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Paediatrics Flashcards

1
Q

What are the clinical abdominal signs of intussusception?

A

Abdominal distension, tenderness, sausage-shaped mass on palpation.

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2
Q

What investigations would you perform for ?intussusception and what would you be looking for?

A

Abdominal USS - may reveal the mass, ‘target’ appearance
AXR - small bowel obstruction (fluid levels, dilated loops of small bowel)
Air enema - may be therapeutic as well as diagnostic

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3
Q

How would you manage intussusception?

A

Inital fluid resus as needed - ‘drip and suck’ = NG tube and IV fluids
Air (or contrast) enema reduction
Surgical reduction +/- resection if enema contra-indicated

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4
Q

What are contra-indications to managing intussusception with an air enema?

A

Rectal bleeding

Peritonism (i.e. Guarding, Rebound tenderness, rigid abdomen)

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5
Q

What are common pathological causes of intussusception?

A

Meckel’s diverticulum (75%).
Polyps and Peutz-Jeghers syndrome (16%).
Henoch-Schönlein purpura (3%).
Lymphoma and other tumours (3%).

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6
Q

What organisms are common causes of intussusception?

A

Viral - Rotavirus, adenovirus, HHV-6

Amoebomata, shigella, yersinia.

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7
Q

What is Meckel’s Diverticulum?

A

A congenital bulge of the small intestine, usually ileal, which is a remnant of the yolk stalk.

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8
Q

How can Meckel’s Diverticulum present?

A

Asymptomatically
Painless rectal bleeding (melena)
Epigastric pain
Mimics appendicitis

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9
Q

What are patients with Meckel’s Diverticulum at risk of developing?

A

Intestinal obstruction
Volvulus
Intussusception

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10
Q

What diagnostic test would you like to perform to confirm your ?meckel’s diverticulum

A

A technetium scan - gastric mucosa of the diverticulum show increased uptake

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11
Q

How should you manage a Meckel’s Diverticulum?

A

Small bowel resection

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12
Q

What is the “rule of 2’s” for Meckel’s Diverticulum?

A

2% of population affected
2 inches long
2 feet proximal to ileocaecal valve
2 types of mucosa - gastric and pancreatic
2 years old is a common age of presentation
2:1 male:female

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13
Q

What investigations would you like to perform for ?pyloric stenosis

A

FBC, Glucose, Serum electrolytes (low Cl, low potassium)
LFTs if jaundiced
Blood gas - venous or capillary (alkalosis)

Test feed = infant feeds, palpate olive mass and observe for peristalsis moving from left to right.

or

Abdo USS = outline the ‘dough-nut’ ring of the hypertrophic stenosis.

can sometimes do x-rays with contrast agent.

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14
Q

How would you manage a child with pyloric stenosis?

A

NBM, NG tube with aspirations
Fluid monitoring and correct dehydration - something with KCl and dextrose in.
Regular BM and serum electrolyte/pH monitoring.
Once stable - discuss with surgeons for ?pyloromyotomy

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15
Q

What do you want to know in a status epilepticus history? (it’s a mnemonic!)

A

Duration of convulsions and any treatment given already?

also, "PEE FIT"
Poisons ingested?
Epilepsy history?
Eaten recently?
Febrile illness recently?
Illnesses that are ongoing?
Trauma recently?
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16
Q

What does AVPU stand for?

A

Alert
Voice responsive
Pain Responsive
Unresponsive

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17
Q

Easy Paediatrics book:

What’s the fluid requirement for children weighing 0-10kg?

A

100-120 mL/kg/24hr

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18
Q

Easy Paediatrics book:

What’s the fluid requirement for children weighing 10-20kg?

A

1000 + [50mL for each kg over 10] mL/kg/24hr

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19
Q

Easy Paediatrics book:

What’s the fluid requirement for children weighing >20kg?

A

1500 + [20mL for each kg over 20] mL/kg/24hr

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20
Q

What is the initial management of DKA?

