Paediatrics Flashcards
What is the common pathogen causing pneumonia in infancy?
RSV
What are the common organisms causing pneumonia in childhood?
Strep pneumoniae
Mycoplasma pneumoniae/H.influenza
What are the four categories of child development?
Vision and fine motor
Gross motor
Speech, hearing and language
Social development
What can be given to aid closure of the ductus arteriousus?
Indomethacin (prostaglandin inhibitor)
What is the definition of precocious puberty?
Puberty occurring before 8 years in girls and 9 years in boys
When is puberty considered delayed?
If first signs have not shown by 13 years in girls and 14 years in boys
What is a red flag in terms of developmental milestones at 6 weeks?
Not smiling
By when should the developmental milestone of smiling be reached?
6 weeks
What is a red flag in terms of developmental milestones at 4 months?
Cannot bring hands together
Head lag still present
What is a red flag in terms of developmental milestones at 6 months?
Cannot roll over
What is a red flag in terms of developmental milestones at 9 months?
Cannot sit unsupported
What is a red flag in terms of developmental milestones at 12 months?
Unable to crawl
What is a red flag in terms of developmental milestones at 18 months?
Not walking
By when should the developmental milestone of bringing hands together and supporting their own head be reached?
4 months
By when should the developmental milestone of rolling over be reached?
6 months
By when should the developmental milestone of sitting unsupported be reached?
9 months
By when should the developmental milestone of crawling be reached?
12 months
By when should the developmental milestone of walking be reached?
18 months
What are the common complications of measles?
Febrile convulsions
Otitis media
Bronchopneumonia
What are the rarer, more serious complications of measles?
Meningitis
Encephalitis
Subacute sclerosing panencephalitis
What are the possible complications of Rubella?
Thrombocytopenia
Encephalitis
Arthritis
If exposure
What are the possible complications of mumps?
Meningitis Encephalitis Pancreatitis Nephritis Orchitis (older males)
What is the criteria for Kawasaki’s disease? (5/6)
Fever for 5 days Conjunctivitis Cervical lymphadenopathy Polymorphous exanthema Reddening, oedema and desquamation of hands and feet Mucous membranes -Strawberry tongue
What is the common organism causing pneumonia in neonates?
Group B strep
What is McArdle’s disease?
Glycogen Storage disease type 5
Glycogen storage disease caused by a deficiency of myophosphorylase
Exercise intolerance - pain, early fatigue, painful cramps and myoglobin in the urine
What is Kawasaki’s disease?
Acute vasculitis of medium vessels, which classically involves the coronary arteries.
Prolonged fever, lymphadenopathy and desquamation of the fingers and toes
What are the possible complications of Kawasaki’s disease?
Coronary artery aneurysm
Myocarditis
What is a cavernous haemangioma?
Type of blood vessel malformation which leads to a collection of dilated blood vessels forming a benign tumour
What is Wilms tumour?
Nephroblastoma
Most common kidney cancer in children
What is the commonest presentation of a child with Wilm’s tumour?
An assymptomatic abdominal mass
Rarely - abdo pain, vomiting, HTN
What are the features of pyloric stenosis?
Projectile vomiting, typically 30 minutes after feeds
Constipation and dehydration occasionally
Occ. palpable mass may be present in abdomen
Hypochloraemic, hypokalaemic alkalosis
What are the features of Intussusception?
Paroxysmal abdominal colic pain
Vomiting
Blood stained stool - ‘red current jelly’
Sausage-shaped mass in the RLQ
At what age should a child with a fever automatically be referred to a paediatrician?
Any child less 38 is regarded as a red flag
What four things should be recorded in all febrile children?
Temperature
Heart rate
RR
CRT
What are the possible features of Wilms Tumour?
Abdominal mass
Painless haematuria
Flank pain
Other - anorexia, fever
What is Hirschsprung’s disease?
Aganglionic section of bowel due to the failure to develop the parasympathetic plexuses (Auerbach and Meissner)
What is the possible presentation of Hirschsprung’s?
Neonates - failure or delay to pass meconium
Older - constipation, abdominal distension
What is Erbs palsy?
Damage to the upper brachial plexus most commonly from shoulder dystocia
Adduction and internal rotation of the arm
Pronation of the forearm
‘Waiters tip’
What is Klumpke’s palsy?
Damage to the lower brachial plexus
Commonly affects the nerves innervating the hand
‘Claw hand’
What are the features of Acute Epiglottitis?
Rapid onset
High temperature, generally unwell
Stridor
Drooling of saliva
Which organism causes Acute Epiglottitis?
Haemophilus Influenzae Type B
At what age should a child be referred to a paediatric surgeon regarding an undescended testis?
3 months
Make a diagnosis of cryptorchidism at this age
Need to be seen before 6 months old
What are the possible complications of cryptorchidism?
Infertility
Torsion
Testicular cancer
Psychological
What is the most common cause of headaches in children?
Migraines
What is the acute management for migraines in children?
Ibuprofen (more effective than paracetamol)
Prophylaxis - 1st - pizotifen and propranolol
- 2nd - valproate, topiramate, amitryptiline
What is Hand, foot and Mouth disease?
Self-limiting disease affecting children.
Caused by coxsackie A16 and enterovirus 71 most commonly
Contagious
Most common in age
What are the clinical features of Hand, foot and mouth disease?
Mild systemic upset: sore throat, fever
Oral ulcers
Followed later by vesicles on palms and soles of feet
What is the most common pathogen associated with Croup?
