Paediatrics Flashcards
1
Q
Nocturnal Enuresis Management?
A
- Enuresis alarm: most effective non pharm treatment for primary enuresis. The alarm wakes the child as soon as wetness is detected, helping to condition them to wake up before wetting the bed. Consistency is key. May take 3-6 months to achieve results. Other behavioural therapies include bladder training, positive reinforcement, fluid management (avoid excessive caffeinated/sugary drinks in the evening)
- Pharm therapy: Desmopressin (Others (Imipramine, Oxybutynin)
- Psychosocial interventions: Addressing stressors (moving, family stress, bullying), family support.
- Treatment of underlying conditions (secondary enuresis): constipation, UTI, DM, Sleep apnea
2
Q
Nocturnal Enuresis General Management?
A
- Fluid intake
- Toileting patterns
- Lifting and waking
- Reward systems e.g. star charts
3
Q
Nocturnal Enuresis underlying causes?
A
- Constipation
- Diabetes
- UTI if recent onset
4
Q
Desmopressin MOA?
A
Vasopressin analogue
P.S hyponatraemia is an important side effect. Ensure fluid restriction to avoid water intoxication
5
Q
Desmopressin side effect?
A
Hyponatraemia
6
Q
‘Other’ Nocturnal Enuresis management?
A
- Imipramine
- Oxybutynin
7
Q
Imipramine MOA?
A
TCA
8
Q
Oxybutynin MOA?
A
Anticholinergic
9
Q
Nocturnal Enuresis Classification?
A
- Primary = never achieved continence
- Secondary = dry for at least 6m before
10
Q
Desmopressin for NE preferable?
A
Short term control e.g. sleepovers
11
Q
Child development referral points?
A
- Doesnt smile at 10 weeks
- Cannot sit unsupported at 12 months
- Cannot walk at 18 months
12
Q
Hand preference before 12 months?
A
Hand preference (or handedness) in infants typically does not become apparent before 12 months of age. In most children, clear hand preference develops gradually between 18 to 24 months and becomes firmly established by about 3 to 4 years.
Before 12 months, infants should use both hands equally for reaching, grasping, and exploring their environment.
*Abnormal: Neurological deficit (Cerebral Palsy) or other motor problems.
13
Q
Probability of septic arthritis in children criteria?
A
Kocher’s criteria
14
Q
Kocher’s criteria (1 point each)?
A
A set of clinical findings used to differentiate septic arthritis of the hip from transient tenosynovitis in children presenting with a painful hip.
- Non weight bearing on the affected side
- Fever > 38.5 (101.3 f)
- WCC > 12,000 cells/mm3
- ESR > 40 mm/hr
Interpretation
0 = <0.2% probability
1 = approx 3% probability
2 = approx 40% probability
3 = approx 93% probability
4 = approx 99% probability
15
Q
Kocher’s criteria score interpretation?
A
- Very low risk
- 3% probability
- 40% probability
- 93% probability
- 99% probability
16
Q
Septic arthritis children epidemiology?
A
- 4-5/100,000 children
- 2M:1F
17
Q
Septic arthritis most commonly affected joints?
A
HAK joints
Hip, knee, ankle
18
Q
Septic arthritis symptoms x4?
A
- Joint pain
- Limp
- Fever
- Systemically unwell: lethargy
19
Q
Septic arthritis signs x3?
A
MRS
- Swollen
- Red joint
- Minimal movement of affected joint
20
Q
Septic Arthritis Ix?
A
- Joint aspiration (for culture, WCCs)
- Bloods (raised inflammatory markers)
- Blood cultures
21
Q
Kawasaki disease diagnosis?
A
BCCOPS
Fever for >5 days + 4/5 of:
1. Bilateral conjunctivitis
2. Cervical lymphadenopathy
3. Cracked lips
4. Oedema/desquamation of hands/feet
5. Polymorphic rash
6. Strawberry tongue
22
Q
Kawasaki disease management?
A
- High dose aspirin
- IVIG
- Echo (for detecting Coronary Artery Abnormalities including aneurysms)
23
Q
Kawasaki disease complication?
A
Coronary artery aneurysm
24
Q
Why is aspirin C/I in children?
A
Reye’s syndrome
25
CXR in TTN?
Hyperinflation and fluid in the horizontal fissure
26
TTN pathophysiology?
Delayed resorption of fluid in the lungs
27
Commonest cause of respiratory distress in newborns?
TTN
28
What mode of birth is TTN more common in?
C-sections (lung fluid not being squeezed out during passage through the birth canal)
29
TTN Management?
1. Observation
2. Supportive care
3. Supplementary oxygen may be required
30
When does TTN usually settle?
1-2 days
31
Even if you suspect TTN what should be done?
Baby screened and treated for sepsis
32
RDS CXR findings?
Ground glass appearance and low volume lungs
33
Meconium aspiration syndrome CXR findings?
Asymmetric patchy opacities
34
Patau syndrome genetics?
Trisomy 13
35
Patau syndrome features?
*CMS-P
1. Microcephalic, small eyes
2. Cleft lip/palate
3. Polydactyly
4. Scalp lesions
36
Edward's syndrome genetics?
Trisomy 18
37
Edward's syndrome features?
*MICRO*
1. Micrognathia
2. Low set (inserted) ears
3. Clenched hands (overlapping fingers)
4. Rocket bottom feet
5. Odd facial features (prominent occiput)
38
Fragile X features?
2M-3L
1. Learning difficulties
2. Macrocephaly
3. Long face
4. Large ears
5. Macro-orchidism
39
Noonan syndrome features?
2PHC-TSW
1. Webbed neck
2. Pectus excavatum (sometimes, carinatum or scoliosis)
3. Short stature
4. Pulmonary stenosis
*Triangular face with broad forehead
*Hypertelorism
*Cryptochidism
40
Pierre-Robin syndrome features?
*PCM
1. Micrognathia
2. Posterior displacement of the tongue (may result in upper airway obstruction)
3. Cleft palate
41
Prader-Willi syndrome features?
3-H
*loss of fxn, usually deletion, of specific genes on Chromosome 15
1. Hypotonia
2. Hypogonadism
3. Hyperphagia and Obesity
42
William's syndrome features?
*My short, learning, friendly, hearty, and calcemic friend, Williams*
1. Short stature
2. Learning difficulties
3. Friendly, extrovert personality
4. Transient neonatal hypercalcaemia
5. Supravalvular aortic stenosis
43
Cri du chat syndrome genetics?
*Chromosome 5p deletion
*Characteristic Cry: A high-pitched, cat-like cry in infancy (due to abnormal laryngeal development). This feature often diminishes with age.
44
Cri du chat syndrome features?
1. Characteristic cry due to larynx and neurological problems
2. Feeding difficulties and poor weight gain
3. Learning difficulties
4. Microcephaly and micrognathism
5. Hypertelorism
45
Difference between Pierre-Robin and Treacher-Collins syndrome?
TC syndrome is AD so usually FHx of similar problems
46
Acute epiglottitis cause?
Haemophilus Influenzae type B
47
Why acute epiglottitis decreased?
Introduction of HiB vaccine
48
Acute epiglottitis features x5?
1. Rapid onset
2. High temp, generally unwell
3. Stridor
4. Drooling of saliva
5. Tripod position (a classic posture often assumed by children with acute epiglottitis)
49
Acute epiglottitis Ix?
XR if concern about foreign body
50
Acute epiglottitis XR findings?
Lateral view will show swelling of epiglottis = Thumb sign
51
Croup XR findings?
PA view will show subglottic narrowing = Steeple sign
52
Croup Rx?
1. Immediate senior involvement, endotracheal intubation may be necessary to protect airway
2. Oxygen
3. IV Abx
4. Do NOT examine throat (in order not to worsen airway obstruction)
53
Asthma 5-16 y/o Rx?
1. SABA
2. SABA + Low dose Inhaled ICS
3. SABA + LD ICS + LTRA
4. SABA + LD ICS + LABA
5. SABA + MART
6. SABA + MD ICS + MART
7. SABA + (HD ICS as part of fixed dose regime or MART/trial of additional drug e.g. theophylline/refer to expert)
54
When should you prescribe SABA + LD ICS in asthma 5-16 y/o?
1. Not controlled on previous step OR
2. Newly diagnosed asthma with >=3/week or night time waking
55
Asthma <5 y/o Rx?
1. SABA
2. SABA + 8 week MD ICS (3 offshoots)
3. SABA + LD ICS + LTRA
4. Stop LTRA and refer to paediatric asthma specialist
56
Asthma <5y/o Step 2 Offshoots?
