PAEDIATRICS Flashcards
What organism causes hand, foot and mouth?
Cossackie A16
Whats the most common childhood leukaemia?
ALL
Murmur associated with Turner’s syndrome?
Ejection systolic murmur loudest over aortic valve - due to bicuspid aortic valve
Slipped capital femoral epiphysis symptoms?
Hip, groin, medial thigh or knee pain
Loss of internal rotation of leg in flexion
Often in higher percentiles for weight
Which infants require routine USS for DDH of hip at 6 weeks?
first-degree family history of hip problems in early life
breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
multiple pregnancy
Which TORCH infection is most commonly associated with chorioretinitis in a newborn?
Toxoplasmosis
A pregnant woman develops a rash that begins on her face and spreads to her body, accompanied by a low-grade fever and lymphadenopathy. What TORCH infection is she likely experiencing?
Rubella
Which TORCH infection is the most common congenital infection?
Cytomegalovirus
Which TORCH infection can cause hearing loss, vision impairment, LBW and microcephaly?
Cytomegalovirus
How can toxoplasmosis be caught?
By eating undercooked meat or contact with cat faeces containing the parasite toxoplasma gondii
In which TORCH infection might you find blueberry muffin spots in a newborn?
Rubella
These are congenital dermal haematopoeisis
Which TORCH infection is most likely responsible for intracranial calcifications, hydrocephalus and chorioretinitis?
Toxoplasmosis
Which TORCH infection is most likely responsible for congenital heart defects, deafness, cataracts?
Rubella
What is in the 6-in-1 vaccine?
Diphtheria
Pertussis
Polio
Hep B
HiB
Tetanus
What is in the 4-in-1 vaccine?
Diphtheria
Polio
Tetanus
Pertussis
What is in the 3-in-1 vaccine?
Polio
Tetanus
Diphtheria
What vaccines are given at 8 weeks?
6 in 1
Men B
Rotavirus
What vaccines are given at 12 weeks?
6 in 1
Rotavirus
PCV
What vaccines are given at 16 weeks?
6 in 1
Men B
What vaccines are given at 1 year?
PCV
MMR
Men B
HiB/Men C
What vaccines are given at 3 years and 4 months?
4 in 1 booster
MMR
What vaccines are given at 12-13 years?
HPV
What vaccines are given at 14 years?
Men ACWY
3 in 1 booster
What vaccines are given at 65 years?
Annual flu
Pneumococcal
Shingles (used to be 70 but now can be given at 65! At 50 if immunocompromised)
What type of vaccine is diphtheria?
Toxoid
What type of vaccine is pertussis?
Toxoid
What type of vaccine is oral polio?
Live attenuated
What type of vaccine is hepatitis B?
A subunit vaccine
What type of vaccine is HiB?
A conjugate vaccine
What type of vaccine is tetanus?
A toxoid
What type of vaccine is oral rotavirus?
A live attenuated vaccine
What type of vaccine is Men B?
A conjugate vaccine
What type of vaccine is PCV?
A conjugate vaccine
What type of vaccine is MMR?
A live attenuated vaccine
What type of vaccine is Men C?
A conjugate vaccine
What type of vaccine is HPV?
A subunit vaccine
What type of vaccine is Men ACWY?
A conjugate vaccine
What type of vaccine is influenza?
A live attenuated vaccine
For which hepatitis are there vaccines?
A
B
Which types of vaccines often require booster doses to maintain immunity?
Inactivated preparations
Toxoid
Subunit and conjugate
Examples of live attenuated vaccines?
BCG
MMR
Influenza intranasl
Oral rotavirus
Oral polio
Yellow fever
Oral typhoid
Examples of inactivated vaccines?
Rabies
Hep A
Influenza IM
Examples of toxoid vaccines?
Tetanus
Diphtheria
Pertussis
Examples of subunit and conjugate vaccines?
Pneumococcus
Haemophilus
Meningococcus
Hep B
HPV
Characteristics of innocent murmurs?
Soft blowing in pulmonary area or short buzzing in aortic area
Systolic - no diastolic component!
Symptomless - no thrill, added sounds, other abnormalities
Situation dependent - varies with posture
Types of innocent heart murmurs?
Venous hums
Stills murmur
What do venous hums sound like?
Continuous blowing murmurs heard just below the clavicles
What causes venous hums?
Turbulent blood flow in the great veins returning blood to the heart
What does a stills murmur sound like?
Low-pitched sound heard at the lower left sternal edge
Differentials of a pan systolic murmur?
MR
TR
VSD
Differentials of an ejection systolic murmur?
AS
Pulmonary stenosis
HOCM
What does VSD sound like? How does it present?
Pan systolic murmur heard at the left lower sternal border
Can present with failure to thrive or features of HF
What causes VSDs?
Congenital are associated with chromosomal disorders - downs, edwards, pataus, cri-du-chat. OR congenital infections
Can also be acquired e.g. post MI
What is the most likely congenital heart defect to be found in adulthood?
Atrial septal defects
Mortality of ASD?
50% by age 50
2 types of ASD and which is more common?
Ostium primum
Ostium secundum - more common 70%
Whats the murmur of ASDs?
Ejection systolic murmur with fixed splitting of S2
What is a fixed split second heart sound?
Splitting of the heart sound does not change with inspiration and expiration
This occurs in ASD as blood is flowing from L atrium into R atrium increasing the volume of blood the R ventricle has to empty before the pulmonary valve can close
Risk factors for PDA?
Prematurity
Being born at high altitude
Maternal rubella infection in first trimester
Features of PDA?
Left subclavicular thrill
Continuous machinery murmur
Large volume bounding collapsing pulse
Wide pulse pressure
Heaving apex beat
HF symptoms : SOB
Failure to thrive
Multiple respiratory infections
What is the most common type of cyanotic congenital heart disease?
