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MBBS > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the pathophysiology of ITP?

A

Destruction of circulating platelets by anti-platelet IgG autoantibodies

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2
Q

Oppositional defiance disorder behaviours:

A

(ARE BRATS)

  • Annoying
  • Rule breaker
  • Easily Annoyed
  • Blames others
  • Resentful
  • Argues with adults
  • Temper
  • Spiteful/ vindictive
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3
Q

Cardiovascular defects associated with Down Syndrome?

A
  • Atrial Septal Defect
  • Ventricular Septal Defect
  • Atrio-ventricular Septal Defect
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4
Q

Cardiovascular defects associated with Marfan’s syndrome?

A
  • Aortic root dilation
  • Mitral valve prolapse
  • Aortic regurgitation
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5
Q

webbing

Cardiovascular defects associated with Turner’s syndrome?

A
  • Coarctation of the aorta
  • Bicuspid aortic valve
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6
Q

Chromosomal abnormality -> Down syndrome?

A

Triplication of chromosome 21 (all or part)

  • trisomy 21
  • translocation -> 3 chromosome 21s
  • mosaicism
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7
Q

Chromosomal abnormality -> Turner’s syndrome?

A

X chromosome abnormality (a whole or part of an X missing)

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8
Q

Sites for eczema?

A

Infants: head (cheeks, foreheads, skalp), extensor

Children: flexors (wrists, ankles, popliteal fossae and antecubital fossae)

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9
Q

Eczema Treatment

A

General

  • Moisturiser
  • Occlusive dressing - up to several times/ day
  • Topical corticoseroids Infected
  • Systemic antibiotics
  • Salt or bleach baths

Persistent pruruitis

• Antihistamine

○ phenergan If really severe

  • Calcineurin inhibitors
  • TAR
  • UV light
  • immunosuppressants
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10
Q

Causes of Acyanotic heart disease in infants

A

L->R shunt

  • ASD
  • VSD
  • AVSD
  • PDA

Obstructive

  • Aortic Stenosis
  • Pulmonary stenosis
  • Coarctation of the aorta
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11
Q

Causes of Cyanotic heart disease in infants

A

R -> L shunt

  • Ebstein’s anomoly
  • TOF

Other

  • Transposition of great arteries
  • total anomolous pulmonary drainiage
  • tricuspid atresia
  • hypoplastic left heart syndrome
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12
Q

Causes of jaundice Day 1

A

Day 1 - Always pathological

  • Congenital Infection
  • Hemolytic diseases

○ Erythroblastals faetalis

  • Rhesus incompatability
  • ABO incompatability

○ G6PD deficiency

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13
Q

Causes of jaundice Day 2 - 2 weeks

A
  • Haemolytic - as above, more commonly present in the first day or 2
  • Infection, as above + UTI or other infection
  • Physiological/ breastmilk
  • Polycythaemia
  • Bruising
  • CN syndrome
  • Dehydration - exacerbating factor
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14
Q

Causes of jaundice >2 Week

A

Conjugated

  • biliary duct obstruction - atresia
  • Hepatitis

Unconjugated

• As above

○ Physiological

○ Breast milk

○ Haemolytic - G6DP in particular

○ Polycythamia

• Bowel obstruction

○ Hypothyroidism

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15
Q

Normal baby weight?

A

2500-4250g

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16
Q

Normal baby height?

A

48-53cm (50cm)

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17
Q

Normal baby head circumfrence

A

35cm average

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18
Q

Of the neonatal head bleeds, which one are you most concerned about?

A

Subgaleal - Baby can bleed out, so want to have IV cannula in if suspicious. Not defined by suture lines.

Also SAH and subdural haemorrhage for neurological complications

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19
Q

Where is a subgaleal haemorrhage?

A

below the (galeal) aponeurosis but above the periosteum

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20
Q

Where is a cephalhaematoma?

A

between the skull bone and periostem (cannot cross over bone edge)

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21
Q

Where is a caput succundeum?

A

Under the scalp but overlies the aponeurosis. Crosses suture lines. (is a oedamatous swelling from pressing against the cervix. Generally resolves after a few days.)

