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Revision Qs > Paediatrics 2 > Flashcards

Paediatrics 2 Flashcards

1
Q

In kids, what 2 inhaled mediations are typically used together as preventers? Which one is started first?

A

Inhaled corticosteroids and inhaled LABA

Start with the corticosteroid

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2
Q

What can be used after LABA in preventing asthma attacks, particularly in younger kids?

A 
Leukotriene antagonists (montelukast)
Or occasionally oral aminophylline
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3
Q

What is a nebuliser used for?

A

Acute attacks of e.g. Asthma, when oxygen is needed alongside inhaled medication

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4
Q

Management of acute asthma in kids?

A 
Oxygen + everything possible short acting bronchodilator (consider neb) + oral pred
IV hydrocortisone (-> intensive care)
IV salbutamol and aminophylline
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5
Q

What medications are commonly used in pneumonia management in kids?

A

Amoxicillin/co-Amox

erythromycin

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6
Q

When does epiglottitis most commonly occur?

A

2-8 year olds

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7
Q

Most common causative organism of epiglottitis historically? What about now?

A

HiB

Now more common to be strep pneumoniae, GAS etc.

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8
Q

Presentation of epiglottitis?

A

Sore throat, odynophagia, drooling (can’t swallow secretions)
Fever, tachy
Ant neck tenderness over hyoid
cervical lymphadenopathy

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9
Q

What features indicate severe epiglottitis?

A

Stridor, SOB/splinting

Dysphagia and dysphonia

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10
Q

Gold standard diagnostic for epiglottitis?

A

Fibre optic laryngoscopy

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11
Q

Most common complication of epiglottitis?

A

Abscess formation

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12
Q

Describe the use of PEFR in asthma investigations?

A

Do mornings and evenings (diurnal variation)
Observe day-day variation
And do in response to treatment (bronchodilator)

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13
Q

If you suspect epiglottitis what must you absolutely not do?

A

Stick a tongue depressor in

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14
Q

What factors of a gastroenteritis suggest a bacterial cause?

A

Bloody stool
Rapid dehydration
Severe abdo pain

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15
Q

What situations should increase index of suspicion for dehydration in kids with gastroenteritis?

A

Infants under 6m or low BW
Excess diarrhoea/vomiting
Unable to take extra fluids
Malnourishment

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16
Q

How is dehydration ideally investigated in kids?

A

Body weight change over course of illness; less than 5% is not clinically dehydrated, 5-10 % is clinical dehydration and >10% is shocked

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17
Q

Features which indicate dehydration in a child?

A 
Look unwell, altered consciousness
Reduced urine output
Reduced skin turgor, dry mucus membranes
Sunken eyes and fontanelles
Tachycardia, tachypnoea
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18
Q

Features which indicate severe dehydration/shock in a child?

A

Features of dehydration + increased CRT, cold peripheries and mottled skin, weak pulses, hypotension, grossly sunken eyes

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19
Q

General principles of ORT in gastroenteritis in kids?

A

Avoid anti-diarrhoeals, Abx may be necessary if septic
If dehydrated and able to take oral fluids, ORT solution for maintenance and rehydration
If severe or unable to take oral, IVT rapid infusion followed by deficit and maintenance

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20
Q

What is impetigo?

A

Staph (occasionally strep) infection in skin causing honey-coloured crusting via vesicles/pustules/bullae rupture

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21
Q

RFs for impetigo?

A

Young kids

Preexisting skin stuff e.g. Eczema

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22
Q

Can kids with impetigo go to school?

A

No - not until lesions are cleared and dry

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23
Q

Signs of orbital cellulitis?

A

Proptosis
Painful eye movement
Reduced visual acuity

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24
Q

Causes of petechial/purpural rash and fever in kids?

A 
Meningococcal sepsis or other bacterial
Infective endocarditis
ITP
HSP and other vasculitis 
Entero-or other viruses
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25
Q

Viral causes of macropapular rashes + fever in kids?

A 
HHV 6/7 (Roseola)
Enterovirus
Slapped cheek (PVB19)
Measles
Rubella
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26
Q

Bacterial causes of maculopapular rash + fever in kids?

A 
Scarlet fever (GAS)
Erythema marginatum (rheumatic fever)
Salmonella typhi (typhoid rose spots)
Lyme disease (erythema migrans)
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27
Q

Non-infective causes of a maculopapular rash in kids?

A

JIA

Kawasaki

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28
Q

3 viral causes of vesicular rash in kids?

A

Chicken pox
HSV
Coxsackievirus - hand foot and mouth

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29
Q

Bacterial causes of vesicular rash in kids?

A

Impetigo
Boils and furuncles, carbuncles
Scalded skin, toxic epidermal necrolysis

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30
Q

Differentiating factors between nappy rash and thrush in kids?

