6
36
What are some features of roseola infantum?
Nagayama spots
Exanthem subitum, fourth disease
3-5 days fever
37
How is chickenpox managed?
Calamine lotion
No NSAIDs
Associated with VZV and with group A strep cellulitis, leads to necrotising fascitis
38
How should neonates be managed with HIV?
PEP for 4 weeks starting <4h from birth: zidovudine monotherapy and co-trimoxole pcp treatment
39
What is 90-90-90 by 20?
A goal set up for 90% of people to know their status, 90% treatment and 90% U=U
40
What are some differentials for stridor?
Laryngomalacia
Bacterial tracheitis
Croup
Foreign body
41
What is the scoring system used for croup?
42
What are the treatments for croup?
Dexamethasone and nebulised adrenaline
43
Compare croup, tracheitis and epiglossitis
44
How is epiglossitis managed?
Call the anaethetist
Ceftriaxone IV
45
What are the URTI infections in children?
Tonsilitis
Acute epiglossitis
Bacterial tracheitis
Croup
46
What are the LRTI in children?
Pneumonia
Bronchiolitis
Whooping cough
47
How is bronchiolitis managed?
Pavlizumab
Oxygen therapy
Bronchodilators
48
How is whooping cough managed?
Clarithromycin
49
What is the treatment for children with asthma?
Inhalers and spacer
50
What is needed for asthma discharge?
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
51
What is the classification of asthma?
Moderate - 50-70%, increasing symptoms
Severe - cant complete sentences, 110, 25
Life threatneing - <92%, <33%, CHEST symptoms
52
What does CHEST stand for?
Cyanosis
Hypotension
Exhaustion
Silent chest
Tiring
53
What is seen on spirometry tested?
<70% fev1/fvc
>12% bronchodilator therapy
54
What should be asked about asthma?
Night symptoms.
Inhaler use > 3 times a week
Hospital
Admissions
55
What are the treatments for asthma?
SABA
SABA + ICS
SABA + ICS + monteleukast OR LABA
MART
Referral
56
How is meconium ileus treated?
Stabilise with NG tube and use hyperosmolar enemas
57
What are some complications of CF?
Bronchiectasis
Infections
Pancreatic insufficiency
Malabsorption
Faltering growth
Distal intestinal obstruction syndrome
Impaired glucose tolerance
58
How is CF managed?
Dornase alfa
Ivacaftor
Abidec
Pancrex
Creon
Physiotherapy - teach parents to percuss and postural drainage. Older children expiration techniques
Lung transplantation
Gene therapies
59
What is tested in babies for CF?
Immunoreactive trypsinogen
60
What is tested in older children with suspected CF?
Pilocarpine sweat test
61
What is the mean age for people with CF?
Median age is 47
62
What are some differentials for abdominal pain in children?
Acute
Hepatitis
Biliary atresia
Gastritis
Gastroenteritis
Mesenteric adenitis
Hirshsprung's
Intersusseption
Appendicitis
Torsion
IBD
Pneumonia
Recurrent
Lactose intolerance
PICA
Coeliac
Stress
63
How should children with abdominal pain always be investigated?
Urine dip
FBC, U and E's, amylase/ lipase, TTG +iGA level
If functional avoid over investigation
64
What are the causes of abdominal distension?
F: fat
F: fluid
F: flatus
F: faeces
F: fetus
F: fulminant mass
65
What are the causes of hepatomegaly?
Infections like CMV, malaria, EBV
Malignancy like leukemia, lymphoma and neuroblastoma
Metabolic disease like Gaucher's disease
66
What needs to be measured in coleiac patients with IgA deficiency?
igG gliadin
67
What us coeliac?
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
68
What is appendicitis and how does in present in children?
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
What is seen in intusseption?
Inconsolable crying
Drawing up of legs
Red currant jam stool
Target sign on US
Air enema
Laparatomy
69
What are the features of pyloric stenosis?
Hypochloremic hypokalaemic metabolic alkalosis
Non-billious vomiting
Olive shaped mass
69
What are the features of VUR?
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
What is a mictruating cystourethrogram?
70
What is DMSA?
71
What are the features of nephrotic syndrome?
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
What are the features of nephritic syndrome?
Haematuria, oedema, Blood pressure
IgA nephropathy and PSGN
73
What are some of the causes of bladder obstruction?
Posterior urethral valves
Hypospadias, epispadias
74
What are the RIFLE grades for AKI?
