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Paediatrics Flashcards

1
Q

What is hypoxia ischaemic encephalopathy?

A

Compression of umbilical cord during birth causing brain damage due to lack of oxygenation.
Results in seizures, hypotonia, poor feeding.

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2
Q

What is the ratio of neonatal compressions in resuscitation? When do you begin them?

A

3:1 once HR drops below 60bpm

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3
Q

What is a Potter Sequence?

A

Flattened nose, recessed chin, low-set ears, and the presence of respiratory distress due to pulmonary hypoplasia. Also associated with renal a genesis (failure to develop).
Results from oligohydramnios (lack of amniotic fluid) in utero.

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4
Q

What are the consequences of congenital toxoplasmosis?

A

Hydrocephalus, chorioretinitis, intracranial calcifications (USS)

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5
Q

What is the Pierre-Robin Sequence?

A

Cleft palate, retracted tongue (glossoptosis), small lower jaw (micrognathia).
It tends to resolve on its own within 3-6 months but if not may require surgery.

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6
Q

What signs do you get with a PDA due to turbulent blood flow?

A

collapsing pulse and murmur at the left sternal border

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7
Q

What is osteogenesis imperfecta?

A

Collagen type synthesis defect causing easy breaking of bones, blue sclera, dental abnormalities, virus deformity, and possibly hearing defects as they age.

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8
Q

What is Ebstein’s abnormality?

A

Lithium during pregnancy causes baby to have a tricuspid valve defect (septal and posterior leaflets are downwardly displaced in RV) causing blood to leak back into RA, causing an enlarged RA and congestive heart failure due to insufficient blood flow.

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9
Q

What is Acute Bilirubin Encephalopathy (ABE)?

A

Sustained/prolonged elevated levels of bilirubin in neonates can cross the blood brain barrier and penetrate the neuronal and glial membranes (as it is lipid soluble) causing lethargy and hypotonia.

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10
Q

What is Meckel’s Diverticulum? How does it present? How is it diagnosed?

A

Congenital abnormality where thee is a remnant of the embryonic Vitelli-intestinal duct. Painless rectal bleeding, non-specific abdominal pain, intestinal obstruction/intussusception.
Technetium 99 scan will show an increased uptake in the ectopic tissue.

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11
Q

What is tuberous sclerosis?

A

TSC1 or 2 gene mutation causes growth of benign tumours in different areas of the body.

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12
Q

What are the manifestations of tuberous sclerosis?

A

Skin: ash-leaf macules, shagreen patches, facial angiofibromas, subungual fibromas
Neuro: infantile spams with hypsarrhythmia on EEG (interictal high amplitude waves on a background of irregular spikes), learning disabilities, subependymal cysts.
Renal: angiolipomas
Cardio: cardiac rhabdomyomas

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13
Q

What is a Capet succadeneum?

A

Fluid filled lump on head due to fluid crossing suture lines during birth due to pressure.
Usually self resolving.

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14
Q

What are the consequences of foetal alcohol syndrome?

A

Microcephaly, short palpebral fissures, hypoplastic upper lip and absent philtrum, decreased IQ, cardiac abnormalities.

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15
Q

What are the signs of NEC? How is it managed?

A

Bilious vomiting, blood stained stools, pneumatosis intestinalis (gas cysts in the bowel wall), bowel wall oedema, dilated bowel, pneumoperitoneum (if perforated).
Broad spec Abx and tpn instead of milk to rest the bowel.

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16
Q

A long lasting cough causing vomiting and cyanosis should make you suspicious of what?

A

Bordetella pertusis (gram -ve cocobacilli): whooping cough

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17
Q

What causes Roseola infantum? How does it present? How should it be managed?

A

HHV 6/7.
High temperature followed by rose pink macular rash as the fever goes down.
Manage conservatively.

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18
Q

What virus causes croup? How does it usually present?

A

Parainfluenza.
Barking (seal-like) cough, inspiratory stridor, and respiratory distress usually affecting 6 month olds to 2 year olds.