Tetralogy of fallot
What are the 4 features of tetralogy of fallot?
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction = pulmonary stenosis
overriding aorta
What determines the degree of clinical severity in tetralogy of falloy?
The severity pf the right ventricular outflow tract obstruction
What murmur does tetralogy of fallot cause?
Ejection systolic loudest in pulmonary area due to pulmonary stenosis
CXR findings in tetralogy of fallot?
Boot-shaped heart
What are causes of cyanotic heart disease?
Tetralogy of Fallot
Transposition of the great arteries
Truncus arteriosus
Total anomalous pulmonary venous return
Tricuspid atresia
Ebsteins anomaly
What is acrocyanosis?q
Cyanosis around the mouth and extremities
Seen in healthy babies
Occurs immediately after birth and may persist for up to 48 hours
What causes transposition of the great arteries?
Caused by failure of the aorticopulmonary septum to spiral during septation which means the aorta leaves the R ventricle and pulmonary trunk leaves the L ventricle q
Who is at greater risk of transposition of the great arteries?
Children of diabetic mothers
What is eisenmengers syndrome?
Reversal of a L to R shunt in a congenital heart defect due to pulmonary hypertension (VSD, ASD, PDA)
What is Ebstein’s anomaly?
Congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle
What can cause Ebstein’s anomaly?
Exposure to lithium in utero
What do 80% of pts with Ebstein’s anomaly also have?
A patent foramen ovale or ASD
What can cause persistent or severe neonatal hypoglycaemia?
Preterm birth
Maternal DM
IUGR
Hypothermia
Neonatal sepsis
In born errors of metabolism
Beckwith-wiedemann syndrome
Nesidioblastosis
Why is transient neonatal hypoglycaemia normal?
Transition from placental nutrition to- may be issues with milk supply etc
Increased metabolism e.g. for maintaining body temp
Liver glycogen stores may take a while to activate
Organisms causing meningitis in children <3 months?
GBS
E. coli
Listeria monocytogenes
Organisms causing meningitis in children 1 month-6 years?
N. Meningitidis
Strep pneumoniae
H. Influenzas
Organisms causing meningitis in children >6 years?
N. Meningitidis
Strep pneumoniae
2 inherited causes of unconjugated hyperbilirubinaemia?
Gilberts syndrome
Crigler-najjar syndrome
2 inherited causes of conjugated hyperbilirubinaemia?
Dubin-Johnson syndrome
Rotor syndrome
When is jaundice in the newborn period considered pathological?
First 24 hours
Prolonged i.e. after 14 days (21 days if premature)
Causes of neonatal jaundice in the first 24 hours?
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency
Causes of prolonged neonatal jaundice?
Biliary atresia
Hypothyroidism
Galactosaemia
UTI
Breast milk jaundice
Prematurity i.e. immature liver function
Congenital infections e.g. CMV
Why is jaundice more common in breastfed babies?
Thought to be due to high concentrations of beta-glucuronidase = increased intestinal absorption of unconjugated bilirubin
Features of cystic fibrosis?
In the neonatal period there may be meconium ileus or prolonged jaundice
Recurrent chest infections
Malabsorption - steatorrhoea, FTT
Short stature
Delayed puberty
Infertility males, subfertility in females
Nasal polyps
Rectal prolapse due to bulky stools
What is a specific contraindication to lung transplantation in CF?
Chronic infection with burkholderia cepacia
Which organisms may colonise CF patients?
Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus
What is plagiocephaly?
Parallelogram shaped head often due to baby sleeping in the same position each night
What is bronchopulmonary dysplasia?
chronic lung disease of prematurity
Symptoms of cows milk protein intolerance?
regurgitation and vomiting
diarrhoea
urticaria, atopic eczema
‘colic’ symptoms: irritability, crying
wheeze, chronic cough
rarely angioedema and anaphylaxis may occur
Symptoms of measles?
Prodromal phase of irritability, conjunctivitis and fever
Koplik spots
Maculopapular rash that starts behind ears
Desquamation sparing palms & soles after a week
Symptoms of mumps?
Fever
Malaise and muscular pain
Parotitis - ear ache or pain on eating
Symptoms of rubella?
Prodrome of low grade fever
Maculopapualr rash that starts on face and spreads to body
Lymphadenopathy
Poor prognostic factors for ALL?
Age <2 or >10
WBC >20 at diagnosis
T or B cell surface markers
Non-Caucasian
Male sex
What is the prognosis of ALL in children?
For those <15, 90% will survive 5 years or more
Life-threatening signs of asthma?
PEFR <33%
Ox sats <92%
Normal pCO2
Silent chest
Cyanosis
Feeble respiratory effort
Shock
Exhaustion
Confusion
Coma
When can a child talk in short sentences of 3-5 words?
3 years
When can a child combine 2 words?
2 years
When can a child understand simple commands e.g. give it to mummy?
12-15 months
When does a child know and respond to their own name?
12 months
When can a child say mama and dada?
9 months
What is the triad of shaken baby syndrome?
Retinal haemorrhages
Subdural haematoma
Encephalopathy
Inheritance pattern of haemophilia?
X-linked recessive
What causes haemophilia A and B?
A - deficiency in factor 8
B - deficiency in factor 9
Investigation for slipped capital femoral epiphysis?
AP and lateral XR of both hips (as bilateral in 20%!)
What is diagnostic for SUFE on an XR of the hip?
Line of klein (lune drawn up the lateral edge of the femoral neck) fails to intersect the epiphysis
Where is the most commonly affected location for eczema in infants
Face and trunk
Where is the most commonly affected location for eczema in young children?
Extensor surfaces
Where is the most commonly affected location for eczema in older children?
Flexor surfaces and creases of face and neck