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22
Q

What is the cause of Erb’s palsy?

A

Upper brachial plexus injury during birth (C5, C6), very common in breech babies and large for gestation age babies.

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23
Q

What is the most common neonatal fracture during birth?

A

Clavicle

(Humorous is most common long bone fracture)

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24
Q

Risk Factors for Clavicle fracture during birth?

A
  • increased weight,
  • operative vaginal delivery,
  • shoulder dystocia
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25
Q

What vertebrae is the level of the posterior iliac crests?

A

L4

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26
Q

what level can you do an LP

A

Between L3/L4 or L4/L5

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27
Q

What medication do you give to a child who is currently undergoing seizures?

A

intranasal midazolam

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28
Q

Treatment of thalassaemia major?

A
  • Transfusion
  • folate
  • Iron chelation
  • Splenectomy
  • Bone marrow transplant
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29
Q

Signs of lead poisoning?

A

Mental

○ Irritability

○ Learning difficulties

○ Difficulty concentrating

Blood - anaemia

Abdomen upset

○ Pain

○ Constipation

Kidney failure

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30
Q

Adolescent psychiatric history points

A

HEADDS

  • Home and environment
  • Education/ employment
  • Alcohol
  • Drugs
  • Sexuality
  • Suicide/ Self harm and depression
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31
Q

Domains of ADHD?

A

○ Decreased attention

○ Hyperactivity

○ Impulsivity

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32
Q

MOA of Catapres/ clonidine?

A

Alpha 2 receptor agonist

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33
Q

What is ritalin also called?

A

methylphenidate (other brand name is concerta)

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34
Q

What is the classical triad that Haemolytic Uraemic syndrome presents with?

A
  1. Microangiopathic haemolytic anaemia
  2. Thrombocytopaenia
  3. Acute renal failure
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35
Q

What are the developmental domains?

A
  • Gross motor
  • Fine motor
  • Social/ personal
  • Language
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36
Q

What is Atomoxetine (Strattera )

A

An ADHD medication, a Noradreniline reuptake inhibitor

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37
Q

What’s the technical name for croup?

A

Laryngo tracheitis

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38
Q

Clinical Features of Croup?

A
  • Croupy cough - sounds like a seal
  • Stridor
  • Breathlessness
  • Hoarse voice
  • Low grade fever
  • Often preceded by virus
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39
Q

Viruses causing croup?

A

○ parainfluenza virus - most common

○ Human metapneumovirus

○ Influenza

○ RSV

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40
Q

DDx for croup?

A
  • epiglottitis
  • foreign body
  • asthma
  • bacterial tracheitis
  • retropharyngeal abscess
  • anatomical issues (sub-glottic stenosis, laryngo-malacia)
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41
Q

When do you need to treat croup?

A

Indicated if they have stridor while resting

42
Q

Treatment of croup?

A
  • Dexamethasone - prednisalone often used but it is probably not as good. Nebulised budesonide can be used but doesn’t seem to be as effective.
  • Oxygen -only sometimes appropriate, should be in PICU
  • Adrenaline nebulised
  • Intubation - if very severe
43
Q

Bronchiolitis RFs

A

RFs

  • No breast feeding - Ab from the breast milk protect
  • Prem babies
  • Cardiac or lung conditions
  • Decreased immune system
  • Tobacco smoke
  • Viral exposures - Having siblings
44
Q

Aetiology of bronchiolitis?

A
  • RSV - the most common cause, but all the viruses can cause it
  • Influenza A, B
  • Parainfluenza virus
  • Rhinovirus
45
Q

Treatment of bronchiolitis?

A

Supportive therapy

○ Antivirals don’t have a role, neither to antibiotics,

○ Fluids

○ oral corticosteroids

○ bronchodilaters - can give in some situations (Hx of atopy, past efficacy), salbatumol

  • Respiratory support (CPAP)
  • Intubation - very rarely needed
46
Q

Frequency of CF

A

1 in 2500 births

47
Q

Chromosome with the CF gene?

A

Chromosome 7

48
Q

Tests for CF?

