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
2
Q
What can be used after LABA in preventing asthma attacks, particularly in younger kids?
A
Leukotriene antagonists (montelukast) Or occasionally oral aminophylline
3
Q
What is a nebuliser used for?
A
Acute attacks of e.g. Asthma, when oxygen is needed alongside inhaled medication
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
5
Q
What medications are commonly used in pneumonia management in kids?
A
Amoxicillin/co-Amox
erythromycin
6
Q
When does epiglottitis most commonly occur?
A
2-8 year olds
7
Q
Most common causative organism of epiglottitis historically? What about now?
A
HiB
Now more common to be strep pneumoniae, GAS etc.
8
Q
Presentation of epiglottitis?
A
Sore throat, odynophagia, drooling (can’t swallow secretions)
Fever, tachy
Ant neck tenderness over hyoid
cervical lymphadenopathy
9
Q
What features indicate severe epiglottitis?
A
Stridor, SOB/splinting
Dysphagia and dysphonia
10
Q
Gold standard diagnostic for epiglottitis?
A
Fibre optic laryngoscopy
11
Q
Most common complication of epiglottitis?
A
Abscess formation
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)
13
Q
If you suspect epiglottitis what must you absolutely not do?
A
Stick a tongue depressor in
14
Q
What factors of a gastroenteritis suggest a bacterial cause?
A
Bloody stool
Rapid dehydration
Severe abdo pain
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
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
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
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
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
20
Q
What is impetigo?
A
Staph (occasionally strep) infection in skin causing honey-coloured crusting via vesicles/pustules/bullae rupture
21
Q
RFs for impetigo?
A
Young kids
Preexisting skin stuff e.g. Eczema
22
Q
Can kids with impetigo go to school?
A
No - not until lesions are cleared and dry
23
Q
Signs of orbital cellulitis?
A
Proptosis
Painful eye movement
Reduced visual acuity
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
25
Viral causes of macropapular rashes + fever in kids?
```
HHV 6/7 (Roseola)
Enterovirus
Slapped cheek (PVB19)
Measles
Rubella
```
26
Bacterial causes of maculopapular rash + fever in kids?
```
Scarlet fever (GAS)
Erythema marginatum (rheumatic fever)
Salmonella typhi (typhoid rose spots)
Lyme disease (erythema migrans)
```
27
Non-infective causes of a maculopapular rash in kids?
JIA
| Kawasaki
28
3 viral causes of vesicular rash in kids?
Chicken pox
HSV
Coxsackievirus - hand foot and mouth
29
Bacterial causes of vesicular rash in kids?
Impetigo
Boils and furuncles, carbuncles
Scalded skin, toxic epidermal necrolysis
30
Differentiating factors between nappy rash and thrush in kids?
Thrush may be present elsewhere e.g. Mouth, has satellite lesions, may have exudate and may appear in creases
31
What lesions are pathognomic of measles?
Koplich spots - White lesions in mouth
32
Symptoms of measles?
Coryzal, conjunctivitis, coughing
Febrile
Diffuse MP rash and Koplich spots
33
Describe urticaria?
'Hives' - itchy, blotchy skin (inflammation of superficial skin)
Central White papule (wheal) surrounded by erythematous flare
Can precede angioedema
34
What can HSV 1 and 2 cause in kids?
```
As well as cold sores, can cause gingivostomatitis
Eczema herpeticum
Herpetic whitlows
CNS infection
Conjunctivitis
```
35
Describe progression of chicken pox?
Papules appear day 0
Typically start crusting after 5 or 6 days
May be fluctuant fever and coryza
36
Progression of lesions in chicken pox?
Macule -> papule -> vesicle -> pustule -> crust
37
Complications of chickenpox?
Bacterial superinfection
| Encephalitis
38
What infection does EBV most classically cause?
Mono
39
What virus is implicated in Burkitts lymphoma?
EBV
40
Common differential for measles and rubella?
Roseola infantum (HHV 6/7)
41
3Cs of measles? Other Sx?
Cough coryza conjunctivitis
Fever
MP rash and koplichs spots
42
Sx of mumps?
Fever, malaise, coryza
| Parotitis - unilateral->bilateral
43
What blood result may be present in mumps? If associated with abdo pain what might be going on?
Increased amylase
| Can cause pancreatitis
44
What complication may arise from the parotitis associated with mumps? Other major complications?
Transient unilateral hearing loss
| Orchitis (mumps orchitis)
45
Features of rubella?
Major importance in congenital infection
| Otherwise mild illness associated with non-itchy MP rash (like measles)
46
Describe the rash in rubella?
Maculopapular (ddx for measles, Roseola)
| Non-itchy in kids
47
What is transient tachypnoea of the newborn?
Presumed retained lung fluid which causes tachypnoea amongst other symptoms in the newborn lasting 1-2 days
48
Major RFs for transient tachypnoea of the newborn?
Slightly preterm infants delivered by CS
49
CXR findings for transient tachypnoea of newborn?