A

Thrush may be present elsewhere e.g. Mouth, has satellite lesions, may have exudate and may appear in creases

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31
Q

What lesions are pathognomic of measles?

A

Koplich spots - White lesions in mouth

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32
Q

Symptoms of measles?

A

Coryzal, conjunctivitis, coughing
Febrile
Diffuse MP rash and Koplich spots

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33
Q

Describe urticaria?

A

‘Hives’ - itchy, blotchy skin (inflammation of superficial skin)
Central White papule (wheal) surrounded by erythematous flare
Can precede angioedema

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34
Q

What can HSV 1 and 2 cause in kids?

A 
As well as cold sores, can cause gingivostomatitis
Eczema herpeticum
Herpetic whitlows
CNS infection
Conjunctivitis
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35
Q

Describe progression of chicken pox?

A

Papules appear day 0
Typically start crusting after 5 or 6 days
May be fluctuant fever and coryza

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36
Q

Progression of lesions in chicken pox?

A

Macule -> papule -> vesicle -> pustule -> crust

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37
Q

Complications of chickenpox?

A

Bacterial superinfection

Encephalitis

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38
Q

What infection does EBV most classically cause?

A

Mono

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39
Q

What virus is implicated in Burkitts lymphoma?

A

EBV

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40
Q

Common differential for measles and rubella?

A

Roseola infantum (HHV 6/7)

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41
Q

3Cs of measles? Other Sx?

A

Cough coryza conjunctivitis
Fever
MP rash and koplichs spots

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42
Q

Sx of mumps?

A

Fever, malaise, coryza

Parotitis - unilateral->bilateral

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43
Q

What blood result may be present in mumps? If associated with abdo pain what might be going on?

A

Increased amylase

Can cause pancreatitis

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44
Q

What complication may arise from the parotitis associated with mumps? Other major complications?

A

Transient unilateral hearing loss

Orchitis (mumps orchitis)

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45
Q

Features of rubella?

A

Major importance in congenital infection

Otherwise mild illness associated with non-itchy MP rash (like measles)

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46
Q

Describe the rash in rubella?

A

Maculopapular (ddx for measles, Roseola)

Non-itchy in kids

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47
Q

What is transient tachypnoea of the newborn?

A

Presumed retained lung fluid which causes tachypnoea amongst other symptoms in the newborn lasting 1-2 days

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48
Q

Major RFs for transient tachypnoea of the newborn?

A

Slightly preterm infants delivered by CS

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49
Q

CXR findings for transient tachypnoea of newborn?

A

Hyperinflation signs
Prominent pulmonary vasculature
Fluid in fissures

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50
Q

What is neonatal respiratory distress syndrome?

A

Combo of lack of surfactant and structural lung immaturity in preterm infants
Leading to tachypnoea, tachycardia, increased respiratory effort etc.

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51
Q

CXR findings of NRDS?

A

Reduced chest volume, ground glass appearance, air bronchograms
Absent thymus

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52
Q

Prevention and management of NRDS?

A

Prevention is maternal steroids before 34 weeks

Management is CPAP and other respiratory support

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53
Q

What is meconium aspiration syndrome?

A

Meconium passed into amniotic fluid in response to Fetal distress/hypoxia and then aspirated by fetus causing respiratory distress

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54
Q

RFs for NRDS?

A

Prematurity
Maternal DM
Multiple pregnancy

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55
Q

Indications of meconium aspiration syndrome?

A 
Yellow-green amniotic fluid
Tachypnoea, brady/tachycardia
Cyanosis
Barrel chest
Low APGAR scores
56
Q

Findings and CXR/ABG findings indicating meconium aspiration?

A

Crackles in chest
Respiratory acidosis
Hyperinflation, patchy atalectasis

57
Q

In what babies is meconium aspiration more common?

A

Over 40 weeks

58
Q

What is the likely cause of respiratory distress in a newborn at 41 weeks with yellow-green amniotic fluid?

A

Meconium aspiration

59
Q

2 likely differentials for tachycardia at preterm gestations?

A

NRDS

TTN

60
Q

What is meconium ileus?

A

Meconium sticky and creates obstruction in lower GI tract

61
Q

What disease is meconium ileus suggestive of?

A

Cystic fibrosis

62
Q

What is hypoxic ischaemic encephalopathy?

A

Evidence of asphyxia-related brain injury in neonates

63
Q

2 common causes of hypoxic ischaemic encephalopathy?

A

Systemic hypoxaemia secondary to respiratory distress etc.

Reduced cerebral blood flow

64
Q

Symptoms of severe hypoxic ischaemic encephalopathy?