1. If symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely
2. If symptoms resolved then reoccurred within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy
3. If symptoms resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8‑week trial of a paediatric moderate dose of ICS
57
What is MART?
1. Maintenance and Reliever Therapy
2. A form of combined ICS and LABA treatment in which a single inhaler, containing both ICS and a fast-acting LABA, is used for both daily maintenance therapy and the relief of symptoms as required
3. MART is only available for ICS and LABA combinations in which the LABA has a fast-acting component (for example, formoterol)
58
LD ICS dose?
<= 200mcg budesonide or equivalent
59
MD ICS dose?
200-400mcg budesonide or equivalent
60
HD ICS dose?
>400mcg budesonide of equivalent
61
DDH risk factors?
1. 6F:1M
2. Breech
3. FHx
4. Firstborn
5. Oligohydramnios
6. >5kg
7. Congenital calcaneovalgus foot deformity
62
DDH hip preference?
1. Left hip
2. 20% bilateral
63
DDH screening?
1. Clinically at newborn and 6 week baby check using Barlow and Ortolani Tests
2. US for 3 conditions
64
DDH US screening at 6 weeks?
1. 1st degree FHx of hip problems in early life
2. Breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
3. Breech presentation at delivery if earlier than 36 weeks
4 Multiple pregnancy
65
DDH clinical examination?
1. Barlow = dislocate an articulated femoral head
2. Ortolani = relocate a dislocated femoral head
3. Others = leg length symmetry, level of knees when hips and knees bilaterally flexed, restricted abduction of the hip in flexion
66
DDH imaging?
1. US if clinically suspected
2. If Infant > 4.5 months then XR 1st line
67
DDH Rx?
1. Most unstable hips will spontaneously stabilise by 3-6 weeks of age
2. Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
3. Older children may require surgery
68
Serum markers in severe asthma?
IL-6 and MMP-9
69
Commonest cause of vomiting in infancy?
GORD
70
GORD risk factors?
1. Pre-term delivery
2. Neurological disorders
71
GORD features?
1. Typically develops before 8 weeks
2. Vomiting/regurgitation following feeds
72
GORD diagnosis?
Clinical
73
GORD Rx?
1. 30 degree head up during feed
2. Sleep on back
3. Smaller and more frequent feeds
4. Trial of thickened formula
5. Trial of alginates (Gaviscon), not at same time as thickening agents
6. PPI with certain criteria
7. Metoclopramide only used with specialist advice
74
GORD PPI criteria?
1. Unexplained feeding difficulties (refusing feeds/gagging/choking)
2. Distressed behaviour
3. Faltering growth
75
GORD complications?
FFADD
1. Distress
2. FTT
3. Aspiration
4. Frequent OM
5. Dental erosion in older children
76
GORD fundoplication consideration?
If severe complications e.g. FTT and Medical Rx ineffective
77
Bronchiolitis most common cause?
RSV in 75-80%
78
Bronchiolitis epidemiology?
90% in 1-9m, peak incidence 3-6 months
79
What protects newborns against RSV?
Maternal IgG
80
Other causes of bronchiolitis?
1. RSV
2. Mycoplasma, adenovirus
81
When is bronchiolitis more severe?
PCC
1. Premature (bronchopulmonary dysplasia)
2. Congenital heart disease
3. Cystic fibrosis
82
Bronchiolitis features?
Coryzal symptoms incl. mild fever precede:
1. Dry cough
2. Increasing SOB
3. Wheezing, fine inspiratory crackles
83
Bronchiolitis referral criteria?
1. Apnoea
2. Looks unwell
3. Respiratory distress
4. RR > 70 breaths/min
5. Central cyanosis
6. SpO2 <92%
84
Bronchiolitis Ix?
Immunofluorescence of nasopharyngeal secretions may show RSV
85
Bronchiolitis Rx?
Supportive
1. Humidified oxygen via head box if SpO2 <92%
2. NG feed if indicated
3. Suction sometimes used for excessive upper airway secretions
86
What should be recorded in all febrile children?
1. Temp
2. HR
3. RR
4. CRT
5. Signs of dehydration
87
CF genetics?
-AR inheritance.
-The CFTR gene (Cystic Fibrosis Transmembrane Conductance Regulator) encodes a cAMP-regulated chloride channel located on the apical surface of epithelial cells in various tissues, including the lungs, pancreas, sweat glands, and intestines.
-It plays a crucial role in maintaining the balance of salt and water across epithelial membranes
88
4 organisms which may colonise CF patients?
1. S. aureus
2. P. aeruginosa
3. B. cepacia
4. Aspergillus
*Burkholderia cepacia
89
Hand, foot and mouth disease cause?
Coxsackie A16 and Enterovirus 71
90
HFM disease features?
1. Mild systemic upset = sore throat, fever
2. Oral ulcers
3. Vesicles on palms and soles of the feet
91
HFM disease Rx?
1. Symptomatic (hydration and analgesia)
2. No link to cattle disease
3. Do not need to be excluded from school
92
Immunisations at birth?
BCG if risk factor
93
Immunisations at 2 months?
1. '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
2. Oral rotavirus vaccine
3. Men B
94
Immunisations at 3 months?
1. '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
2. Oral rotavirus vaccine
3. PCV
95
Immunisations at 4 months?
1. '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
2. Men B
96
Immunisations at 12-13 months?
1. Hib/Men C
2. MMR
3. PCV
4. Men B
97
Immunisations at 2-8 years?
Flu vaccine (annual)
98
Immunisations at 3-4 years?
1. '4-in-1 pre-school booster' (diphtheria, tetanus, whooping cough and polio)
2. MMR
99
Immunisations at 12-13 years?
HPV vaccine
100
Immunisations at 13-18 years?
1. '3-in-1 teenage booster' (tetanus, diphtheria and polio)
2. Men ACWY
101
Croup main cause?
Parainfluenza virus
102
Croup epidemiology?
6m - 3y
More common in autumn
103
Croup features?
1. Stridor
2. Barking cough (worse at night)
3. Fever
4. Coryzal symptoms
104
Croup admission features?
1. Any child with moderate or severe croup
2. <6 m/o
3. Known upper airway abnormalities e.g. laryngomalacia, Down's
4. Uncertainty about diagnosis
105
Croup Rx?
Single dose oral dexamethasone 0.15mg/kg to all children regardless of severity
106
Emergency croup Rx?
1. High flow O2
2. Nebulised adrenaline
107
Hypospadia characteristics?
1. Ventral urethral meatus
2. Hooded prepuce
3. Chordee in more severe forms
4. Urethral meatus may open more proximally in more severe variants
108
Hypospadia managament?
1. Referral to specialist when identified.
2. Corrective surgery usually at 12 m/o.
3. Essential not to circumcised prior to surgery. (This is because the foreskin is often used as a critical tissue source -graft material- during the surgical repair).
4. Rx may not be needed in very distal disease.
109
Commonest gynaecological disorder in (prepubertal) girls?
Vulvovaginitis
110
Vulvovaginitis Rx?
1. Advise about hygiene
2. Soothing creams may be useful
3. Topical Abx/antifungals
4. Oestrogen cream in resistant cases
111
When does mucoid white vaginal discharge disappear?
3m of age
*Typically disappears by 2–3 months of age as maternal estrogen levels in the baby decline.
112
CMPI/CMPA epidemiology?
3-6% of all children and typically presents in the first 3 months of life in formula-fed infants, although rarely it is seen in exclusively breastfed infants
113
CMPI vs. CMPA IgE status?
Both IgE mediated (immediate) and delayed (non-IgE mediated reactions are seen)
CMPI = mild-moderate delayed reactions
CMPA = immediate reactions
114
CMPI/CMPA features?
1. Regurgitation and vomiting
2. Diarrhoea
3. Urticaria, atopic eczema
4. 'Colic' symptoms: irritability, crying
5. Wheeze, chronic cough
6. Rarely angioedema and anaphylaxis may occur
115
CMPI/CMPA Dx?
Often clinical, e.g. improvement with CMP elimination
116
CMPI/CMPA Ix?
1. Skin prick/patch testing
2. Total IgE and specific IgE (RAST) for cow's milk protein
117
CMPI/CMPA management classification?
1. Formula fed
2. Breastfed
118
CMPI/CMPA formula fed management?
1. Extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms
2. Amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF
3. Around 10% of infants are also intolerant to soya milk
119
CMPI/CMPA breastfed management?
1. Continue breastfeeding
2. Eliminate cow's milk protein from maternal diet. Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet
3. Use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
120
CMPI prognosis?
