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MSRA > Paediatrics 2 > Flashcards

Paediatrics 2 Flashcards

1
Q

Jaundice
Pathological
Physiological
Prolonged

A

In the first 24 hours
2-14 days
> 14 days

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2
Q

Causes of pathological jaundice (4)

A

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
G6PD

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3
Q

Causes of prolonged jaundice

A 
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections e.g. CMV, toxoplasmosis
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4
Q

Tests for prolonged jaundice

A 
conjugated and unconjugated bilirubin
direct antiglobulin test (Coombs' test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs
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5
Q

Raised conjugated bilirubin could indicate which condition?

Mx

A

biliary atresia –> urgent surgery

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6
Q

Juvenile idiopathic arthritis (JIA)
Definition

Pauciarticular JIA definition
Antibody
Associated with which extrarticular issue?

A

arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks

4 or less joints are affected
ANA
Anterior uveitis

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7
Q

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel =

Mx

Complication
Ix for screening

A

Kawasaki

  1. High dose aspirin
  2. IV IG

Coronary artery spasm
ECHO as screening

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8
Q

Limping child
Name the condition
Limp may be painless

A

Juvenile arthritis

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9
Q

Limping child
Name the condition
Usually detected in neonates
6 times more common in girls

A

Development dysplasia of the hip

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10
Q

AP mimicking appendicitis
Rectal bleeding
Obstruction
Mx Surgery

A

Meckel’s diverticulum

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11
Q

Meningitis

Contraindications for LP

A 
focal neurological signs
papilloedema
significant bulging of the fontanelle
DIC
signs of cerebral herniation
meningococcal septicaemia
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12
Q

Meningitis

Mx

A

< 3 months: IV amoxicillin + IV cefotaxime

> 3 months: IV cefotaxime (or ceftriaxone)

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13
Q

Meningitis

When would you give dexamethasone?

A

frankly purulent CSF
CSF white blood cell count > 1000
raised CSF white blood cell count with protein conc >1
bacteria on Gram stain

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14
Q

Meningitis
Common organisms
Neonatal to 3 months (3)

A

Group B Strep
(E. coli
Listeria)

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15
Q

Meningitis
Common organisms
1 month to 6 years (3)

A

Neisseria meningitidis
(Streptococcus pneumoniae
Haemophilus influenzae)

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16
Q

Meningitis
Common organisms
Greater than 6 years (3)

A

Neisseria meningitidis

Streptococcus pneumoniae

17
Q

Common age of achieving day and night time continence

A

3-4yo

18
Q

Nocturnal enuresis

Mx

A

Look for underlying causes
Advice of diet, fluid intake, star charts etc
< 7yo - enuresis alarm
> 7yo - desmopressin

19
Q 
Meningococcal septicaemia 
Mx
Dosages
<1yo 
1-10yo 
>10yo
A

IV benpen

300mg, 600mg, 1200mg

20
Q

Umbilical cord contains?

How many arteries and how many veins?

A

two umbilical arteries and one umbilical vein

21
Q

Mx umbilical hernia versus paraumbilical

A

likely resolve on its own by 1-3yo

unlikely with paraumbilical

22
Q

cherry red lesions surrounding the umbilicus
may bleed on contact and be a site of seropurulent discharge
=

Mx

A

Umbilical granuloma

chemical cautery with topically applied silver nitrate

23
Q

urinary discharge from the umbilicus

associated with other urogenital abnormalities.

A

Persistent urachus

24
Q

umbilical discharge that discharges small bowel content

A

Persistent vitello-intestinal duct

25
Q 
left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
=

Mx
If needing to keep it open give?

A

PDA

indomethacin or ibupofen
to inhibit PG synthesis to help close it

PGE1

26
Q

hip pain: develops progressively over a few weeks
limp
stiffness and reduced range of hip movement
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
More common in boys than girls
4-8yo

A

Perthes

27
Q

What is the Caterall staging?

A

Staging for Perthes
Stage 1 Clinical and histological features only
Stage 2 Sclerosis with or without cystic changes and preservation of the articular surface
Stage 3 Loss of structural integrity of the femoral head
Stage 4 Loss of acetabular integrity

28
Q

Perthes disease

Mx

A

Management
To keep the femoral head within the acetabulum: cast, braces
If less than 6 years: observation
Older: surgical management with moderate results
Operate on severe deformities

Prognosis
Most cases will resolve with conservative management.

29
Q

usually presents by 6 months e.g. with developmental delay
child classically has fair hair and blue eyes
learning difficulties
seizures, typically infantile spasms
eczema
‘musty’ odour to urine and sweat*
=

AD/AR
Chrm
Diagnosed through which investigations?

A

PKU
AR
Chrm 12

Guthrie test (heel prick)
hyperphenylalaninaemia
phenylpyruvic acid in urine

30
Q

Define precocious puberty

A

‘development of secondary sexual characteristics before 8 years in females and 9 years in males’

31
Q

What does thelarche mean?

What does adrenarche mean?

A

thelarche (the first stage of breast development)

adrenarche (the first stage of pubic hair development)

32
Q

Precocious puberty

Classification

A
  1. Gonadotrophin dependent
    due to premature activation of the hypothalamic-pituitary-gonadal axis
    FSH & LH raised
  2. Gonadotrophin independent
    due to excess sex hormones
    FSH & LH low

MSRA (22 decks)

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