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Specialities > Paediatrics 3 > Flashcards

Paediatrics 3 Flashcards

1
Q

What are the techniques that can be used to collect a urine sample from a baby?

A

Clean catch sample

Catheter specimen

Suprapubic catheter

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2
Q

List some causes of gross motor developmental delay:

A

Cerebral palsy

Duchene muscular dystrophy

Traumatic brain injury

Infections
- TORCH

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3
Q

At what age can a Diskus dry powder device for asthma be used?

A

> 8 years and above

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4
Q

If a cystic fibrosis patient presents with abdominal pain, what diagnosis should always be considered? and how is it diagnosed?
and how is it treated?

A

Distal Intestinal Obstruction Syndrome
- DIOS

Abdominal x-ray
+
Water- soluble contrast study

Stool softeners

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5
Q

What is the device used to deliver regular prophylactic antibiotics centrally to children and what group of patients maybe likely to have one?

A

Port-a-cath
(differs to a Hickman line as the tubes are underneath the skin)

Cystic fibrosis

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6
Q

What ages are children vaccinated against H. Influenza?

A

2,3,4 and 12

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7
Q

What things must you NOT do when presented with a child with likely epiglottitis?

A

Distress

Examine the throat

Cannulate (distressing)

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8
Q

What are the differentials for stridor:

A

Croup

Bacterial tracheitis

Foreign body

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9
Q

List some causes of stridor in children:

A

Epiglottitis

  • very high temperature
  • drooling
  • very unwell looking

Croup

  • barking cough
  • coryzal symptoms

Laryngomalacia
- 4 weeks of age

Inhaled foreign body

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10
Q

What is the term when the skull sutures widen apart and why is it clinically significant?

A

Suture Diastasis

if this is present with a fracture it is suggestive of Non- Accidental injury

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11
Q

What is the treatment of hypoglycaemia in a child who is unconscious? - with dose

A

Glucagon - IM or IV

2ml/kg of 10% Dextrose
or
2.5ml/kg of 10% Dextrose in neonate

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12
Q

What are the congenital disorders causing hypothyroidism? and what is the signs and symptoms?

A

Thyroid dysgenesis
- poorly formed or non existent

Thyroid dyshormonogenesis
- enzyme defect

Maternal Hypothyroidism
- iodine deficiency causing cretinism

Symptoms:

  • poor feeding
  • lethargy
  • hoarse cry

Signs:

  • prolonged jaundice
  • coarse faces
  • hypotonia
  • wide fontanelle
  • bradycardia
  • goitre
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13
Q

List some aetiologies to Vesico-Ureteric reflux and highlight the investigations and management:

A

Primary:

  • abnormal ureteric orifice
  • short submucosal tunnel

Secondary:

  • Obstructive - posterior urethral valves
  • Neuropathic bladder
  • dysfunctional bladder

Investigations:

  • MCUG
  • DMSA (for scarring)

Management:

  • prophylactic antibiotics
  • Laxatives to prevent constipation

Surgical:

  • STING operation - bulking
  • Re-implantation of ureters
  • Nephrectomy
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14
Q

What are the signs of a complex febrile seizure?

A

> 15 mintues

Focal neurology

> 2 seizures within 24 hours

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15
Q

What other disorders are associatted with austism?

A

ADHD
Tourettes
Depression
Fragile X syndrome

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16
Q

When is performing a LP contraindicated in suspected meningococcal disease?

A

In shock
- as they are unstable

Rash development
- DIC has begun so will have coagulopathy

Signs of raised ICP

*the rash if pathomenomic and the bacteria are not resistant to any forms of the antibiotics. therefore cultres and sensitivity from a LP add little value in the acute setting.
Further PCR of blood cultures can be obtained with 24 hours

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17
Q

What are the classic signs of infantile spasm (West Syndrome?)
and what is the treatment?

A

Flexion of head
Flexion of hips and legs
Extension of arms
- looks like a startled response

Prednisolone

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18
Q

What is the first line management for intussusception?

A

Catheter insertion with air inflation.
- done under fluoroscopic guidance

2nd line:
- urgent laparotomy with manual reduction

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19
Q

How can you distinguish oligoarticular JIA from Systemic JIA?

A

Systemic:

  • more severe
  • destructive
  • swinging fever
  • maculopapular rash

Oligo-articular affects larger joints and the patient is usually relatively well.

  • <4 joints
  • asymmetrical
  • uveitis
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20
Q

In precocious puberty in boys, if the testes are small what does this highlight and name a typical condition?

A

Shows a peripheral cause. Most commonly adrenal hyperplasia as this will create a negative feedback to FSH and LH which means reduced enlargement of testes.

*note if it was a sex-cord stromal tumour you would expect one testes to be larger than the other

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21
Q

What is the main cause of a massive G.I bleed in children between 1-2 years old - often requiring a transfusion?

A

Merkel’s diverticulum

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22
Q

What is the pathogen of Roseola infantum and what is the most common complication?

A

Human herpes -6 disease - HHV-6

Febrile convulsions

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23
Q

If a child <3 months has a UTI, what should the management be?