1. CMPI usually resolves in most children
2. In children with IgE mediated intolerance around 55% will be milk tolerant by the age of 5 years
3. In children with non-IgE mediated intolerance most children will be milk tolerant by the age of 3 years
4. A challenge is often performed in the hospital setting as anaphylaxis can occur.
121
Labial adhesion definition?
Fusion of the labia minora in the midline
122
Labial adhesion epidemiology?
1. 3m - 3y/o
123
Labial adhesion features?
Majority of cases are symptomatic
1. Micturition problems incl. vaginal pooling
2. On examination thin semitranslucent adhesions covering the vaginal opening between the labia minora are seen, which sometimes cover the vaginal opening completely
124
Labial adhesion Rx?
1. Usually conservative (spontaneous resolution around puberty)
2. If associated problems e.g. UTI --> oestrogen cream
3. If this fails surgical intervention may be warranted
125
Labial adhesion cause?
Low level of oestrogen
126
Umbilical embryology?
During development the umbilicus has two umbilical arteries and one umbilical vein. The arteries are continuous with the internal iliac arteries and the vein is continuous with the falciform ligament (ductus venosus). After birth, the cord dessicates and separates and the umbilical ring closes.
127
Umbilical hernia?
1. 20% neonates
2. Majority will close within 12m-3y
3. Strangulation rare
128
Paraumbilical hernia?
1. Defect in linea alba close to umbilicus
2. Edge more clearly defined than umbilical hernia
3. Less likely to resolve than umbilical hernia
129
Omphalitis?
1. Infection of the umbilicus, usually S. Aureus
130
Why is omphalitis dangerous?
Infection may spread through umbilical vessels with risk of portal pyaemia and portal vein thrombosis
131
Omphalitis Rx?
Topical and systemic Abx
132
Umbilical granuloma?
1. Cherry red lesions surrounding the umbilicus, may bleed on contact and be a site of seropurulent discharge
2. Infection is unusual
133
Umbilical granuloma Rx?
1. Regular application of salt to wound
2. Chemical cautery with topically applied silver nitrate
134
Persistent urachus?
1. Urinary discharge from umbilicus
2. Caused by persistence of urachus which attaches to the bladder
3. Associated with other urogenital abnormalities
135
Persistent vitello-intestinal duct?
1. Umbilical discharge that discharges small bowel content
2. Complete persistence of duct is rare
3. More common is persistence of part of duct (Meckel's)
4. Best imaged using contrast study to delineate anatomy
5. Managed by laparotomy and surgical closure
136
Jaundice in first 24 hours?
Always pathological
137
Causes of Jaundice in first 24 hours?
1. Rhesus haemolytic disease
2. ABO haemolytic disease
3. Hereditary spherocytosis
4. G6PDD
138
Causes of jaundice from 2-14 days?
1. Common (up to 40%), usually physiological. Due to more RBCs, more fragile RBCs, and less developed liver function
2. More commonly seen in breastfed babies
139
Jaundice after 14 days Ix?
Prolonged jaundice screen (>21 days if premature)
1. Conjugated and unconjugated bilirubin
2. DAT (Coombs)
3. FBC, U&E, LFT, TFT, blood film
4. Urine for MC&S and reducing sugars
140
Meningococcal septicaemia benzylpenicillin community doses?
1. <1 y/o = 300mg
2. 1-10 y/o = 600mg
3. >10 years = 1200mg
141
Brushfield spots?
Down's syndrome
142
Coloboma?
1. Defect causing gap in lens, iris or retina
2. Associated with Patau syndrome
143
Down's features?
1. Face = upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
2. Flat occiput
3. Single palmar crease, sandal gap
4. Hypotonia
5. Congenital heart defects (40-50%)
6. Duodenal atresia
7. Hirschprung's disease
144
Down's cardiac complications?
1. Endocardial cushion defect (most common, 40%, AKA atrioventricular septal canal defect)
2. VSD (30%)
3. Secundum ASD (10%)
4. Tetralogy of Fallot (5%)
5. Isolated PDA (5%)
145
Down's fertility?
1. Males = almost always infertile due to impaired spermatogenesis
2. Females = usually subfertile and have an increased incidence of problems with pregnancy and labour
146
Down's other features?
1. LD
2. Short stature
3. Repeated respiratory infections and glue ear
4. ALL
5. Hypothyroidism
6. Alzheimer's disease
7. Atlanto-axial instability
147
5 normal lower limb variants in children?
1. Flat feet (pes planus)
2. In toeing
3. Out toeing
4. Bow legs (genu varum)
5. Knock knees (genu valgum)
148
Flat feet mushkies?
1. Present at all ages
2. Absent medial arch on standing
3. Typically resolves b/w 4-8 y/o, orthotics not recommended, parental reassurance appropriate
149
In toeing mushkies?
1. Typically presents in 1st year
2. Possible causes = metatarsus adductus, internal tibial torsion, femoral anteversion
150
Out toeing mushkies?
1. Common in infancy and usually resolves by 2 y/o
2. Usually due to external tibial tosion
3. Intervention may be appropriate if doesnt resolve as increases risk of patellofemoral pain
151
Bow legs mushkies?
1. Presents in 1st-2nd year
2. Increased intercondylar distance
3. Typically resolves by age of 4-5 years
152
Knock knees mushkies?
1. Presents in 3rd-4th year
2. Increased intermalleolar distance
3. Typically resolves spontaneously
153
Most common cause of cyanotic CHD?
Tetralogy of Fallot
154
Tetralogy of Fallot time of presentation?
1-2 months, although may not be picked up until 6 months old
155
ToF x4?
1. VSD
2. RVH
3. PS
4. OA
156
Features of ToF?
1. Right to left shunt
2. Ejection systolic murmur due to PS
3. Right sided aortic arch in 25%
157
ToF Cyanosis mushkies?
1. Unrepaired TOF infants may develop episodic hypercyanotic 'tet' spells due to near occlusion of the right ventricular outflow tract
2. Features of tet spells include tachypnoea and severe cyanosis that may occasionally result in loss of consciousness
3. They typically occur when an infant is upset, is in pain or has a fever
158
ToF CXR?
Boot shapes heart
159
ToF ECG?
RVH
160
ToF management?
1. Surgical repair often undertaken in two parts
2. Cyanotic episodes may be helped by BB to reduce infundibular spasm
161
Chondromalacia patellae mushkies?
1. Softening of the cartilage of the patella
2. Common in teenage girls
3. Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
4. Usually responds to physiotherapy
162
Osgood-Schlatter disease (tibial apophysitis) mushkies?
1. Seen in sporty teenagers
2. Pain, tenderness and swelling over the tibial tubercle
163
Osteochondritis dissecans mushkies?
1. Pain after exercise
2. Intermittent swelling and locking
164
Patellar subluxation mushkies?
1. Medial knee pain due to lateral subluxation of the patella
2. Knee may give way
165
Patellar tendonitis mushkies?
1. More common in athletic teenage boys
2. Chronic anterior knee pain that worsens after running
3. Tender below the patella on examination
166
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
167
Respiratory distress syndrome (RDS) AKA?
1. Surfactant lung deficient disease (SDLD)
2. Hyaline membrane disease (HMD)
168
SDLD cause?
Insufficient surfactant production and structural immaturity of the lungs
169
SDLD prevalence?
1. 50% born at 26-28 weeks
2. 25% born at 30-31 weeks
170
Risk factors for SDLD?
1. Male sex
2. Diabetic mothers
3. C-section
4. Second born of premature twins
171
SDLD CXR?
Ground glass appearance with indistinct heart border
172
SDLD clinical features?
Similar to respiratory distress in the newborn i.e. tachypnoea, intercostal recession, expiratory grunting and cyanosis
173
SDLD management?
1. Prevention during pregnancy = maternal corticosteroids to induce fetal lung maturations
2. Oxygen
3. Assisted ventilation
4. Exogenous surfactant given via endotracheal tube
174
Caffeine in newborn babies?
Used as a respiratory stimulant
175
Sildafenil in neonates?
Pulmonary hypertension
176
Speech and hearing 3m?
Quietens to parents voice, turns towards sound, squeals
177
Speech and hearing 9m?
Mama and Dada
Understands no
178
Speech and hearing 12m?
Knows and responds to own name
179
Speech and hearing 12-15m?
Knows 2-6 words, understands simple commands
180
Speech and hearing 2y?
Combines two words, points to parts of the body
181
Speech and hearing 2.5y?
Vocabulary of 200 words
182
Speech and hearing 3y?
Talks in short sentences (e.g. 3-5 words)
Asks 'what' and 'who' questions
Identifies colours
Counts to 10 (little appreciation of numbers though)
183
Speech and hearing 4y?