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19
Q

What do you see on CXR of Croup? Mx?

A

Steeple sign due to oedema of the larynx resulting in supraglottic narrowing.
Mx: Steroids - dex.

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20
Q

How does ITP present in children?

A

Non-blanching, non-palpable rash that appears shortly after infection in the absence of other features.
Platelets are significantly decreased

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21
Q

How is ITP managed in children?

A

Supportively - self limiting condition in children

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22
Q

What must you rule out in children presenting with ITP?

A

Leukaemia - repeat bloods 1 week after presentation to rule this out

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23
Q

What is HSP? How does it present?

A

Henoch-Scholein purpura: IgA vasculitis.
Often in 3-15 y/o following URTI. You get a non-thrombocytopenic purpura, arthralgia, haematuria, and non-specific abdo pain.

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24
Q

How do we manage HSP?

A

Mainly supportive (aka analgesia) however corticosteroids may be used.
Regular urine dips up to 1 year after diagnosis to monitor for haematuria and proteinuria.

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25
Q

How does transient synovitis present? How is it managed?

A

Inflammation of the hip causing pain, following URTI. Most commonly in 3-10 y/o males.
Mx: PRN painkillers. Resolves spontaneously.

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26
Q

Children <6 months presenting with recurrent UTIs should be referred for what?

A

MCUG (micturating cystourethrogram)

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27
Q

Koplik spots on buccal mucosa and a rash that starts behind the ear and spreads throughout the body is likely what?

A

Measles.

28
Q

Vesicles in mouth, on palms and on soles of feet is likely what?

A

Hand/foot/mouth disease: coxsakie A16 virus.

29
Q

Bright red rash on cheeks is likely what?

A

Slapped cheek: Parvovirus B19

30
Q

Pink/white pearly papules is likely what?

A

Molloscum contagiosum: poxvirus

31
Q

A fever followed by a rash which starts on the head/trunk accompanied by mild systemic upset is what?

A

Chicken pox.

32
Q

A mild maculopapular rash that starts on the face and behind the ears and spreads down neck and body is what?

A

Rubella

33
Q

A non-blanching rash accompanied by photophobia and neck stiffness is what?

A

Meningococcal rash

34
Q

A sandpaper rash which spares the mouth and causes a ‘strawberry’ tongue is what?

A

Scarlet fever (group A strep).

35
Q

Golden crusted lesions around the face is what?

A

Impetigo

36
Q

What are the features of Kawasaki disease?

A

CREAM:
- Conjunctivitis
- Morbilliform, maculopapular, erythematous rash
- Edema/erythema of hands and feet (often peels)
- Adenopathy
- Mucosal involvement

37
Q

Why must all Kawasaki pts have an echo?

A

Cx of coronary artery aneurysms

38
Q

What is the management of Kawasaki disease?

A

High dose aspirin for 48-72 hours before reducing and IVIG.

39
Q

What is a Wilm’s Tumour?

A

Nephroblastoma, found in children presenting with abdominal distension and pain which is normally unilateral.
USS will show a mass.

40
Q

What are the components of Alport Syndrome? What is it caused by?

A

Microscopic haematuria, bilateral sensorineural hearing loss, and retinitis pigmentosa.
Genetic abnormality in the gene that codes for type 4 collagen.

41
Q

What are the RFs for DDH?

A

Developmental dysplasia of the hip:
- family hx
- female
- breech
- decreased uterine space
- postural deformities

42
Q

How do you diagnose DDH?

A

Screening tests: ortolani test causes a jerk when abducting hips, galeazzis test will show whether or not the shortening is femoral.
Diagnosis: USS

43
Q

What is duodenal atresia? What genetic abnormality is it associated with?

A

Non-patent duodenum due to closure after birth or it may have developed this way in utero. Usually presents within the first week of life with bilious vomiting and absent stools (if it closed after birth they may have produced meconium).
Down’s syndrome.