A

Admitted to hospital.

They will also require an ultrasound
plsu potentially further workup depending on atypical, recurrent etc

*IV amox + Gent

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24
Q

Why is hand preference <18 months a bad thing?

A

Suggestive of Spastic hemiplagia

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25
Q

What are the major types of Cerebral palsy?

A

Spastic cerebral palsy

  • hemiplegia (one side)
  • diplegia (legs)
  • quadraplegia

Extrapyramidal

  • Dystonic movements
  • chorea movements
  • Athetoid movements

Ataxic cerebral palsy
- cerebellar damage

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26
Q

List some key referral points in the developmental history:

A

No smile - 10 weeks
Unable Sit unsupported - 12 month s
no walking - 18 months

Preferred dominance before 18 months

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27
Q

What is the most important cause of conjugated bilirubin to rule out in a baby with jaundice?

A

Biliary atresia

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28
Q

What is the definition of prolonged jaundice in a neonate?

A

Term baby:
- >14 days

Pre-term baby:
- >21 days

29
Q

What are differentials for respiratory distress in a neonate?

A

Transient tachypnoea of newborn

Respiratory distress syndrome

Meconium aspiration

Pneumothorax

Respiratory infection

30
Q

What are the associated gastrointestinal defects with Down’s syndrome?

A

Increased risk of:

  • Hirschsprung’s disease
  • duodenal atresia
  • imperforate anus
  • oesophageal reflux
  • Coeliac disease
31
Q

What are some of the symptoms of Rubella syndrome?

A 
Cataracts 
Microphthalmos - abnormal eye formation 
Sensorineural hearing loss 
Thrombocytopenic purpura/ Blue berry muffin rash 
Heart defects: PDA most common
32
Q

List some teratogenic drugs and their effects:

A

Phenytoin:

  • cleft lip
  • cardiac defects
  • craniofacial abnormalities (foetal hydantoin syndrome)

Sodium Valproate
- neural tube defects

Lithium
- Ebstein’s anomaly

Warfarin

  • frontal bossing
  • cardiac defects

Tetracycline
- discoloration of teeth

33
Q

What features of short stature suggest a pathological origin:

A

Discrepancy between weight and height

Movement away from mid-parental height

Slow velocity of height

34
Q

What are the definitions of faltering growth:

A

A drop deceleration of >2 centiles in weight

Extremely low BMI

Slow height growth or weight for length

Weight less than 5th percentile more than 2 occasions

35
Q

When is the Guthrie heel prick test done, what 5 core conditions are tested for and what are some caveats to performing the test?

A

Completed at 5 days old.

PKU 
Congenital hyporthyroidism (cretinism) 
Cystic fibrosis 
sickle cell diseases 
MCADD 
Maple Syrup Urine Disease

Infants must have been on milk feeds for at least 48 hours and not had a blood transfusion in the last 72 hours.

36
Q

What is the term used to describe a flattened one side of the head due to the position of the child?

A

Positional plagiocephaly

37
Q

What sign is seen bilaterally on both sides of the costal margin across he diaphragm in chronic asthma and in osteomalacia?

A

Harrison’s sulcus

Diaphragm tension pulls the bones in causing a groove. this may be from normal tension with soft bones as seen in osteomalacia or in abnormal tension as seen in chronic lung disease

38
Q

Give some differentials for an acute and chronic cough:

A

Acute:

  • URTI
  • Croup
  • Bronchiolitis
  • Acute exacerbation of asthma/ Viral wheeze
  • Pertussis
  • Inhaled foreign body

Chronic:

  • Asthma
  • Infection
  • GORD
  • Chronic illness (CF, Kartagener)
39
Q

What is the most common cause of pneumonia in 5-15 year olds?

A

Mycoplasma pneumoniae

40
Q

What age must a child be to use a dry powder device?

A

> 8 years old

41
Q

High light the key management of cystic fibrosis:

A

Daily chest physiotherapy

Prophylaxis antibiotics
- may require portacath

Creon supplements

Fat soluble vitamins

High calorie diet

42
Q

What are the two main screening methods for CF?

A

Immunoreactive trypsinogen
- done on spot test

Sweat test, genetic testing
*done if failure to thrive and failure of first pass meconium

43
Q

List 5 causes of cyanosis in a child:

A

Respiratory disease

Cardiac

During a seizure

Stress
- infection, hypoglycaemia

CNS depression

  • drugs
  • trauma
44
Q

List some differentials for hepatosplenomegaly:

A

Infection

  • malaria
  • parasitic infection

Congestive cardiovascular disease

Extramedullary hematopoiesis
- thalassemia

Malignancy
- leukemia

45
Q

What are the top causes for haematemesis?

A

Swallowed blood

  • from cracked nipples
  • epistaxis

Repeated vomit

Ulceration/ hiatus hernia

Bleeding disorders

Oesphageal varices `

46
Q

List 5 medical causes of acute abdomen in a child:

A

Gastroenteritis

Henock sholien

Constipation

DKA

Acute nephritis

47
Q

List 5 surgical causes of acute abdomen in a child:

A

Acute appendicitis

Intussusception

Volvulus

Strangled inguinal hernia

Torsion of testes

48
Q

What are the risk factors for iron deficiency anaemia in children and what can be given alongside the supplements to aid absorption:

A

Preterm
Low birth weight
Multiple births
Excessive cow’s milk

Vitamin C increases absorption

49
Q

What are the poor prognostic indicators for leukemia?