Asks why, when, how questions
184
Gross motor 3m?
Little or no head lag on being pulled to sit
Lying on abdomen, good head control
Held sitting, lumbar curve
185
Gross motor 6m?
Lying on abdomen, arms extended
Lying on back, lifts and grasps feet
Pulls self to sitting
Held sitting, back straight
Rolls front to back
186
Gross motor 7-8 months?
Sits without support (refer at 12 months)
187
Gross motor 9m?
Pulls to standing, crawls
188
Gross motor 12m?
Cruises, walks with one hand held
189
Gross motor 13-15m?
Walks unsupported (refer at 18 months)
190
Gross motor 18m?
Squats to pick up a toy
191
Gross motor 2y?
Runs
Walks upstairs and downstairs holding on to rail
192
Gross motor 3y?
Rides a tricycle using pedals
Walks up stairs without holding on to rail
193
Gross motor 4y?
Hops on one leg
194
When should you consider pneumonia over bronchiolitis?
High fever (>39 degrees) and/or persistently focal crackles
195
Most common cause of nephrotic syndrome in children?
Minimal change disease
196
Nephrotic syndrome triad?
1. Proteinuria (>1g/m^2 per 24 hours)
2. Hypoalbuminaemia (<25g/l)
3. Oedema
197
Minimal change disease management?
90% cases responding to high dose oral steroids
198
Minimal change disease peak incidence age?
2-5 y/o
199
Other features of nephrotic syndrome?
1. Hyperlipidaemia
2. Hypercoagulable state (due to loss of antithrombin III)
3. Predisposition to infection (due to loss of Igs)
200
ADHD epidemiology?
1. 2x autism, 4M:1F
2. Most diagnosed 3-7 y/o
3. Possible genetic component
201
ADHD triad?
1. Inattention
2. Hyperactivity
3. Impulsivity
202
ADHD diagnosis?
1. 6 features up to 16 y/o
2. 5 features > 17 y/o
203
ADHD management?
1. Ten week watch and wait period
2. If persists then referral to secondary care
3. Mild/moderate = parents attending education and training programmes
4. Methylphenydate on a 6 week trial basis
5. If inadequate response switch to lisdexamfetamine
6. Dexamfetine if cant tolerate lisdexamfetamine side effects
204
Age at which methylphenidate can be started?
> 5 y/o
205
Methylphenidate MOA?
CNS stimulant which primarily acts as a dopamine/noradrenaline reuptake inhibitor
206
Methylphenidate s/e?
Abdominal pain, nausea, dyspepsia
207
Methylphenidate monitoring?
Weight and height monitored every 6 months
208
Adult ADHD medication?
1. Methyphenidate or lisdexamfetamine are first line options, switch between these drugs if no benefit is seen after a trial of the other
209
Methylphenidate heart effects?
1. Cardiotoxic
2. Perform baseline ECG before Rx, refer to cardiologist if any doubt
210
Gastroschisis definition?
Congenital defect in the anterior abdominal wall just lateral to the umbilical cord
211
Gastroschisis managament?
1. Vaginal delivery may be attempted
2. Newborns should go to theatre ASAP after delivery e.g. within 4 hours
212
Exomphalos (omphalocoele) definition?
Abdominal continents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by the amniotic membrane and peritoneum
213
Exomphalos associations?
1. Beckwith-Wiedamann syndrome
2. Down's syndrome
3. Cardiac and kidney malformations
214
Exomphalos management?
1. C-section indicated to reduce risk of sac rupture
2. Staged repair may be undertaken as primary closure may be difficult due to high intra-abdominal pressure
215
Is gastroschisis associated with other tings?
Tends to be a stand-alone medical condition
216
What is palivizumab?
mAb used to prevent RSV in those at increased risk of disease
217
SUFE mushkies?
1. Typically obese boys 10-15 years
2. Displacement of femoral head epiphysis postero-inferiorly
3. May present acutely following trauma or more commonly with chronic, persistent symptoms
218
SUFE features?
1. Hip, groin or medial thigh or knee pain
2. Loss of internal rotation of the leg in flexion
3. Bilateral slip in 20% cases
219
SUFE Ix?
AP and lateral (typically frog-leg) views diagnostic
220
SUFE Rx?
Internal fixation: typically a single cannulated screw placed in the centre of the epiphysis
221
Aortic stenosis associations?
1. William's syndrome
2. Coarctation of the aorta
3. Turner's syndrome
222
Management of aortic stenosis in children?
1. Aim is to avoid or delay valve replacement if possible
2. If gradient across valve is >60mmh Hg then balloon valvotomy may be indicated
223
Meconium aspiration syndrome mushkies?
1. More common in post-term, 44% in babies born after 42 weeks
2. Higher rates occur in Hx of maternal HTN, pre-eclampsia, chorioamnionitis, smoking or substance abuse
224
Milk ladder?
1. Malted milk biscuits
2. Digestive biscuits
3. Chocolate and yoghurt
225
Haemorrhagic disease of the newborn mushkies?
1. Newborn babies relatively deficient in Vit K, may result in impaired production of clotting factors which can lead to HDN
226
Increased risk of HDN?
1. Breastfed babies
2. Maternal use of antiepileptics
227
How to reduce risk of HDN?
All newborns in Uk are offered Vitamin K
228
Measuring BP in children?
1. Correct cuff size is approximately 2/3 the length of the upper arm
2. 4th Korotkoff sound is used to measure the diastolic blood pressure until adolescence, when the 5th Korotkoff sound can be used
3. Results should be compared with a graph of normal values for age
229
Most common cause of HTN in younger children?
Secondary HTN, with renal parenchymal disease accounting for up to 80%
230
Causes of HTN in children?
1. Renal = parenchymal/vascular disease
2. Coarctaction of the aorta
3. Phaeochromocytoma
4. Congenital adrenal hyperplasia
5. Essential/Primary (more common as children become older)
231
Bartter's syndrome definition?
Autosomal recessive cause of severe hypokalaemia due to defective chloride absorption at the NaK2Cl cotransported in the ascending loop of Henle, associated with normotension
232
Bartter's syndrome features?
1. Usually presents in childhood with e.g. failure to thrive
2. Polyuria, polydipsia
3. Hypokalaemia
4. Normotension
5. Weakness
233
Meningitis cause in neonatal to 3m?
1. GBS
2. E. coli and other gram -ves
3. Listeria monocytogenes
234
Meningitis cause in 1m to 6y?
1. N. meningitidis
2. S. pneumoniae
3. H. Influenzae
235
Meningitis cause in >6 years?
1. N. meningitidis
2. S. pneumoniae
236
Chickenpox muskies?
1. Fever initially
2. Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
3. Systemic upset is usually mild
237
Measles mushkies?
1. Prodrome: irritable, conjunctivitis, fever
2. Koplik spots: white spots ('grain of salt') on buccal mucosa
3. Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
238
Mumps mushkies?
1. Fever, malaise, muscular pain
2. Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
239
Rubella mushkies?
1. Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
2. Lymphadenopathy: suboccipital and postauricular
240
Erythema infectiosum mushkies?
1. Also known as fifth disease or 'slapped-cheek syndrome'
2. Caused by parvovirus B19
3. Lethargy, fever, headache
4. 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
241
Scarlet fever mushkies?
1. Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
2. Fever, malaise, tonsillitis
3. 'Strawberry' tongue
4. Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
242
When does TGA tend to present?
Within first 24 hour of life
243
Umbilical hernia associations?
1. Afro-Caribbean infants
2. Down's syndrome
3. Mucopolysaccharide storage disease
244
RDS with CPAP risk?
Pneumothorax
245
Contraindications to LP?
Any signs of ICP
1. Focal neurological signs
2. Papilloedema
3. Significant bulging of the fontanelle
4. DIC
5. Signs of cerebral herniation
246
LP in meningococcal septicaemia?
Contraindicated - blood cultures and PCR for meningococcus should be obtained
247
Meningitis management?
1. Abx
2. Steroids
3. IVF
4. Cerebral monitoring (mechanical ventilation if respiratory impairment)
5. Public health notification and antibiotic prophylaxis of contacts (ciprofloxacin preferred over rifampicin)
248
Meningitis Abx?
1. < 3m = IV Amoxicillin/ampicillin + IV Cefotaxime
2. > 3m = IV Cefotaxime (or ceftriaxone)
249
Meningitis steroids?
1. Not for children under 3 years
2. Dexamathasone considered if LP: frankly purulent, >1000/microlitre, protein >1g/litre, bacteria on gram stain
250
Benign Rolandic epilepsy age?