Parainfluenza Virus
What are the features of Croup?
Stridor
Barking cough (worse at night)
Fever
Coryzal symptoms
What features of croup prompt admission?
Moderate/severe
What are the important differentials for Croup?
Acute Epiglottitis
Bacterial tracheitis,
Peritonsillar abscess
Foreign body inhalation
What is the Rx for Croup?
Single dose of Dexamethasone (0.15mg/kg) to all children regardless of severity
Emergency - high flow 02, Nebulised adrenaline
What is the major risk factor for NRDS?
Prematurity
What is the major risk factor for Tachypnoea of the Newborn (TTN)?
Caesarean section
What is the major risk factor for Aspiration Pneumonia in a newborn?
Meconium staining in the liquor
What are the common organisms that cause meningitis in neonates to 3 months old?
Group B strep
E.coli
Listeria monocytogenes
What are the common organisms that cause meningitis in the age group 1 month to 6 months?
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus Influenzae
What are the common organisms that cause meningitis in children greater than 6 years?
Neisseria meningitidis
Streptococcus pneumoniae
What are the main features of Erythema Infectiosum?
Fifth disease or ‘slapped cheek’ syndrome
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped cheek’ rash spreading to proximal arms and extensor surfaces
What are the key features of Rubella?
Rash - pink, maculapapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy - suboccipital and postauricular
Which is the pathogen responsible for scarlet fever?
Group A haemolytic streptococci
(Usually strep. Pyrogenes)
Reaction caused to the erythrogenic toxins caused by strep.
What are the characteristics of ADHD?
Extreme restlessness
Poor concentration
Uncontrolled activity
Impulsiveness
What are the key features of patau syndrome?
Microencephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
What are the key features of Edwards syndrome?
Micrognathia
Low set ears
Rocker bottom feet
Overlapping of fingers
What are the key features of Fragile X?
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
What are the features of Noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
What are the features of Pierre-Robin syndrome?
Micrognathia
Posterior displacement of the tongue
Cleft palate
What are the key features of Prada-Willi syndrome?
Hypotonia
Hypogonadism
Obesity
What are the key features of Williams syndrome?
Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supra valvular aortic stenosis
What is the commonest cause of gastroenteritis in children?
Rotavirus
What are the features of hypernatraemic dehydration in children with diarrhoea?
Jittery movements Increased muscle tone Hyperreflexia Convulsions Drowsiness/coma
What three features must be present for a diagnosis of autism to be made?
Global impairment of language and communication
Impairment of social relationships
Ritualistic and compulsive phenomena
What conditions are associated with Autism?
Fragile X
Rett’s syndrome
List the criteria for admitting a child with Bronchiolitis
Episodes of apnoea
Persistent sats 50
What are the commonest causes of haemorrhagic gastroenteritis?
Campylobacter
Salmonella
What is the management for threadworms?
Single dose of mebendazole for the whole household and issue hygiene advice
What are the features of Bronchiolitis?
Coryzal symptoms (inc mild fever) precede: Dry cough Increasing breathlessness Wheezing, fine inspiratory crackles Occ feeding difficulties
What are the central causes of hypotonia in a child?
Down’s syndrome
Prader-Willi syndrome
Hypothyroidism
Cerebral palsy (hypotonia may precede spasticity)
What are the neurological and muscular problems that can cause Hypotonia in a child?
Spinal muscular atrophy Spina bifida Guillain-Barré syndrome Myasthenia Gravis Muscular dystrophy Myotonic dystrophy
What are the risk factors for developmental dysplasia of the hip?
Female Breech Positive family history First born child Oligohydramnios Birth weight >5kg Congenital calcaneovalgus foot deformity
What are the three features that form the classical triad of Haemolytic Uraemic syndrome?
Haemolytic anaemia
Raised urea
Thrombocytopenia
What pathogen commonly causes Haemolytic Uraemic syndrome?
Escherichia Coli Subtype 0157
What are the main features of DKA?
Abdominal pain
Polyuria, polydipsia, dehydration
Kussmaul respiration (deep ventilation)
Acetone-smelling breath
What are the features of Roseola Infantum?
High fever lasting a few days
Then a maculopapular rash develops
Occ febrile convulsions
Diarrhoea and cough common
What causes Roseola Infantum?
Human Herpes Virus 6 (HHV6)
What are the main types of cerebral palsy?
Spastic (hemiplegia, diplegia, quadriplegia)
Dyskinetic
Ataxic
Mixed
Which type of cerebral palsy is intraventricular haemorrhage most commonly associated with?
Spastic diplegic CP
What is the criteria for severe asthma in a 2-5 year old?
Sats 140/min
RR >40/min
Use of accessory muscles
What is the criteria for a severe asthma attack in a child over the age of 5?
Sats 125/min
RR >30/min
Use of accessory neck muscles
What is the criteria for a life-threatening asthma attack in a child aged between 2 and 5?
Sats
What is the criteria for a life-threatening asthma attack in a child over the age of 5?
Sats
What are the features for Achondroplasia?
short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis
What are the antibiotics used to treat meningitis?
3 months: IV cefotaxime
Which immunisations are live attenuated viruses?
BCG MMR oral polio yellow fever oral typhoid
Causes for neonatal hypoglycaemia?
maternal diabetes mellitus prematurity IUGR hypothermia neonatal sepsis inborn errors of metabolism nesidioblastosis