A 
Age <1 year, >10 years 
Male 
T cell linage 
WCC >50 
Failure to respond to chemotherapy
50
Q

What are the features of malignancy in lymphadenopathy?

A

Supraclavicular, epitrochlear nodes
Systemic symptoms
Hepatosplenomegaly
Signs of marrow infiltration

51
Q

What are the top causes of malignant lymphadenopathy in children?

A

ALL, AML

Lymphoma

Hodgkin’s disease

Neuroblastoma

Rhabdomyosarcoma

52
Q

List some differentials for abdominal masses which are malignant:

A 
Neuroblastoma 
Wilm's tumour 
Hepatoblastoma 
Lymphoma 
Germ cell tumours
53
Q

Highlight some of the signs and symptoms seen in neonates who have meningitis:

A

High pitched crying

Uncontrollable crying

Poor feeding

Cyanotic episodes

Seizures

Budging fontanelle

54
Q

What things should be analysed for in CSF of a child with suspected meningitis?

A

WCC

Protein

Organism cultures/ staining

PCR for pneumococcus/ meningococcus/ HSV/ VZV and enterovirus

55
Q

What is the treatment for bacterial meningitis?

A

<6 weeks:

  • IV Cefotaxime
  • Amoxicillin
  • Gentamicin

> 3 months
+ dexamethasone
*only add if no petechial or purpuric rashes

56
Q

What is the management for sepsis in a child (not listing sepsis 6):

A

High flow oxygen

IV fluid - 20mls/kg 0.9% saline

IV cefotaxime

Correction of metabolic derangements

57
Q

What are the most common causes of oedema in children?

A

Heart failure

Nephrotic syndrome

Liver failure

Malnutrition

58
Q

What are the risk factors for nephrotic syndrome and what are some investigations into it and how is it treated?

A 
Male 
Asian 
Previous infection 
Previous nephrotic syndrome 
Family history

Investigations

  • FBC
  • U&Es
  • LFTs
  • complement studies
  • Infection (varicella, Streptolysin O antigen)
  • Urine - PCR
  • Biopsy (if indicated)

Treatment:

  • High dose prednisolone
  • 20% albumin + furosemide
  • Pneumococcal vaccine
  • Penicillin prophylaxis
  • salt/ fluid restriction
59
Q

During an asthma attack or severe croup what blood pressure sign may be seen and why?

A

Pulsus paradoxical

  • more than a >10mmHg drop in the systolic blood pressure during inspiration than expiration.
    probably due to less blood being able to enter the lung, bulging the right atrium compressing the left atrium reduces preload.
60
Q

What are the drugs used in an acute asthma attack in children?

A 
Oxygen
Salbutamol 
Hydrocortisone
Ipratropium 
Theophylline

“O-SHIT”

61
Q

What are the degrees of dehydration in a child, and what is the volume of replacement?

A

mild 5% body weight (50ml/kg):

  • lethargic
  • loss of skin turgor
  • dry mouth
  • fontanelle slack

moderate 10% (100ml/kg):

  • tachycardia
  • tachypnoea
  • fontanelle sunken
  • eyes sunken
  • mottle skin

Severe 15% (>150ml/kg)

  • shock
  • hypotension

Replacement:

  • body weight loss
  • maintenance (150ml/kg infants, 100ml/kg children)
  • fluid loses

*fluid is replaced over 48 hours. so is added onto the chart

62
Q

What are the drugs used in infantile spasm disorders?

A

ACTH
or
Corticosteroids

63
Q

What is the complication that can occur with diffuse neonatal haemangiomatosis and segemental haemangiomas?

A

High output cardiac failure

64
Q

What is the amount of neonatal need for fluid?

A

150ml/kg/day

After day 5

65
Q

What constitutes the HEAD assessment for adolescents?

A

Home life

Education

Activities

Drinking
Driving
Drugs

Sex
Smoking
Suicide

66
Q

What is the order of puberty in males and females?

A

Females:

  • Breast development
  • Pubic hair
  • Rapid growth
  • Menarche

Males:

  • Testicular enlargement
  • Pubic hair growth
  • Height spurt
67
Q

What drug can be used in delayed puberty in males?

A

Oxandrolone

or in older males intramuscular testosterone injections

68
Q

What factors can be implemented to help with transitioning from paediatric services to adult?

A

inform early

Run specific teenage clinics

INvolve the GP

Encouragement self help

69
Q

Highlight the management of a febrile seizure and list some differentials:

A

If:
less than 5mins and well and present then:
- antipyretics

If >5mins or not well
- Buccal midazolam
or
- PR diazepam

  • education o parents and risk of recurrence. *to seek medical advice if it occurs >5mins.

differentials:
- Meningoencephalitis
- Epilepsy

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