44
Q

How can you diagnose and manage duodenal atresia?

A

Abdo XR shows double bubble sign (gas in stomach and small intestine).
Mx- duodenoduodenostomy

45
Q

What is Oesophageal atresia? How is it diagnosed?

A

Blind ended oesophagus, may be accompanied by a fistula connecting oesophagus to trachea.
Dx- pass NGT down as far as possible, when it stops, get a CXR and this shows the level of the atresia.

46
Q

How does pyloric stenosis present?

A

Non-bilious, projectile vomiting, especially after feeds, distended abdomen, olive shaped mass in RUQ. Most commonly in 3-6 weeks old, more common in males.

47
Q

What electrolyte abnormality is associated with pyloric stenosis?

A

Hypochloraemic, hyperkalaemic metabolic alkalosis,
Loss of HCL causes increased eased reabsorption of H+ in kidneys in exchange for K+.

48
Q

What scan is used to diagnose pyloric stenosis?

A

USS abdo

49
Q

How does biliary atresia present?

A

Progressive jaundice, dark urine, chalky-white stools, bruising, conjugated hyperbilirubinaemia. Due to obstructive jaundice (post hepatic) caused by fibrosis and destruction of biliary tree.
Usually presents 4-6 weeks of life.

50
Q

How is biliary atresia managed?

A

Kasai procedure which creates a new pathway from the liver to the gut to bypass the fibroses bile ducts.

51
Q

What causes a meconium ileus? What disorder is it associated with

A

Thick, sticky meconium becomes lodged in the data, ileum.
Distension, bilious vomiting, inability to pass meconium.
Associated with CF.

52
Q

How does intussusception present?

A

Colicky abdo pain, crying, bilious vomiting, sausage shaped mass in RUQ, target/doughnut sign on USS. Usually peaks around 5-7 months.

53
Q

What causes a volvulus? How does it present?

A

Gut rotates and fixes in an abnormal position, twisting and cutting off the blood supply.
Child presenting with bilious vomiting and XR shows embryo sign (caecal volvulus) or coffee bean sign (sigmoid volvulus).

54
Q

How is a volvulus managed?

A

A Ladd’s procedure straightens out the bowel and divides any abdominal peritoneal bands (Ladd’s bands).

55
Q

What are the components of Tetralogy of Fallot (TOF)? How does it present if not identified in utero?

A

Overriding aorta, VSD, pulmonary stenosis, RV hypertrophy.
‘Tet spells’ caused by reversal of the left to right shunt so it becomes right to left meaning deoxygenated blood is pumped into systemic circulation causing acute cyanosis.

56
Q

Mx of TOF?

A

Repair of VSD and pulmonary valve surgically.

57
Q

What murmur is heard with a VSD?

A

Pansystolic murmur loudest at the left sternal border which radiates to the left axilla and to the back.

58
Q

A thrill is a palpable murmur, what does this mean for the intensity of the murmur?

A

At least grade 4-6 - always pathological.

59
Q

How do you calculate maintenance fluids for children?

A

100ml/kg/day for 10kg, he 50ml/kg/day for the second 10kg, then 20ml/kg/day for any further body weight.

60
Q

What are the categories for the AOGAR score?

A

Appearance (skin colour), Pulse, Grimace (reflex irritability), Activity (tone), respiration.
Each receives a score of 0,1, or 2 making it /10.

61
Q

When do you measure APGAR? What is the threshold?

A

1 and 5 minutes after birth.
<7 at 5 minutes requires urgent medical assessment.

62
Q

What is first line pharmacological treatment for depression in children?

A

Fluoxetine.

63
Q

What is the management for nocturnal eneuresis?

A

1) Star reward chart and reduced water intake before bed
2) Enuresis alarm
3) Medication (desmopressin), stop after one month is unsuccessful, continue for 3 months if successful.

64
Q

Congenital heart block is associated with mother’s with what autoimmune pathology?

A

SLE/Sjogren’s.

65
Q
A

Clinical (27 decks)

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