75
What are the KDIGO staging for AKI?
76
What are the types of AKI?
77
How is AKI managed in children?
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
What is HUS?
79
What are the features of HUS?
Neurological
Uraemia
Haemolytic anaemia
Thrombocytopenia
ADAM 13
Fever
Not Unless He Takes A Fire
NUHTF
80
What are the causes of thrombocytopenia?
HIT or HUS
ITP
TTP
Chemotherapy
Hereditary
Infection
Neoplasm
Splenomegaly
81
How is HUS managed?
Supportive management
82
How is ITP managed?
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
How is ITP managed if platelets <30,000 and active bleeding?
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
What are the features of HSP?
Pain
Abdominal pain
Renal disease
Petechiae
85
What are some differentials for a seizure in children?
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
What is Todd's paresis?
Weakness for >48 h of muscles involved in seizure
87
What are febrile convulsions?
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
Which epilepsy is associated with hypassrythrmia?
West syndrome
89
Which epilepsy is assoictaed with centrotemporal spikes?
Rolandic seizures
90
Apart from medication what else can be advised in epilepsy?
Ketogenic diet
91
What is the most common tumours in children and what are the features?
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
Compare and contrast VSD and ASD
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
What are the 5 cyanotic heart disease?
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
What happens in Eisemenger?
Left to Right shunt
which later changes
95
What tests should be done in a newborn with congenital heart disease?
FBC, CXR, Po2, pre-ductal and post ductal sats
Echo
96
What is a feature of PDA?
Machinery like murmur below left clavicle
Can use ibuprofen
97
How is coarctation treated?
Treat with stent or surgery before 5 years to reduce HTN and HF
98
How are tet spells managed?
Bring knees to chest and give oxygen, morphine, beta blockers and phenylephrine
99
What are signs of tetralogy of fallot?
Clubbing, harsh ESM, LSE
100
What are features of coarctation?
Difference in femoral pulses
Ejection systolic
101
What is Still's murmur?
Musical murmur
Heard in 4th intercostal space on left sternum border
102
What are the types of innocent murmurs?
Flow murmur ULSE
Venous hum
Still's murmur LLSE
103
What are the signs of HSP?
Petechiae on buttocks
Arthralgia
Renal disease - haemturia
Pain in abdomen
104
How is HSP treated?
Steroids and analgesia
105
What is tested in HSP?
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
How is ITP managed and tested?
Steroids and IVIG
Chronic management may be rituximab and splenectomy
RISS
107
T or F, platelets are normal in HSP?
T
108
What are the causes of bruising in young children?
ITP
TTP
DIC
ALL
VWF
Haemophilia
+
HUS
ITP
TTP
Chemo
Hereditary
Infection
Neoplasm
Splenomegaly
109
What is the main presentation of ALL?
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
What is the treatment of ALL?
Induction
Consolidation
Maintenance
111
Discuss the primary immunodefencies.
SCID
IgA deficiency
Treatment hypogammaglobulinemia
Common variable immunodeficiency
Bruton's X linked aggamaglobulinemia
IgG subclass deficiency
Chronic granulomatous disease
Di-George
112
What are the features of Di George syndrome?
113
What is the most common type of MODY?
MODY 3 HIF-alpha, treat with gliclazide
114
What are the symptoms of diabetes type 1?
Polydispsia, polyuria, lethargy, weight loss
115
What is involved in the diagnosis of diabetes?
Blood sugars + symptomatic 11.1 > for eating and >7 (fasting)
116
When is glucose added for DKA?
When blood glucose <14
117
What is a complication of treating a patient with DKA?
Cerebral oedema
If this occurs call a senior
Mannitol
Restrict IV maintenance
fluid
118
What are the causes of primary hypothyroidism in children?
Hashimito's
Iodine deficiency
Amiodarone or lithium exposure
119
What are the causes of secondary hypothyroidism in children?
Intracranial tumour, radiotherapy and surgery
120
What are the symptoms and signs of hypothyroidism?
Dry skin, coarse hair, poor growth, low IQ, hypotonia, tongue protrusion
Cretinisim is an old fashioned term
121
What might babies of mother's with Grave's acquire?
Transient neonatal thyrotoxicosis
122
What is a cause of precocious puberty?
Between 8 in girls and 9 in boys
123
What is delayed puberty?
No findings in a girl of 13 or no progression in characteristics aged 15
124
What is the healthy start programme?
