Paediatrics Flashcards
What are the features of Wilm’s tumour (nephroblastoma)?
Abdominal mass
Painless haematuria
Flank pain
Fever, anorexia
What are the causes of aortic stenosis in children?
William’s syndrome
Coarctation of the aorta
Turner’s syndrome
What are the clinical features of Transposition of the great arteries (TGA)?
Clinical features
1) cyanosis
2) tachypnoea
3) loud single S2
4) prominent right ventricular impulse
5) ‘egg-on-side’ appearance on chest x-ray
What is the management of transposition of the great arteries?
1) maintenance of the ductus arteriosus with prostaglandins (Prostaglandin E1)
2) surgical correction is the definite treatment.
What is the management of unilateral undescended testes?
1) referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
2) orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
What is the management of bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
What are the causes of snoring in children?
1) obesity
2) nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
3) recurrent tonsillitis
4) Down’s syndrome
5) hypothyroidism
What is the treatment of ADHD in children?
1st line: Methylphenidate (SEs abdo pain, nausea, dyspepsia)
2nd line: lisdexamfetamine
Note in adults: Methylphenidate OR lisdexamfetamine
NOTE: these are cardio toxic so need baseline ECG. Also monitor height and weight evert 6 months
What are the Kocher criteria for septic arthritis in children?
1) fever >38.5 degrees C- 1pt
2) non-weight bearing- 1pt
3) raised ESR- 1pt
4) raised WCC- 1pt
What are the features of Tetraology of Fallot (ToF)?
Use mnemonic PROV
Pulmonary stenosis
Right Ventricular hypertrophy
Overriding aorta
Ventricular septal defect
Note: PS= ejection systolic murmur
CXR- boot-shaped heart
What is the management of Tetraology of Fallot (ToF)?
1) surgical repair is often undertaken in two parts
2) cyanotic episodes may be helped by beta-blockers to reduce infundibular spasm
What is benign Rolandic epilepsy?
1) seizures characteristically occur at night
2) seizures are typically partial (e.g. paraesthesia affecting the face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements)
3) the child is otherwise normal
Good prognosis- seizures stop by adolescence
What are the features of Patau’s syndrome and which chromosome is affected?
1) Microcephaly
2) Small eyes
3) Low-set ears
4) Cleft lip
5) Polydactyly
Trisomy 13
What are the features of Kawasaki’s disease?
1) Bilateral conjunctivitis
2) Cervical lymphadenopathy
3) Polymorphic rash
4) Cracked lips/strawberry tongue
5) Oedema/desquamation of the hands/feet
4 of the 5 must be present for >5 days
What is the management of Kawasaki’s disease?
1) High-dose aspirin
2) IV Ig
3) Echo
What is the main complication of Kawasaki’s disease?
Coronary artery aneurysm
What are the causes of jaundice in the neonate within the first 24 hours?
1) rhesus haemolytic disease
2) ABO haemolytic disease
3) hereditary spherocytosis
4) glucose-6-phosphodehydrogenase
What is normally the cause of neonatal jaundice from 2-14 days?
Normally physiological (more blood cells, more fragile blood cells and less developed liver function)
More common in breastfed babies
Causes of prolonged neonatal jaundice
1) Biliary atresia
2) Hypothyroidism
3) Galactosaemia
4) UTI
5) Breast milk jaundice
6) Prematurity
7) Congenital infections (e.g. CMV, toxoplasmosis)
What are the common causative organisms for meningitis in 0-3month olds?
1) Group B Streptococcus
2) E. coli and other Gram -ve organisms
3) Listeria monocytogenes
What are the common causative organisms for meningitis in 1 month- 6 year olds?
1) Neisseria meningitidis (meningococcus)
2) Streptococcus pneumoniae (pneumococcus)
3) Haemophilus influenzae
What are the common causative organisms for meningitis in those over 6 years old?
1) Neisseria meningitidis (meningococcus)
2) Streptococcus pneumoniae (pneumococcus)
What are the features of patent ductus arteriosus?
1) left subclavicular thrill
2) continuous ‘machinery’ murmur
3) large volume, bounding, collapsing pulse
4) wide pulse pressure
5) heaving apex beat
What is the management of patent ductus arteriosus?