A
  • Heelprick test (screening)
  • Sweat test (gold standard)
49
Q

Symptoms of CF?

A

Respiratory Symptoms

  • Chronic productive cough
  • recurrent infections

Gastrointestinal Symptoms

  • malabsorption - diarrhoea and fatty stool
  • reflux

Gowth issues

  • feeding difficulties
  • failure to thrive
50
Q

Complications of CF?

A

Respiratory

  • bronchiectasis
  • infections

Growth and metabolism issues

  • DM
  • Growth issues
  • Osteoporosis
  • liver disease
  • pancreatitis

Genitourinary issues

  • Male infertility
  • Urinary incontinence

Secondary issues

  • Psychological difficulties
  • Hearing impairment
51
Q

What are the most common congenital cardiology conditions?

A
  • VSD (30%)
  • PDA (12%)
  • ASD (8%)
  • pulmonary stenosis (8%)
  • aortic stenosis (5%)
  • coarctaion of the aorta (5%)
  • TOF (5%)
  • TGA (5%)
52
Q

What is the main cardiac condition associated with William’s syndrome?

A

Aortic stenosis (supra-valvular) (also PS)

53
Q

What is truncus arteriosus?

A

Where the aorta and pulmonary artery fail to divide and are one big trunk. (needs to be operated on in first 6 months)

54
Q

Cardiac conditions associated with Marfan’s?

A
  • Aortic root dilation
  • AR
  • Mitral Valve prolapse
55
Q

Features of MPS?

A
  • large heads
  • broad nose with flat bridge and upturned nostrils
  • coarse and abundant body hair
56
Q

What does Still’s murmur sound like?

A
  • short,
  • mid systolic, ejection murmur
  • between LLSE and apex
  • low pitched, vibratory, musical quality
57
Q

What does a Pulmonary flow murmur sound like?

A
  • soft
  • “blowing”
  • ejection
  • best heard pulmonary area, radiates to axilla
  • no associated click
58
Q

What does a carotid bruit sound like?

A
  • short
  • mid-systolic
  • best heard over neck or back (radiates there)
59
Q

What does a Venous Hum sound like?

A
  • low pitched
  • continuous
  • loudest above clavicles
60
Q

What mechanism is usually responsible for heart failure in neonates as compared to infants?

A

neonates: obstruction
infants: L-R shunt

61
Q

What is a boot shaped heart on x-ray a sign of?

A

TOF

62
Q

What are the components of TOF?

A
  1. VSD
  2. Overriding aorta
  3. Pulmonary stenosis
  4. Right ventricular hypertrophy
63
Q

Clinical picture of TOF?

A

Wide spectrum

Variable cyanosis

Loud systolic murmur, gets quieter as obstruction gets worse.

64
Q

RHD treatment

A

Symptommatic (aspirin, bed rest)

IM benpen (every month for 10 years)

If carditis severe - Steroids

Manage complications (arrhythmias, HF)

65
Q

Clinical Picture of Kawasaki’s disease?

A
  • Erythema of

○ Tongue - strawberry tongue

○ Lips

○ Palms +/- edema of the back of hands, desquamation of fingers

○ Soles

○ Perineum - rash

○ Peri-anal

○ BCG vaccine site

  • Fever - resistant to antipyretics
  • Swelling of conjunctiva - Bilateral, Exudative
66
Q

Management of Kawasaki’s?

A
  • IVIG - 10 days
  • Aspirin - for at least 6-8 weeks
67
Q

Complications of Kawasaki’s?

A
  • Coronary artery aneurysm
  • Depressed myocardial contractility
  • Myocardial failure
68
Q

What is the rule of 2s?

A

For Meckel’s Diverticulum

  • 2% of population • 2% become symptomatic • 2 feet from terminal ileum
  • 2 inches long
  • 2 types of tissue (pancreatic and gastric)
  • 2/3 have ectopic mucosa
69
Q

Complications of Meckel’s Diversticulum?

A

○ Lead point for intussusception

○ Cause volvulus - still has fibrous connection to umbilicus that bowel flops over

○ Inflammation - diverticulitis

○ Seem like an appendix/ appendicitis

○ acid secretion -> ulcer

70
Q

X-ray signs of intussusception?