Hyperinflation signs
Prominent pulmonary vasculature
Fluid in fissures
50
What is neonatal respiratory distress syndrome?
Combo of lack of surfactant and structural lung immaturity in preterm infants
Leading to tachypnoea, tachycardia, increased respiratory effort etc.
51
CXR findings of NRDS?
Reduced chest volume, ground glass appearance, air bronchograms
Absent thymus
52
Prevention and management of NRDS?
Prevention is maternal steroids before 34 weeks
| Management is CPAP and other respiratory support
53
What is meconium aspiration syndrome?
Meconium passed into amniotic fluid in response to Fetal distress/hypoxia and then aspirated by fetus causing respiratory distress
54
RFs for NRDS?
Prematurity
Maternal DM
Multiple pregnancy
55
Indications of meconium aspiration syndrome?
```
Yellow-green amniotic fluid
Tachypnoea, brady/tachycardia
Cyanosis
Barrel chest
Low APGAR scores
```
56
Findings and CXR/ABG findings indicating meconium aspiration?
Crackles in chest
Respiratory acidosis
Hyperinflation, patchy atalectasis
57
In what babies is meconium aspiration more common?
Over 40 weeks
58
What is the likely cause of respiratory distress in a newborn at 41 weeks with yellow-green amniotic fluid?
Meconium aspiration
59
2 likely differentials for tachycardia at preterm gestations?
NRDS
| TTN
60
What is meconium ileus?
Meconium sticky and creates obstruction in lower GI tract
61
What disease is meconium ileus suggestive of?
Cystic fibrosis
62
What is hypoxic ischaemic encephalopathy?
Evidence of asphyxia-related brain injury in neonates
63
2 common causes of hypoxic ischaemic encephalopathy?
Systemic hypoxaemia secondary to respiratory distress etc.
| Reduced cerebral blood flow
64
Symptoms of severe hypoxic ischaemic encephalopathy?
Generalised seizures
Stupor/coma, loss of pupillary reflexes
Cardiorespiratory collapse
Hypotonia and absent primitive reflexes
65
Symptoms of mild hypoxic ischaemic encephalopathy?
Transient hypertonia and brisk reflexes
| Behavioural abnormalities
66
Signs of moderate hypoxic ischaemic encephalopathy?
Hypotonia and diminished reflexes
Absent primitive reflexes
Apnoeas and mild seizures
67
Why is neonatal hypoglycaemia common?
Neonates have large glucose demand and poor glucose regulatory mechanisms
68
RFs for neonatal hypoglycaemia split into causes?
Decreased glucose - IUGR, prem, inborn errors of metabolism
Increased insulin - maternal DM
Increased requirements - hypothermia, sepsis, NRDS
Misc - hypothyroidism, polycythaemia, CNS stuff
69
What is hirschprungs disease?
Aganglionic bowel segments which therefore can't relax, meaning meconium cant be passed and leading to obstruction
70
When should meconium have been passed?
Most by 24 hours
| Definitely by 48 hours
71
Gold standard investigation for hirschprungs?
Suction rectal biopsy
72
Other than failure to pass meconium, features suggestive of hirschprungs?
Greeny brown vomit
Obstruction - distension, flatus
Explosive bloody stools post PR
73
Management of hirschprungs?
Surgically resect the aganglionic segment, followed by reanastamosis
74
What chromosomal abnormality is linked to hirschprungs?
Down's syndrome
75
Aetiology of enlarged adenoids?
Recurrent or chronic infection e.g. EBV
Allergies and irritants
GORD
76
When are the adenoids largest? When have they significantly atrophied by?
Largest age 5ish, atrophy by age 7 and normally gone by teenage years
77
Symptoms of enlarged adenoids?
Recurrent sinusitis, OM, OME etc.
Chronic cough
Difficulty nose breathing, instead mouth breathing
Snoring, sleep apnoea and noisy breathing
Nasal voice
78
Investigation for suspected enlarged adenoids?
Flexible fibre optic nasopharyngoscopy
79
Management of enlarged adenoids?
Can try steroids and stuff, might end up whipping them out along with tonsils
80
What is used to screen for hearing abnormalities in the newborn?
EOAE (evoked otoacoustic emission)
81
How does visual acuity change in newborn? When is it like that of adults?
Starts off poor
| Adult by about 3 years
82
Eye positional problem 'normal at birth'? When should this by gone by?
Squint - gone by 12 weeks
83
When does a palmar grasp arise?
4-6 months
84
When should lost body weight at birth be gone by?
10 days
85
When do motor problems manifest in kids?
Within first 18 months
86
When do speech and language problems manifest in kids?
Around 18m to 3yrs
87
When do social and communication problems manifest in kids?
2-4 years
88
Up to what age can brain injury potentially cause cerebral palsy in kids?
2 years
89
When are temper tantrums normal in kids?
15m-4yrs
90
When should kids have grown out of temper tantrums?
Around 5-6 years
91
1-2-3 approach to temper tantrums?
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
Describe autistic spectrum disorders?