A

Generalised seizures
Stupor/coma, loss of pupillary reflexes
Cardiorespiratory collapse
Hypotonia and absent primitive reflexes

65
Q

Symptoms of mild hypoxic ischaemic encephalopathy?

A

Transient hypertonia and brisk reflexes

Behavioural abnormalities

66
Q

Signs of moderate hypoxic ischaemic encephalopathy?

A

Hypotonia and diminished reflexes
Absent primitive reflexes
Apnoeas and mild seizures

67
Q

Why is neonatal hypoglycaemia common?

A

Neonates have large glucose demand and poor glucose regulatory mechanisms

68
Q

RFs for neonatal hypoglycaemia split into causes?

A

Decreased glucose - IUGR, prem, inborn errors of metabolism
Increased insulin - maternal DM
Increased requirements - hypothermia, sepsis, NRDS
Misc - hypothyroidism, polycythaemia, CNS stuff

69
Q

What is hirschprungs disease?

A

Aganglionic bowel segments which therefore can’t relax, meaning meconium cant be passed and leading to obstruction

70
Q

When should meconium have been passed?

A

Most by 24 hours

Definitely by 48 hours

71
Q

Gold standard investigation for hirschprungs?

A

Suction rectal biopsy

72
Q

Other than failure to pass meconium, features suggestive of hirschprungs?

A

Greeny brown vomit
Obstruction - distension, flatus
Explosive bloody stools post PR

73
Q

Management of hirschprungs?

A

Surgically resect the aganglionic segment, followed by reanastamosis

74
Q

What chromosomal abnormality is linked to hirschprungs?

A

Down’s syndrome

75
Q

Aetiology of enlarged adenoids?

A

Recurrent or chronic infection e.g. EBV
Allergies and irritants
GORD

76
Q

When are the adenoids largest? When have they significantly atrophied by?

A

Largest age 5ish, atrophy by age 7 and normally gone by teenage years

77
Q

Symptoms of enlarged adenoids?

A

Recurrent sinusitis, OM, OME etc.
Chronic cough
Difficulty nose breathing, instead mouth breathing
Snoring, sleep apnoea and noisy breathing
Nasal voice

78
Q

Investigation for suspected enlarged adenoids?

A

Flexible fibre optic nasopharyngoscopy

79
Q

Management of enlarged adenoids?

A

Can try steroids and stuff, might end up whipping them out along with tonsils

80
Q

What is used to screen for hearing abnormalities in the newborn?

A

EOAE (evoked otoacoustic emission)

81
Q

How does visual acuity change in newborn? When is it like that of adults?

A

Starts off poor

Adult by about 3 years

82
Q

Eye positional problem ‘normal at birth’? When should this by gone by?

A

Squint - gone by 12 weeks

83
Q

When does a palmar grasp arise?

A

4-6 months

84
Q

When should lost body weight at birth be gone by?

A

10 days

85
Q

When do motor problems manifest in kids?

A

Within first 18 months

86
Q

When do speech and language problems manifest in kids?

A

Around 18m to 3yrs

87
Q

When do social and communication problems manifest in kids?

A

2-4 years

88
Q

Up to what age can brain injury potentially cause cerebral palsy in kids?

A

2 years

89
Q

When are temper tantrums normal in kids?

A

15m-4yrs

90
Q

When should kids have grown out of temper tantrums?

A

Around 5-6 years

91
Q

1-2-3 approach to temper tantrums?

A

Ask child to stop and tell them what you want to do
Warn them what will happen if they don’t stop
Punish them

92
Q

Describe autistic spectrum disorders?

A

Pervasive developmental disorders which are lifelong

93
Q

3 categories of ASD required symptoms?

A

Difficulty communicating
Difficulty with social interaction
Difficulty with behaviours, interest and activities

94
Q

What 3 other disorders are common with ASDs?

A

Anxiety
Depression
ADHD

95
Q

When does ADHD usually manifest in kids?

A

Age 5/6

96
Q

3 criteria of ADHD?

A

Poor attention
Hyperactivity
Impulsivity

97
Q

Management approaches to ADHD?

A

Behavioural, social support

Meds e.g. Methylphenidate (Ritalin)

98
Q

Side effects of Ritalin (methylphenidate)?

A

Insomnia (give melatonin)

Reduced appetite

99
Q

What personality disorder are kids with conduct disorder at 50% risk of growing into as an adult?

A

Dissocial PD

100
Q

5 common causes of false positives for CF sweat test?

A 
Atopic eczema
Dehydration
Malnutrition
Hypothyroid
Adrenal insufficiency
101
Q

False negative for CF sweat test?

A

Oedema

102
Q

2 breathing techniques for CF in kids? 1 for older kids?

A

Percussion and postural drainage

Forced expiration techniques

103
Q

Symptoms of cardiac failure in kids?