A

ABCDE approach
If shocked, fluid bolus 10mL/kg 0.9% saline
BM, U+Es, blood gas (venous or capillary)
Maintain potassium levels by giving potassium in each IV bag
Insulin IV after beginning IV fluids

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21
Q

intraventricular haemorrhage is most commonly associated with the development of what type of cerebral palsy?

A

spastic diplegic cerebral palsy

because of the anatomical proximity to the corticospinal tracts.

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22
Q

What does seborrhoeic dermatitis present like?

A

erythematous rash with yellow flakes in first few weeks of life.
Affects the scalp, nappy area, face and limb flexures.

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23
Q

Causes of short stature (it’s a mnemonic!)

A 
"ABCDEFG"
Alone (neglect)
Bone (rickets, achondrodysplasia, scoliosis)
Chromosome (Down's, Turner's)
Delayed
Endocrine (low GH, Cushing's, hypothyroidism)
Familial
GI malabsorption (Crohn's, Coeliac)
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24
Q

What are the causes of true (gonadotrophin-dependent) precocious puberty (it’s a mnemonic!)

A

“FACT” (i.e. facts are true!)

Familial
Acquired (post-sepsis, surgery, radiotherapy)
Central (neurofibromatosis, hydrocephalus)
Tumours

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25
Q

What are the causes of false (gonadotrophin-independent) precocious puberty (it’s a mnemonic!)

A

“HE GAS” (i.e. he gasses a lot of hot air = false)

Hypothyroidism
Exogenous sex steroids

Gonadal (ovarian/testicular tumour)
Adrenal (CAH, tumour)
Syndrome - McCune-Albright

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26
Q

What are the triad of symptoms in McCune-Albright syndrome?

A
  • Precocious puberty
  • polyostotic fibrous dysplasia
  • Cafe-au-lait spots that are large with irregular borders stopping at midline
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27
Q

Causes of delayed puberty?

A

Gonadotrophins are either low or high.

Low “CHEST”:
Congenital - familial or sporadic
Hypothyroidism
Hypothalamic-pituitary, e.g. panhypopituitarism or GnRH deficiency
Emotional, e.g. anorexia nervosa
Systemic Disease
Tumour (intracranial), e.g. prolactinoma.

High "Gonadotrophins Climb Stairs"
Gonadal dysgenesis
Gonadal disease
Chromosomal - klinefelter
Steroid hormone deficiencies
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28
Q

Neonate in first few days of life develops a diffuse macular rash with papules and pustules predominantly on the trunk. The infant is well and goes on to resolve within 2 days. This recurs over the next two weeks.

A

Erythema toxicum neonatorum

  • occurs in first few days of life
  • blotchy red papules +/- pustules
  • anywhere on body (not palms/soles)
  • infant WELL
  • resolve in a few days but can recur over next couple of weeks
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29
Q

Neonate with pinpoint white papules over the nose and cheeks

A

Sebaceous gland hyperplasia

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30
Q

What are Epstein’s Peals?

A

milia in the mouth (white keratinous cysts) along the alveolar ridge and at the junction of the hard/soft palate

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31
Q

What is the other name for Mongolian blue spot?

A

Dermal melanocytosis?

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32
Q

What is the other name for Dermal melanocytosis?

A

Mongolian blue spot

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33
Q

What causes dermal melanocytosis?

A

melanocytes entrapped in the dermis

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34
Q

How long does it take for dermal melanocytosis to fade?

A

a few years
usually all gone by puberty
very rarely for life

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35
Q

Differentials for paediatrics constipation

A

Intake: Diet, dehydration, too much milk
Gut passageway: stricture, anal fissure, Hirschsprung’s disease
Metabolic: Hypothyroidism; cystic fibrosis; hypercalcaemia
Neuromuscular: cerebral palsy; spinal cord lesions
Drugs: narcotics, antidepressants

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36
Q

What is the first-line medical treatment for faecal impaction?

A

Macrogols (polyethylene glycol 3350) and electrolytes

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37
Q

What is first-line maintenance therapy in constipation?