4-12 years
251
Benign Rolandic Epilepsy features?
1. Night time
2. Typically partial but secondary generalisation may occur
3. Child is otherwise normal
252
Benign Rolandic Epilepsy EEG?
Centro-temporal spikes
253
Bengin Rolandic Epilepsy prognosis?
Excellent, seizures stopping by adolescence
254
Precocious puberty definition?
Development of secondary sexual characteristics before 8 years in females and 9 years in males
255
Thelarche?
Breast development
256
Adrenarche?
Pubic hair development
257
Precocious puberty classification?
1. Gonadotrophin dependent (central/true)
2. Gonadotrophin independent (pseudo/false)
258
Gonadotrophin dependent precocious puberty?
1. Due to premature activation of the hypothalamo-pituitary-gonadal axis
2. FSH and LH raised
259
Gonadotrophin independent precocious puberty?
1. Due to excess sex hormones
2. FSH and LH low
260
Male precocious puberty mushkies?
Uncommon and usually has an organic cause, testes:
1. Bilateral enlargement = gonadotrophin release from intracranial lesion
2. Unilateral enlargement = gonadal tumour
3. Small tests = adrenal cause (tumour or hyperplasia)
261
Female precocious puberty causes?
1. Usually idiopathic or familial and follows normal sequence of puberty
2. Organic = rare, associated with rapid onset, neurological symptoms and signs and dissonance e.g. McCune-Albright Syndrome
262
Precocious puberty definition?
Development of secondary sexual characteristics before 8 years in girls and 9 year in boys
263
Pyloric stenosis epidemiology?
1. 4/1000
2. 4M:1F
3. 10% FHx
4. 1st borns more commonly affected
264
Pyloric stenosis presentation age?
1. Usually in 2nd-4th weeks of life with vomiting, although rarely may present later at up to 4 months
265
Pyloric steneosis features?
1. Projectile vomiting, 30 mins after feed
2. Constipation and dehydration
3. Palpable mass in upper abdomen
266
Pyloric stenosis gas?
Hypochloraemic, hypokalaemic metabolic alkalosis
267
Pyloric stenosis diagnosis?
Ultrasound
268
Pyloric stenosis management?
Ramstedt's Pyloromyotomy
269
Paediatric BLS 2015 changes?
1. Lay rescuers should use 30:2, if there are two or more rescuers with duty to respond then 15:2
2. Infant <1 y/o, child 1y-puberty
270
Paediatric BLS algorithm?
1. 5 rescue breaths
2. Check for signs of circulation (infants use brachial or femoral pulse, children use femoral pulse)
3. 15:2 compressions at 100-120/min, depress the lower half of the sternum by at least one-third of the anterior–posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child). In children: compress the lower half of the sternum. In infants: use a two-thumb encircling technique for chest compression
271
IgE mediated allergy investigation?
Skin prick test or blood tests for specific IgE antibodies to the suspected foods and likely co-allergens
272
Non IgE mediated allergy investigation?
Eliminate the suspected allergen for 2-6 weeks, then reintroduce. NICE advise to 'consult a dietitian with appropriate competencies about nutritional adequacies, timings and follow-up'
273
Commonest cause of death in 1st year of life?
SIDS. Most common at 3m of age.
274
SIDS main RFs?
1. Prone sleeping
2. Parental smoking
3. Bed sharing
4. Hyperthermia and head covering
5. Prematurity
275
SIDS side RFs?
1. Male sex
2. Multiple births
3. Social classes IV and V
4. Maternal drug use
5. Incidence increases in winter
276
SIDS protective factors?
1. Breastfeeding
2. Room sharing
3. Dummies
277
Following cot death siblings?
Siblings should be screened for potential sepsis and IEM
278
NEC features?
1. Initial symptoms = feeding intolerance, abdominal distension and bloody stools
2. Can quickly progress to abdominal discoloration, perforation and peritonitis
279
NEC AXR?
1. Bilateral bowel loops (often asymmetrical)
2. Bowel wall oedema
3. Pneumatosis intestinalis (intramural gas)
4. Portal venous gas
5. Pneumoperitoneum resulting from perforation
6. Rigler's sign
7. Football sign = air outlining the falciform ligament
280
Dance's sign?
Emptiness in the right lower
281
Dance's sign?
Emptiness in the right lower quadrant in intussusception
282
Measles overview?
1. RNA paramyxovirus
2. One of the most infectious known viruses
3. Spread by aerosol transmission
4. Infective from prodrome until 4 days after rash starts
5. Incubation period = 10-14 days
283
Measles features?
1. Prodromal phase = irritable, conjunctivitis, fever
2. Koplik spots = typically develop before the rash, white spots on the buccal mucosa (grains of salt)
3. Eash = starts behind ears then whole body, discrete maculopapular rash becoming blotchy and confluent, desquamation that typically spares the palms and soles and may occur after a week
4. Diarrhoea in 10%
284
Measles Dx?
IgM antibodies can be detected within a few days of rash onset
285
Measles Dx?
IgM antibodies can be detected within a few days of rash onsetMeasles management/
286
Measles Rx?
1. Mainly supportive
2. Admission may be considered in immunosuppressed or pregnant patients
3. Notifiable disease --> inform public health
287
Measles complications?
1. Otitis media = most common
2. Pneumonia = most common cause of death
3. Encephalitis = 1-2 weeks after
4. SSPE = 5-10 years
5. Febrile convulsions, keratoconjunctivitis, corneal ulceration, diarrhoea, increased incidence of appendicitis, myocarditis
288
Measles management of contacts?
1. If a child not immunized against measles comes into contact with measles then MMR should be offered (vaccine-induced measles antibody develops more rapidly than that following natural infection)
this should be given within 72 hours
289
Seborrhoeic dermatitis areas?
1. Scalp (cradle cap)
2. Nappy area
3. Face
4. Limb flexures
290
Seborrhoiec dermatitis management?
1. Mild-moderate = baby shampoo and baby oils
2. Severe = mild topical steroids e.g. 1% hydrocortisone
291
Seborrhoiec dermatitis prognosis?
Tends to resolve spontaneously by around 8m of age
292
Child health surveillance schedule?
1. Antenatal = ensure intrauterine growth, check for maternal infections e.g. HIV, US scan for foetal abnormalities, blood tests for NTDs
2. Neonatal = Clinical examination of newborn, Newborn Hearing Screening Programme e.g. oto-acoustic emissions test, Give mother Personal Child Health Record
3. 1st month = Heel-prick test day 5-9 - hypothyroidism, PKU, metabolic diseases, cystic fibrosis, medium-chain acyl Co-A dehydrogenase deficiency (MCADD)
Midwife visit up to 4 weeks*
4. Following months = Health visitor input
GP examination at 6-8 weeks
Routine immunisations
5. Pre-school = National orthoptist-led programme for pre-school vision screening to be introduced
6. Ongoing = Monitoring of growth, vision, hearing, Health professionals advice on immunisations, diet, accident prevention
293
Scarlet fever definition?
Reaction to erythrogenic toxins produced by GAS (usually pyogenes)
294
Scarlet fever age?
2-6 years, peak at 4 years
295
Scarlet fever spread?
Respiratory by inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges
296
Scarlet fever features?
Incubation period of 2-3 days and typically presents with:
1. Fever
2. Pharyngitis
3. Strawberry tongue
4. Sandpaper rash over extremities, spares palms and soles
5. Cervical lymphadenopathy
297
Scarlet fever diagnosis?
Throat swab but Abx should be commenced immediately
298
Scarlet fever management?
1. Oral pencillin V for 10 days
2. Pen allergy = azithromycin
3. Can return to school 24 hours after starting Abx
4. Notifiable disease
299
Scarlet fever complications?
1. Otitis media = most common complication
2. Rheumatic fever = 20 days after
3. Acute glomerulonephritis = 10 days after
4. Invasive = bacteraemia, meningitis, necrotising fasciitis
300
Usual bowel frequency?
Mean of 3 times a day for infants to under 6m old to once a day after 3y of age
301
Constipation red flags?
1. Reported from birth or first few weeks of life
2. Meconium >48 hours
3. Ribbon stools
4. Faltering growth
5. Previously unknown or undiagnosed weakness in legs, locomotor delat
6. Abdominal distension
7. Disclosure of evidence that raises concerns over possibility of child maltreatment
302
Features which suggest faecal impaction?
1. Symptoms of severe constipation
2. Overflow soiling
3. Faecal mass palpable in the abdomen (DRE should only be carried out by a specialist)
303
Faecal impaction management?