Preterm:
1) expectant managament
2) Indomethacin or ibuprofen or paracetamol
Term:
Transcatheter PDA closure
What would you expect to see on X-Ray in transient tachypnoea of the newborn?
1) hyperinflation
2) fluid in the horizontal fissure
Note: supportive management and usually settles within 1-2 days
When can pregnant woman receive whooping cough vaccine?
16-32 weeks
What are complications of whooping cough?
subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures
What is the management of whooping cough?
1) Infants under 6 months admitted
2) Oral macrolide (clari, azithro, erythro) if consent within 21 days
3) Household contacts offered prophylaxis
4) Exclude from school until 48hrs after starting abx
What are the diagnostic criteria for whooping cough?
1) Paroxysmal cough.
2) Inspiratory whoop.
3) Post-tussive vomiting.
4) Undiagnosed apnoeic attacks in young infants.
What are the complications of measles?
otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis
subacute sclerosing panencephalitis
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis
What are the possible complications of Scarlet fever?
1) otitis media (most common)
2) rheumatic fever (20 days later)
3) acute glomerulonephritis (10 days later)
4) invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
What is the investigation for intussusception?
Ultrasound- may show target-like mass
What is the management of intussusception?
1st line: Air insufflation under radiological control
2nd line or if perotonitic: surgery
What are the major risk factor for Sudden Infant Death Syndrome (SIDS)?
1) prone sleeping
2) parental smoking
3) bed sharing
4) hyperthermia and head covering
5) prematurity
What are protective factors for Sudden Infant Death Syndrome (SIDS)?
1) Breastfeeding
2) Room sharing (obvs not bed sharing)
3) Use of dummies (pacifiers)
What acid-base balance is expected in pyloric stenosis?
hypochloraemic, hypokalaemic alkalosis
How is pyloric stenosis diagnosed?
Ultrasound
How is pyloric stenosis managed?
Ramstedt pyloromyotomy
What is the management of Perthe’s disease?
1) To keep the femoral head within the acetabulum: cast, braces
2) If less than 6 years: observation
3) Older: surgical management with moderate results
4) Operate on severe deformities
Which developmental congenital disorder presents with macrocephaly?
Fragile X
Which developmental congenital disorder presents with microcephaly?
Patau’s (Chr 13)
Edward’s
William’s (can be normal)
Cri du chat
What are the characteristics of an innocent murmur?
1) soft-blowing murmur in the
2) pulmonary area or short buzzing
3) murmur in the aortic area
4) may vary with posture
5) localised with no radiation
6) no diastolic component
7) no thrill
8) no added sounds (e.g. clicks)
9)asymptomatic child
10) no other abnormality
What is the emergency treatment in croup?
Oxygen
Nebulised adrenaline
What is the antibiotic management of meningitis in children?
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
What are the causes of cyanotic congenital heart disease?
1) Tetralogy of Fallot
2) transposition of the great arteries (TGA)
3) Tricuspid atresia
NOTE: Fallot’s is more common than TGA. However, at birth TGA is the more common lesion as patients with Fallot’s generally presenting at around 1-2 months
What are the risk factors for surfactant deficient lung disease (SDLD) in neonates?
1) male sex
2) diabetic mothers
3) Caesarean section
4) second born of premature twins
What are the X-Ray findings insurfactant deficient lung disease (SDLD)?
1) ‘ground-glass’ appearance
2) indistinct heart border
What are the risk factors for Hirschsprung’s?
Male (3x more)
Down’s syndrome
What is the investigation for diagnosis of Hirschprung’s?
Rectal biopsy: gold standard for diagnosis
What is the management of Hirschprung’s disease?
initially: rectal washouts/bowel irrigation
definitive management: surgery to affected segment of the colon
NOTE: 3x more common in males, associated with Down’s
What organism most commonly causes croup?
Parainfluenza
What is acrancyanosis?
- refers to cyanosis around the mouth and the extremities such as the hands and feet
- differentiated from other causes of peripheral cyanosis with significant pathology as it occurs immediately after birth in healthy infants.
- common finding and may persist for 24 to 48 hours.
What are the 3 findings in shaken baby syndrome?
1) Retinal Haemorrhage
2) Subdural Haemorrhage
3) Encephalopathy
What is the best investigation for reflux nephropathy?
micturating cystography
NOTE: DMSA scan may also be performed to look for renal scarring