Antenatal testing
Mother and child bonding
Nutritional needs and breastfeeding
Hearing and seeing
Starting school
Immunisations
Reading and bookstart
125
What is the vaccination schedule in the UK?
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
What are the causes of delayed speech?
Hearing impairment
Familial family history of language delay
Environmental, deprivation, poor social interaction
Neuropsychological - autism spectrum disorder, global developmental delay
127
What is a concern for vocab at 3 years?
<50 years suspect deafness
128
What are some signs of cerebral palsy?
Weakness, paralysis, hand dominance or other motor asymmetry, delayed milestones,
129
What are the types of cerebral palsy?
Spastic
Ataxic
Dyskinetic
130
What is the Gross Motor Function Classification System?
131
What are the treatments for cerebral palsy?
Intrathecal baclofen
Deep brain electrostimulation
Botulinum toxin
132
How is enuresis treated?
Reward chart
Enuresis alarms
Desmopressin
133
What are the causes of faltering growth in children?
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
What are the different IQ parameters for learning disability?
<70 mild
<50 moderate
<35 severe
<20 profound
135
What is R14 testing?
R14 is a genetic test for acutely unwell children with a likely monogenic disorder1
136
Who should be admitted for paracetamol poisoning vs who can be treated at home?
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
How is salicylate poisoning managed?
Urinary alkalisation with iv sodium bicarbonate and haemodialysis
138
What is a risk of forceps delivery?
Facial nerve palsy
139
What is the new name for a Mongolian blue spot?
Congenital dermal melanocytosis
140
What is TTN?
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
What is an example of hydrolysed milk?
Nutramigen
142
What is colic?
Paroxysmal crying with pulling up of the legs for >3h on >3 days
143
What are the causes of vomiting in babies?
Posseting
Gord
Gastritis
Over feeding
Pyloric stenosis
Infection
CMPA
Adverse food reaction
Infective gastroenteritis
144
What is CMPA?
Non ige mediated
Reflux, vomiting, blood or mucus in stools
Exclude cows milk in diet
Hydrolyzed milk
145
What are the early causes of jaundice?
Sepsis
Rhesus incomptability
ABO incompatibility
Hemolytic disease of new born
<24 h pathological
146
What type of jaundice is always pathological?
Conjugated
147
Physiological jaundice is always....
Unconjugated
148
Which jaundice causes encephalopathy?
Unconjugated
149
What are causes of physiological jaundice?
Increased breakdown of rbc
Absence of gut flora
Exclusive breastfeeding
150
Define haemolytic disease of the newborn.
Incompatibility between maternal and fetal blood groups --> production of IgG which crosses the placenta --> haemolysis in the fetus and neonate and severe anaemia.
151
What is the physiology behind haemolytic disease of the newborn?
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
What is erythroblastosis fetalis?
Another name for haemolytic disease of the newborn.
153
What is the most common cause of hydrops fetalis?
Haemolytic disease of the newborn.
154
When is anti-D normally give?
Week 28 and week 32
155
What are three causes of SGA babies?
Pre-eclampsia
Chromosomal
Constitutionally small
156
What are the long term effects of SGA?
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
What is shown here?
Coloboma
158
What are the features of foetal alcohol syndrome?
Microcephaly
Short palpebral fissures
Hypoplastic upper lip
Absent philtrum
Small eyes
Low IQ
Cardiac malformations
159
What is the commonest cause of ambigious genitalia?
CAH
160
What are the causes of CAH?
Defiency of 21 hydroxylase
11-hydroxylase
17 alpha hydroxylase
Cortisol is inadequately produced, leading to a rise in ACTH
Testosterone increase
161
What are the features of CAH?
Vomiting, dehydration and ambiguous genitalia
162
How is CAH managed?
Glucocorticoid replacement
Mineralocorticoid replacement
Clitorial reduction and vaginoplasty
163
How can an addisonian crisis be treated?
IV fluids
Glucose 10%
Hydrocortisone
(I get high)
164
What are the signs of respiratory distress syndrome?
Increased work of breathing after birth, tachyponoea, grunting, nasal flaring, intercostal recession, ground glass appearance
Linked to low surfactant
165
What should be given in respiratory distress syndrome?
Glucocorticoids
CPAP
NIPPV
Mechanical ventilation
166
What are the risks of pre-term labour?
Retinopathy of prematurity
Apnoea
NEC
Intraventricular haemorrhage
Anaemia