1. Movicol escalating dose regimen
2. Stimulant if no disimpaction after 2w
3. Stimulant +/- lactulose if movicol not tolerated
4. Inform families that disimpaction treatment can initially increase symptoms of soiling and abdominal pain
304
Constipation maintenance therapy?
1. Movicol
2. Add stimulant laxative if no response
3. Stimulant +/- lactulose/docusate if movicol not tolerated
4. Continue medication at maintenance dose for several weeks after regular bowel habit is established, then reduce the dose gradually
305
Hypotonia classification?
1. Central
2. Neurological and muscular problems
306
Hypotonia associated with encephalopathy in the newborn period?
HIE
307
Central causes of hypotonia?
1. Down's
2. Prader-Willi
3. Hypothyroidism
4. Cerebral palsy (hypotonia may precede the development of spasticity)
308
Neurological and muscular causes of hypotonia?
1. SMA
2. GBS
3. Myasthenia gravis
4. Muscular dystrophy
5. Myotonic dystrophy
6. Spina bifida
309
Contraindications to MMR?
1. Severe immunosuppression
2. Allergy to neomycin
3. Children who have received another live vaccine by injection within 4 weeks
4. Pregnancy should be avoided for at least 1 month following vaccination
5. Immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)
310
MMR adverse effects?
Malaise, fever and rash may occur after the first dose of MMR. This typically occurs after 5-10 days and lasts around 2-3 days
311
How long between MMR doses?
1. 3m to maximise response
2. 1m if >10 y/o
3. If urgent then 1m can be used in younger children e.g. outbreak at school
312
Obtaining consent in children?
1. At 16 years or older a young person can be treated as an adult and can be presumed to have capacity to decide
2. Under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved
3. Where a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child's best interests (but not in Scotland)
313
Contraceptives to under 16y/o?
All 5 of Fraser guidelines:
1. Understands
2. Cant be persuaded to inform parents
3. Will have sex anyways
4. Will suffer without it
5. Best interests
314
Perthes' disease definition?
Degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head, specifically the femoral epiphysis. Impaired blood supply to the femoral head causes bone infarction.
315
Perthes' disease epidemiology?
1. 5x more common boys
2. 10% bilateral
316
Perthes disease features?
1. Hip pain (develops progressively over a few weeks)
2. Limp
3. Stiffness and reduced ROM
317
Perthes disease Ix?
1. XR = early changes include widening of joint space, later changes include decreased femoral head size/flattening
2. Technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist
318
Perthes disease complications?
1. Osteoarthritis
2. Premature fusion of growth plates
319
Perthes disease classification?
Catterall staging
1. Clinical and histological features only
2. Sclerosis with or without cystic changes and preservation of the articular surface
3. Loss of structural integrity of the femoral head
4. Loss of acetabular integrity
320
Perthes disease management?
1. Keep femoral head in acetabulum = cast, braces
2. <6y/o = observation
3. Older = surgical management with moderate results
4. Operate on severe deformities
321
Perthes disease prognosis?
Most cases will resolve with conservative management. Early diagnosis improves outcomes.
322
Growing pain epidemiology?
M=F, 3-12 y/o
323
Growing pain features?
1. Never present at the start of the day after the child has woken
2. No limp
3. No limitation of physical activity
4. Systematically well
5. Normal physical examination
6. Motor milestones normal
7. Symptoms are often intermittent and worse after a day of vigorous activity
324
PDA mushkies?
1. Acyanotic, can result in differential cyanosis if uncorrected
2. Connection b/w pulmonary trunk and ascending aorta
3. Usually DA closes with first breaths due to increased pulmonary flow which enhances prostaglandins clearance
4. More common in premature babies, born at high altitude or maternal rubella infection in the first trimester
325
PDA features?
1. Left subclavicular thrill
2. Continuous machinery murmur
3. Large volume, bounding, collapsing pulse
4. Wide pulse pressure
5. Heaving apex beat
326
PDA management?
1. Indomethacin or ibuprofen = given to neonate, inhibits prostaglandin synthesis, closes in the majority of cases
2. If associated with another CHD amenable to surgery then Prostaglandin E1 is useful to keep the duct open until after surgical repair
327
Cyanotic CHD?
1. ToF
2. TGA
3. Tricuspid atresia
328
Acyanotic CHD?
1. VSD (more common)
2. ASD (more common in adults as present later)
3. PDA
4. Coarctation of the aorta
5. Aortic stenosis
329
Epstein's pearl?
A congenital cyst found in the mouth. They are common on the hard palate, but may also be seen on the gums where the parents may mistake it for an erupting tooth. No treatment is generally required as they tend to spontaneously resolve over the course of a few weeks.
330
Bohn's nodules?
Mucous gland cysts, frequently located on the buccal or lingual aspects of the alveolar ridges and rarely on the palate.
331
Congenital ranula?
A translucent, firm papule or nodule found on the anterior floor of mouth, lateral to lingual frenulum
332
Alveolar lymphangioma?
Bluish fluid-filled lesions on the alveolar ridges, not seen on the palate
333
Duct dependent cardiac lesions?
1. ToF
2. Ebstein's anomaly
3. Pulmonary atresia/stenosis
334
Duct dependent cardiac lesion management?
Keep duct open with prostaglandins
335
X-linked recessive who is affected?
Only males (Turner's is the exception)
336
X-linked recessive transmission?
Transmitted by heterozygote females (carriers) and male to male transmission is not seen
337
X-linked recessive affected male's children?
Unaffected sons and carrier daughters
338
X-linked recessive carrier female's children?
Each male child of a heterozygous female carrier has a 50% chance of being affected whilst each female child of a heterozygous female carrier has a 50% chance of being a carrier
339
Transient synovitis age?
3-8 years old
340
Transient synovitis features?
1. Limp/refusal to weight bear
2. Groin or hip pain
3. Low-grade fever is present in a minority of patients (high fever should raise suspicion of septic arthritis)
341
Transient synovitis management?
Self-limiting, requiring only rest and analgesia
342
Fever, drooling and stridor?
Acute epiglottitis
343
Headache in children epidemiology?
Equally common in boys and girls until puberty and then strong 3:1 female preponderance
344
Most common cause of primary headache in children?
Migraine without aura
345
Acute migraine management?
1. Ibuprofen
2. Triptans if >12 y/o, sumatriptan (nasal) is only one with proven efficacy
346
Triptan s/e?
Tingling, heat and heaviness/pressure sensation
347
Migraine prophylaxis?
In practice, pizotifen and propranolol should be used as first line preventatives in children. Second line preventatives are valproate, topiramate and amitryptiline
348
2nd most common cause of headache in children?
Tension-type headache
349
Eczema prevalence?
Eczema occurs in around 15-20% of children and is becoming more common. It typically presents before 2 years but clears in around 50% of children by 5 years of age and in 75% of children by 10 years of age
350
Eczema features?
1. Itchy, erythematous rash
2. In infants face and trunk are often affected
3. In younger children, eczema often occurs on the extensor surfaces
4. In older children, more typical distribution seen, with flexor surfaces and the creases of the face and neck
351
Eczema management?
1. Avoid irritants
2. Simple emollients
3. Topical steroids
4. Wet wrapping
5. In severe cases, oral ciclosporin may be used
352
What is wet wrapping?
Large amounts of emollient and sometimes topical steroids applied under wet bandages
353
Eczema simple emollient mushkies?
1. Large quantities should be prescribed (e.g. 250g / week), roughly in a ratio of with topical steroids of 10:1
2. If a topical steroid is also being used the emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid
3. Creams soak into the skin faster than ointments
4. Emollients can become contaminated with bacteria - fingers should not be inserted into pots (many brands have pump dispensers)
354
Congenital heart disease presentation?
1. Antenatal = 18-20 week fetal anomaly scan
2. Murmur = routine newborn examination
3. Cyanosis
4. HF
355
Presentation of HF in neonates?
Poor feeding, SOB, sweating, hepatomegaly
356
Rocker-bottom feet?
Edward's
357
Most common cause of pneumonia in children?
S. pneumoniae
358
Pneumonia Rx?
1. Amoxicillin first line
2. Macrolides may be added if no response to first line therapy
3. Macrolides if mycoplasma or chlamydia suspected
359
Pneumonia associated with influenza Rx?
Co-amoxiclav
360
Roseola infantum AKA?
1. Exanthem subitum
2. Sixth disease
361
Roseola infantum cause?
HHV6
362
Roseola infantum features?
1. High fever lasting a few days followed by:
2. Maculopapular rash
3. Nagayama spots (papular enanthem on the uvula and soft palate)
4. Febrile convulsions in 10-15%
5. Diarrhoea and cough are also commonly seen
363
Other consequences of HHV6 infection?