A
  • Target sign
  • Crescent sign
71
Q

Treatment for intussusception?

A
  • enema (can try several times)
  • surgery
72
Q

How early can babies start cow’s milk?

A

12 months

73
Q

Medical term for breast development

A

Thelarche

74
Q

Medical term for appearance of first pubic hair?

A

Pubarche

75
Q

What are causes of precocious puberty?

A
  • Tumours
  • Trauma,
  • Irradiation
  • Familial
  • “treated gonadotrophin-independent puberty” (Congenital adrenal hyperplasia)
76
Q

Causes of Congenital Hypothyroidism?

A
  • Dyshormonegenesis (genetic)
  • Hypopituitarism
  • Thyroid agenesis
  • Iodine deficiency
77
Q

Classic signs of oesophageal atresia?

A
  • Frothing - unable to swallow saliva,
  • Subcostal recession - resp distress
  • Cannot tolerate feeds
  • +/- polyhydramnios Hx - from inability to swallow
78
Q

Ix for oesophageal atresia

A
  • NGT attempt
  • X-ray (gas in stomach means there’s a fistula)
  • USS (if other Sx)
79
Q

What are the 2 major abdomnial wall defects?

A
  • Gastroschesis (no sac)
  • Exomphalos/ amphalocele (with sac)
80
Q

What is the significance of green vomit in a neonate?

A

bile = Midgut malrotation with volvulus until proven otherwise = surgical emergency

81
Q

Midgut malrotation with volvulus treatment?

A

IV antibiotics and fluids

Immediate surgery or imaging

82
Q

Acute testicular pain in children Ddx?

A
  • Testicular torsion
  • Testicular appendage torsion
  • Epididymitis
  • Orchitis
  • Idiopathic Scrotal oedema
  • Appendicitis
  • Inguinal hernia
  • Renal stone
83
Q

Testicular pain in children Ix?

A
  • Scrotal exploration
  • Urinalysis - can help with a really obvious UTI
  • Not USS - not helpful
84
Q

What is paraphimosis?

A

Foreskin does not come back up, causes swelling and oedema which creates a positive feedback loop

85
Q

What is balanitis?

A

inflammaiton of the forekin

(penis can be 3-4x normal size)

86
Q

what is priapsim?

A

erection > 4h

87
Q

What is phimosis?

A

Foreskin unable to be retracted

88
Q

What is hypospadius?

A

When the urethral opening is on the ventral (bottom) surface of the penis (usually the glans)

89
Q

Where is Gastroschesis?

A

right of the midline

90
Q

Undescended testis happens how often on each side?

A
  • 50% right only, 25% left only, 25% bilateral
91
Q

In what age group is appendicitis most common?

A

peak 10-15 years (rare before 2)

92
Q

What is the lifetime incidence of appendicitis?

A

6%

93
Q

Is appendicitis more common in boys of girls?

A

boys (2:1)

94
Q

Paediatric inguinal hernia treatment?

A

Reduce if possible, bot not if septic.

All need surgery.

95
Q

What portion of boys have a hydrocoele?

A

80%

96
Q

Which testis is torted more commonly?

A

The left (L is lower than right), generally torted medially

97
Q

Peak age of testicular appendage torsion?

A

7-11

98
Q

What is the testicular appendage (that’s commonly torted) called?

A

Hyatid of Morgagni

99
Q

Clinicall appearance of Hyatid of morgagni torsion

A

Testicular pain - Acuity and severity of pain reduced compared to testicular torsion

Nil other accompanying symptoms

No movement restiriciton

Pathognomic blue dot sign (visible infarcted appendage) - in 25% of cases

Cremesteric reflex present, normal orientation as opposed to testicular torsion

100
Q

What is the management of suspected torted Hyatid or Morgagni

A

If unsure - Scrotal exploration

If blue-dot - Non-operative (simple analgaesia + rest)

If persistent (>48h) - Exploration & removal of appendage

MBBS (13 decks)

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