A

SOB, trouble feeding, sweating, recurrent chest infections

104
Q

Signs of cardiac failure in kids?

A

FTT, tachycardia, tachypnoea, cyanosis, heart murmurs, cardiomegaly, cool peripheries, hepatosplenomegaly

105
Q

3 Hs of serious causes of constipation in kids?

A

Hypothyroid
Hirschprungs
Hypercalcaemia

106
Q

Management of childhood IBD?

A 
Elevated diet (amino acids)
Azathioprine
Avoid steroids long term
107
Q

When and in whom does pyloric stenosis present?

A

6-8 week males

108
Q

Electrolyte disturbances in pyloric stenosis?

A

Dehydration and hyponatraemia

Hypochloraemic, hypokalaemic metabolic alkalosis

109
Q

What features of history in kids make cows milk intolerance more likely than GORD?

A

Diarrhoea

Allergic reactions

110
Q

What tests are used in kids for cows milk protein intolerance?

A

RAST tests (Ab to food proteins)
Serum IgE
Jejunal biopsy - eosinophils in lam prop

111
Q

When and in whom does intussusception present?

A

5-12 month males

112
Q

What is nocturnal enuresis?

A

Nighttime bed wetting

113
Q

What must you exclude to make transient synovitis diagnosis in acutely limping kids?

A 
Septic arthritis
Perthes
Osteomyelitis
SUFE
TB arthritis
JIA
114
Q

What is West Syndrome? When does it peak?

A

Infantile spasms - clusters of head nodding, arm jerks every 3-30 seconds
Peaks around 5m

115
Q

Meds first line for absence seizures?

A

Ethosuximide

116
Q

What is the presumed mechanism of stillbirth?

A

Lactic acidosis

117
Q

What test is used for haemolytic disorders in little kids?

A

Coombs

118
Q

3 reasons for physiological jaundice?

A

Increased bilirubin production from neonatal blood cell breakdown
Decreased bilirubin excretion due to liver immaturity
Immature gut flora

119
Q

What is SIDS?

A

Unexplained death in infants less than 1 year old, peak 1-4m

120
Q

3 preventative measures for SIDS?

A

Don’t sleep prone - sleep supine
Don’t smoke around kid
Prevent overheating

121
Q

5 things that might make you think of NAI in kids?

A

Child discloses
Odd, incongruent or inconsistent history
Unusual mode of injury or presenting features
Presenting late to different doctor having missed routine appts
Non-parental adult presents with kid

122
Q

Where are bruises common in toddlers?

A

Forehead, shins (learning to walk)

123
Q

When are bruises in kids unusual?

A

Weird places e.g. Back, face, buttocks
Patterns e.g. Hand grip marks, specific objects, slap marks
If they are in immobile babies

124
Q

Causes of NAI head injuries in kids?

A

Shaking - causes apnoea, hypoxic ischaemic damage

Subdurals or haemorrhages

125
Q

What fractures are almost always due to NAI in kids?

A

Rib fractures, particularly posterior

126
Q

Things that are suggestive of accidental burn rather than NAI burn?

A

Asymmetrical, flexure sparing, splash marks etc.

127
Q

3 phases of whooping cough?

A

Catarrhal (1-2 weeks URTI)
Paroxysmal (cough typically around 1m, whoops)
Convalescent (chronic cough for 2 weeks)

128
Q

Early Sx of tetanus?

A

Trismus (jaw locking) - muscle spasms in jaw
Worsening spasms in all muscle groups
Tetany

129
Q

What type of vaccine is the DTaP?

A

Inactivated toxins

130
Q

What does polio cause?

A

Headache, myalgia, generally unwell

And acute onset flaccid paralysis and areflexia in one limb (LMNL)

131
Q

What does neonatal GH deficiency cause?

A

Hypoglycaemia
Jaundice
Doll face
Followed by FTT after 6-12 months

132
Q

When should a kid be able to say their 1st and 2nd names?

A

3 years

133
Q

When should a kid be counting to 10 and beyond?

A

4 years

134
Q

Clinical features of hypothyroidism/cretinism?

A

Hypotonia, coarse facial features/big tongue, hoarse cry, dry skin, hypothermia, prolonged jaundice, umbilical hernia, short stature, developmental delay/learning difficulties, constipation
Delayed ant font closure

135
Q

What characterises Kwashiorkor?

A

Severe protein deficiency (too many carbs) leading to chronic diarrhoea and abdominal distension, oedema, tight skin/funny coloured hair, irritability and anorexia

136
Q

What characterises Marasmus?

A

Total calorie malnutrition leading to emaciated appearance with no abdominal dysfunction

137
Q

How does the HSP rash change and develop?

A

Goes rapidly from urticaria to purpura

Revision Qs (28 decks)

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