1. Aseptic meningitis
2. Hepatitis
364
5 red rashes of childhood?
1. Measles
2. Parvovirus B19
3. Rubella
4. Scarlet fever
5. Roseola infantum
365
Turner's syndrome prevalence?
1 in 2500
366
Turner's syndrome cause?
Presence of only one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes
367
Turner's syndrome features?
1. Short
2. Shield chest with widely spaced nipples
3. Webbed neck
4. Bicuspid aortic valve/coarctation of aorta
5. Primary amenorrhoea
6. Cystic hygroma
7. High arched palate
8. Short 4th metacarpal
9. Multiple pigmented naevi
10. Lymphoedema in neonates esp. in feet
368
Turner's syndrome bloods?
1. elevated gonadotrophin levels
2. Hypothyroidism more common
369
Turner's syndrome bloods?
1. Elevated gonadotrophin levels
2. Hypothyroidism more common
370
Most common renal abnormality in Turner's syndrome?
Horseshoe kidney
371
AI disease in Turner's?
Increased incidence, esp. autoimmune thyroiditis and Crohn's disease
372
Fine motor and vision 3m?
Fixes and follow to 180 degrees, reaches for object
373
Fine motor and vision 6m?
Palmer grasp, passes from one hand to another
374
Fine motor and vision 9m?
Points with finger, early pincer
375
Fine motor and vision
Good pincer, bangs toys together
376
Nappy rash causes?
1. Irritant dermatitis
2. Candida dermatitis
3. Seborrhoeic dermatitis
4. Psoriasis
5. Atopic eczema
377
Irritant dermatitis mushkies?
1. Most common cause, due to irritant effect of urinary ammonia and faeces
2. Creases are charactersically spared
378
Candida dermatitis mushkies?
1. Erythmatous rash which involves the flexures and has satellite lesions
379
General nappy rash management?
1. Disposable preferable to towel nappies
2. Expose napkin area to air when possible
3. Apply barrier cream (zinc and castor oil)
4. Mild steroid cream (1% hydrocortisone in severe cases
380
Candidal nappy rash management?
1. Topical imidazole
2. Cease use of barrier cream until candida has settled
381
Autosomal recessive conditions tend to be?
Metabolic (except for inherited ataxias)
382
Autosomal dominant conditions tend to be?
Structural (except for Gilbert's, hyperlipidaemia Type II)
383
Tuberous sclerosis inheritance?
AD
384
Contraindications to immunisation?
1. Confirmed anaphylactic reaction to a previous dose of a vaccine containing the same antigens
2. Confirmed anaphylactic reaction to another component contained in the relevant vaccine e.g. egg protein
385
Vaccine should be delayed?
Febrile illness/intercurrent infection
386
Contraindications to live vaccines?
1. Pregnancy
2. Immunosuppression
387
When should DTP vaccine be deferred?
In children with evolving or unstable neurological condition
388
Babies born prematurely vaccination?
According to chronological age
389
Babies born prior to 28 weeks gestation immunisations?
First set at hospital due to risk of apnoea
390
G6PDD inheritance?
X-linked recessive
391
Perinatal mortality rate?
Stillbirths + early neonatal deaths (within 7 days) per 1,000 births after 24 weeks gestation
392
Maternal mortality rate?
Deaths in pregnancy, labour and 6 weeks after/total maternities x 1000
393
Stillbirth rate?
Babies born dead after 24 weeks / total births (live + stillborn) x 1000
394
Neonatal death rate?
Babies dying between 0-28 days / total live births x 1000
395
Fetus lost prior vs. after 20 weeks?
Miscarriage vs. stillbirth
396
Shaken baby syndrome triad?
1. Retinal haemorrhages
2. Subdural haematoma
3. Encephalopathy
397
Risk of Down's syndrome with increasing maternal age?
1. 20 = 1/1500
2. 30 = 1/800
3. 35 = 1/270
4. 40 = 1/100
5. 45 = 1/50
398
Down's syndrome genetics?
1. Nondisjunction = 94%
2. Robertsonian translocation (usually onto 14) = 5%
3. Mosaicism = 1%
399
Coeliac disease presentation age?
<3 y/o
400
Coeliac disease incidence?
1 in 100
401
Coeliac disease HLA association?
1. HLA-DQ2 = 95%
2. HLA-DQ8 = 80%
402
Coeliac disease features?
1. Failure to thrive
2. Diarrhoea
3. Abdominal distension
4. Older children may present with anaemia
5. Many cases not diagnosed to adulthood
403
Coeliac disease diagnosis?
1. Jejunal biopsy = subtotal villous atrophy
2. Anti-endomysial and anti-gliadin antibodies are useful screening tests
404
Caput succadeneum?
1. Present at birth
2. Crosses suture lines
3. Resolves within days
405
Cephalohaematoma?
1. Several hours after birth
2. Most commonly in parietal region, doesn't cross suture lines
3. Resolves in months
406
Subgaleal haematoma?
1. Between periosteum and epicranial aponeurosis
2. 12-72 hours post delivery
3. Ventouse-assissted deliveries
407
Threadworm organism?
Enterobius vermicularis
408
Threadworm infestation features?
1. Asymptomatic in 90%
2. Perianal itching, esp. at night
3. Girls may have vulval symptoms
409
Threadworm Dx?
Sellotape to perianal area and sending for microscopy. However most treated empirically
410
Threadworm management?
1. Mebendazole single dose (>6m) and hygeine measures for all members of household
411
Anticipation?
Early onset in trinucleotide repeat disorders in successive generations
412
Fragile X x3?
CGG
413
Myotonic dystrophy x3?
CTG
414
Friedrich's ataxia x3?
GAA
415
Does friedrich's ataxia show anticipation?
No
416
Fever followed later by rash?
Roseola infantum
417
Microcephaly definition?
Occipital-frontal circumference <2nd centile
418
Microcephaly causes?
1. Normal variation
2. Familial
3. Congenital infection
4. HIE
5. FAS
6. Patau's
7. Craniosynostosis
419
APGAR criteria?
1, 5, 10 mins if low
1. Appearance
2. Pulse
3. Grimace
4. Activity
5. Respiration
420
Urinary tract imaging?
1. Infants <6m with first UTI responding to treatment should have US within 6 weeks
2. Children >6m with first UTI responding to treatment do not require imaging unless features suggestive of an atypical infection
421
Features of atypical UTI?
1. Seriously ill
2. Poor urine flow
3. Abdominal or bladder mass
4. Raised creatinine
5. Septicaemia
6. Failure to respond to treatment with Abx within 48h
7. Infection with non-E.coli organisms
422
Most common congenital cardiac abnormality in Down's?
AVSD aka endocardial cushion defect
423
Most common ocular malignancy in children?
Retinoblastoma
424
Average age of onset of retinoblastoma?
18 months
425
Retinoblastoma pathophysiology?
1. AD
2. Loss of function of the Rb TS gene on Chr 13
3. 10% of cases are hereditary
426
Retinoblastoma features?
1. Absence of red reflec, replaced by white pupil (leukocoria)
2. Strabismus
3 Visual problems
427
Retinoblastoma management?
1. External beam radiation
2. Chemotherapy
3. Photocoagulation
428
Retinoblastoma management?
Excellent, 90% survive into adulthood
429
mall testes inprecocious puberty?
Adrenal cause
430
Sexual aggression during childhood?
Testotoxicosis
431
Whooping cough organism?
Bordatella pertussis
432
Pertussis immunisation?
1. Infants are routinely immunised at 2, 3, 4 months and 3-5 years. Newborn infants are particularly vulnerable, which is why the vaccination campaign for pregnant women was introduced
2. Neither infection nor immunisation results in lifelong protection - hence adolescents and adults may develop whooping cough despite having had their routine immunisations
433
Pertussis Dx?
Cough lasting >14 days without another cause plus one of:
1. Paroxysmal cough
2. Inspiratory whoop
3. post-tussive vomiting
3. Undiagnosed apnoeic attacks in young infants
434
Pertussis FBC?
Marked lymphocytosis
435
Pertussis Dx?
1. Per nasal swab for BP, may take several days or weeks to come back
2. PCR and serology now increasingly used
436
Pertussis Rx?
1. <6m admitted
2. Notifiable
3. Macrolide if onset of cough within 21 days
4. Household contacts offered pantibiotic prophylaxis
5. Abx not shown to alter course of illness
6. School exclusion = 48 hours after commencing Abx (or 21 days from onset of symptoms if no Abx)
437
Pertussis complications?