Pervasive developmental disorders which are lifelong
93
3 categories of ASD required symptoms?
Difficulty communicating
Difficulty with social interaction
Difficulty with behaviours, interest and activities
94
What 3 other disorders are common with ASDs?
Anxiety
Depression
ADHD
95
When does ADHD usually manifest in kids?
Age 5/6
96
3 criteria of ADHD?
Poor attention
Hyperactivity
Impulsivity
97
Management approaches to ADHD?
Behavioural, social support
| Meds e.g. Methylphenidate (Ritalin)
98
Side effects of Ritalin (methylphenidate)?
Insomnia (give melatonin)
| Reduced appetite
99
What personality disorder are kids with conduct disorder at 50% risk of growing into as an adult?
Dissocial PD
100
5 common causes of false positives for CF sweat test?
```
Atopic eczema
Dehydration
Malnutrition
Hypothyroid
Adrenal insufficiency
```
101
False negative for CF sweat test?
Oedema
102
2 breathing techniques for CF in kids? 1 for older kids?
Percussion and postural drainage
| Forced expiration techniques
103
Symptoms of cardiac failure in kids?
SOB, trouble feeding, sweating, recurrent chest infections
104
Signs of cardiac failure in kids?
FTT, tachycardia, tachypnoea, cyanosis, heart murmurs, cardiomegaly, cool peripheries, hepatosplenomegaly
105
3 Hs of serious causes of constipation in kids?
Hypothyroid
Hirschprungs
Hypercalcaemia
106
Management of childhood IBD?
```
Elevated diet (amino acids)
Azathioprine
Avoid steroids long term
```
107
When and in whom does pyloric stenosis present?
6-8 week males
108
Electrolyte disturbances in pyloric stenosis?
Dehydration and hyponatraemia
| Hypochloraemic, hypokalaemic metabolic alkalosis
109
What features of history in kids make cows milk intolerance more likely than GORD?
Diarrhoea
| Allergic reactions
110
What tests are used in kids for cows milk protein intolerance?
RAST tests (Ab to food proteins)
Serum IgE
Jejunal biopsy - eosinophils in lam prop
111
When and in whom does intussusception present?
5-12 month males
112
What is nocturnal enuresis?
Nighttime bed wetting
113
What must you exclude to make transient synovitis diagnosis in acutely limping kids?
```
Septic arthritis
Perthes
Osteomyelitis
SUFE
TB arthritis
JIA
```
114
What is West Syndrome? When does it peak?
Infantile spasms - clusters of head nodding, arm jerks every 3-30 seconds
Peaks around 5m
115
Meds first line for absence seizures?
Ethosuximide
116
What is the presumed mechanism of stillbirth?
Lactic acidosis
117
What test is used for haemolytic disorders in little kids?
Coombs
118
3 reasons for physiological jaundice?
Increased bilirubin production from neonatal blood cell breakdown
Decreased bilirubin excretion due to liver immaturity
Immature gut flora
119
What is SIDS?
Unexplained death in infants less than 1 year old, peak 1-4m
120
3 preventative measures for SIDS?
Don't sleep prone - sleep supine
Don't smoke around kid
Prevent overheating
121
5 things that might make you think of NAI in kids?
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
Where are bruises common in toddlers?
Forehead, shins (learning to walk)
123
When are bruises in kids unusual?
Weird places e.g. Back, face, buttocks
Patterns e.g. Hand grip marks, specific objects, slap marks
If they are in immobile babies
124
Causes of NAI head injuries in kids?
Shaking - causes apnoea, hypoxic ischaemic damage
| Subdurals or haemorrhages
125
What fractures are almost always due to NAI in kids?
Rib fractures, particularly posterior
126
Things that are suggestive of accidental burn rather than NAI burn?
Asymmetrical, flexure sparing, splash marks etc.
127
3 phases of whooping cough?
Catarrhal (1-2 weeks URTI)
Paroxysmal (cough typically around 1m, whoops)
Convalescent (chronic cough for 2 weeks)
128
Early Sx of tetanus?
Trismus (jaw locking) - muscle spasms in jaw
Worsening spasms in all muscle groups
Tetany
129
What type of vaccine is the DTaP?
Inactivated toxins
130
What does polio cause?
Headache, myalgia, generally unwell
| And acute onset flaccid paralysis and areflexia in one limb (LMNL)
131
What does neonatal GH deficiency cause?
Hypoglycaemia
Jaundice
Doll face
Followed by FTT after 6-12 months
132
When should a kid be able to say their 1st and 2nd names?
3 years
133
When should a kid be counting to 10 and beyond?
4 years
134
Clinical features of hypothyroidism/cretinism?
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
What characterises Kwashiorkor?
Severe protein deficiency (too many carbs) leading to chronic diarrhoea and abdominal distension, oedema, tight skin/funny coloured hair, irritability and anorexia
136
What characterises Marasmus?
Total calorie malnutrition leading to emaciated appearance with no abdominal dysfunction
137
How does the HSP rash change and develop?
Goes rapidly from urticaria to purpura