1. Subconjunctival haemorrhage
2. Pneumonia
3. Bronchiectasis
4. Seizures
438
Pregnancy pertussis vaccination?
Between 16-32 weeks pregnant
439
Risk of threadworm transmission in families?
75%
440
Plagiocephaly?
Parallellogram shaped head
441
Craniosynostosis?
Premature fusion of skull bones
442
Newborn head molding management?
Can be left alone but document clearly
443
Mama and Dada?
9-10 months
444
Homocystinuria inheritance?
Autosomal recessive
445
When is neonatal blood spot screening performed?
5-9 days of life
446
Neonatal blood spot conditions?
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
447
Friedrich's ataxia inheritance?
Autosomal recessive
448
Hearing tests in children?
1. Newborn = otocaustic emission tests as part of newborn hearing screening programme --> auditory brainstem response if abnormal
2. 6-9 months = distraction test, done by health visitor
3. >2.5 years = speech discrimination tests e.g. Kendall Toy test, McCormick Toy Test
4. >3y = Pure tone audiometry, done at school entry
449
MMR vaccine type?
Live attenuated
450
Sitting without support?
Should be achieved around 7-8m, refer if still not achieved by 12m
451
Acrocyanosis?
Peripheral cyanosis around the mouth and extremities, common in neonates, esp. in first 24-48 hours of life
452
How to distinguish cardiac from non-cardiac causes of cyanosis?
Nitrogen washout test (hyperoxia test)
1. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
453
ITP definition?
Immune-mediated reduction in the platelet count. Abs directed against the glycoprotein IIb/IIIa or Ib-V-IX complex
454
ITP type of reaction?
Type II hypersensitivity reaction
455
ITP features?
1. Bruising
2. petechial or purpuric rash
3. Bleeding is less common and typically presents as epistaxis or gingival bleeding
456
ITP Ix?
1. FBC = isolated thrombocytopenia
2. Blood film
3. Bone marrow exam if atypical features (e.g. lymph node enlargement/splenomegaly, high/low white cells, failure to resolve/respond to treatment)
457
ITP management?
1. Usually none = resolves in 80% children within 6m
2. Avoid activities resulting in trauma
3. If plt count v. low (<10) or bleeding --> oral/IV steroids, IVIG, plt transfusion in emergencies)
458
VUR?
Abnormal backflow of urine from the bladder into the ureter and kidney. It is a relatively common abnormality of the urinary tract in children and predisposes to urinary tract infection (UTI), being found in around 30% of children who present with a UTI. As around 35% of children develop renal scarring it is important to investigate for VUR in children following a UTI
459
VUR pathophysiology?
1. Ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
2. Therefore shortened intramural course of the ureter
3. Vesicoureteric junction cannot, therefore, function adequately
460
VUR presentation?
1. Antenatal = hydronephrosis on US
2. Recurrent childhood UTIs
3. Reflux nephropathy = chronic pyelonephritis secondary to VUR, renal scar may produce renin --> HTN
461
VUR Dx
1. MCUG
2. DMSA to look for renal scarring
462
VUR grading?
1. Into ureter, no dilatation
2. Into pelvis on micturition, no dilatation
3. Mild/moderate dilatation of ureter, renal pelvis and calyces
4. Dilation of renal pelvis and calyces with moderate ureteral tortuosity
5. Gross dilatation of the ureter, pelvis anc calyces with ureteral tortuosity
463
Bulging tympanic membrane?
Acute otitis media
464
Scarlet fever back to school?
24 hours after commencing Abx
465
Whooping cough back to school?
2 days after commencing Abx or 21 days from onset of symptoms if no Abx
466
Measles back to school?
4 days from onset of rash
467
Rubella back to school?
5 days from onset of rash
468
Chickenpox back to school?
All lesions crusted over
469
Mumps back to school?
5 days from onset of swollen glands
470
D&V back to school?
48 hours from symptom settled
471
Impetigo back to school?
Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
472
Scabies back to school?
Until treated
473
Influenza back to school?
Until recovered
474
When is chickenpox infectious?
2 days before rash appears to 5 days after onset of rash
475
Cephalohaematoma location?
Between cranial bone and periossteal membrane
476
Subgaleal bleed location?
Subaponeurotic space
477
Caput succedaneum location?
Subcutaneous tissue
478
When can child usually run?
2y
479
TGA cause?
Failure of the aorticopulmonary septum to spiral during septation
480
Maternal risk factor for TGA?
Diabetic mothers
481
TGA clinical features?
1. Tachypnoea
2. Cyanosis
3. Loud single S2
4. Prominent RV impulse
5. Egg on side appearnce on CXR
482
TGA management?
1. Maintenance of DA with PGs
2. Surgical correction is definite treatment
483
Most common malignancy affecting children?
ALL, accounts for 80% childhood leukaemias, peak 2-5 y/o, M>F
484
ALL features?
1. Anaemia = lethargy and pallor
2. Neutropenia = frequent or severe infections
3. Thrombocytopenia = easy bruising, petechiae
4. Bone pain
5. Splenomegaly, hepatomegaly
6. Testicular swelling
7. Fever in up to 50% new cases
485
ALL types?
1. Common ALL = 75%, CD10 present, pre-B phenotype
2. T-cell ALL (20%)
3. B-cell ALL (5%)
486
ALL poor prognostic factors?
1. Age < 2 years or > 10 years
2. WBC > 20 * 109/l at diagnosis
3. T or B cell surface markers
4. Non-Caucasian
5. Male sex
487
Wilms' tumour typical age?
<5y/o, median age 3 y/o
488
Wilms' associations?
1. Beckwith-Wiedemann syndrome
2. WAGR syndrome
3. Hemihypertrophy
4. Around one-third of cases are associated with a loss-of-function mutation in the WT1 gene on chromosome 11
489
Wilms' features?
1. Abdominal mass (most common presenting feature)
2. Painless haematuria
3. Flank pain
4. Anorexia, fever
5. Unilateral in 95% cases
6. Metastases foud in 20% pts (most common lung)
490
Wilms' management?
1. Nephrectomy
2. Chemotherapy
3. Radiotherapy if advanced disease
4. Prognosis: good, 80% cure rate
491
2-5 y/o asthma prednisolone dose?
20mg OD (1-2mg/kg OD)
492
>5 y/o asthma prednisolone dose?
30-40mg OD (1-2mg/kg OD)
493
<2 y/o asthma prednisolone dose?
10mg OD
494
Most common cause of meningococcal disease?
Meningitis B
495
Meningitis B dose timings?
1. 2 months
2. 4 months
3. 12-13 months
496
Chickenpox management?
1. Keep cool, trim nails
2. Calamine lotion
3. School exclusion until all lesions crusted over/5 days after rash onset
4. Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG). If chickenpox develops then IV aciclovir should be considered
497
Chickenpox complications?
1. Pneumonia
2. Encephalitis (cerebellar may be seen)
3. Disseminated haemorrhagic chickenpox
4. Arthritis, nephritis, pancreatitis
5. Group A strep infection --> Necrotising fasciitis
498
Diffuse enlargement of thyroid gland in puberty?
Normal
499
Male puberty mushkies?
1. First sign is testicular growth at around 12 years of age (range = 10-15 years)
2. Testicular volume > 4 ml indicates onset of puberty
3. Maximum height spurt at 14
500
Female puberty mushkies?
1. First sign is breast development at around 11.5 years of age (range = 9-13 years)
2. Height spurt reaches its maximum early in puberty (at 12) , before menarche
3. Menarche at 13 (11-15)
4. There is an increase of only about 4% of height following menarche
501
Venous hum?
Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles
502
Still's murmur?
Innocent, Low-pitched sound heard at the lower left sternal edge
503
Most common cause of hypothyroidism in UK?
Autoimmune thyroiditis
504
Most common cause of hypothyroidism in developing world?
Iodine deficiency
505
Congenital diaphragmatic hernia?
Congenital diaphragmatic hernia (CDH) occurs in around 1 in 2,000 newborns. It is characterised by the herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm. This can result in pulmonary hypoplasia and hypertension which causes respiratory distress shortly after birth.
506
Congenital diaphragmatic hernia pathophysiology?
Failure of pleuroperitoneal canal to close completely
507
Congenital diaphragmatic hernia prognosis?
Only 50% with CDH survive
508
Obesity management in children NICE recommendations?
1. Tailored clinical intervention at 91st centile or above
2. Assessing for comorbidities if BMI at 98th centile or above
509
Obesity associations?
Female, Asian, Tall
510
Causes of obesity in children?
1. Lifestyle (most common)
2. GH deficiency
3. Hypothyrodism
4. Down's
5. Cushing's
6. Prader-Willi