A

Macrogols (polyethylene glycol 3350) and electrolytes

in conjunction with diet and lifestyle advice

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38
Q

How should the maintenance therapy in constipation be adjusted if the patient doesn’t respond to the first-line treatment?

A

First-line is polyethylene glycol 3350 + electrolytes.

If there is little responsethen add a stimulant laxative, e.g. senna, to the first-line.

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39
Q

How long should a child be on maintenance therapy for constipation?

A

Several weeks after the first normal bowel movement - don’t stop the medications abruptly

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40
Q

What diet + lifestyle advice would you offer to the parent of a child with constipation?

A

Lifestyle:

  • scheduled toilet time
  • Bowel diary
  • Reward system

Intake:

  • Encourage adequate fluid intake
  • Encourage adequate fibre intake (fruit, vegetables)
41
Q

How should you manage faecal impaction?

A

1st-line: macrogol (polyethylene glycol) and electrolytes
2nd-line: if no improvement after two weeks add a stimulant (e.g. senna) to the macrogol

Consider rectal medications if the above fails
Consider enema if the above fails
Consider manual evacuation under anaesthetic if the above fails

42
Q

What are big red flags in a constipation history?

A

Constipation from birth or first few weeks of life
Failure to pass meconium in first 48 hours of life
Abdominal distension with vomiting
Weakness in legs or locomotor delay

43
Q

What are red flags in an examination for constipation?

A

Abnormal appearance/position/patency of anus
Gross abdominal distension

Abnormal spine/gluteal region
Abnormal neurological reflexes

44
Q

What are long term complications of constipation?

A

Faecal impaction –> overflow diarrhoea
Megacolon –> risk of ulcers and perforation
Anal fissures –> pain and chronic fissures
Psychological and behavioural effects

Basically: blockages, tears and psych

45
Q

How would you manage an anal fissure?

A

Osmotic laxative and pain relief (e.g. paracetamol or ibuprofen)

46
Q

How might a child with Hirschprung Disease present?

A

Failure to pass meconium in first 48 hours of life
Vomiting
Abdominal distension
Explosive bowel movements, particularly following examination

47
Q

What genetic condition is associated with Hirschprung Disease?

A

Down syndrome

48
Q

What specific investigations would you like to perform for Hirschprung Disease?

A

Consider Abdominal X-ray (megacolon) or contrast enema

Definitive: Rectal biopsy demonstrating absent ganglions (older children require anaesthetic)

49
Q

What is the management for Hirschprung Disease?

A

Bowel irrigation (this is not an enema)

  • involves small volume of liquid introduced into rectum
  • repositioning a tube to evacuate gas and liquid from the rectum.

Definitive surgery:

  • Removal of aganglionic section and pull-through of normal ganglionic section to rectum
  • usually done by first few months of life
50
Q

What are the differentials for reflux?

A

Possetting (physiological passive reflux)
Allergy (skin rash, vomiting, diarrhoea –> use special formula)
GORD ( weakness or inappropriate relaxation of oesophageal sphincter)
Oesophageal stricture
Pyloric Stenosis

51
Q

What are common causes of pharyngitis?

A

Viral: Adenovirus or parainfluenza virus
Bacterial: Group A Streptococcus

52
Q

What are the treatment options for pharyngitis?

A

Antipyretics and fluids

Antibiotics if ?bacterial

53
Q

How would a child with laryngomalacia present?

A

Stridor (‘floppy’ airway that collapses on inspiration)

Develops early in life (like days)

54
Q

What investigation might you perform to diagnose laryngomalacia?

A

Laryngoscopy

55
Q

How would you manage a child with laryngomalacia?

A

Reassurance - most cases will resolve with time
Rule out GORD
If severe, consider surgical review for endoscopic supraglottoplasty

56
Q

What is the treatment for moderate/severe croup?

A

Consider oxygen if below 92%
Oral dexamethasone (0.15mg/kg)
Paracetamol or ibuprofen for fever and pain relief

Consider neubulised adrenaline
Consider intubation and ventilation if not responding to treatment

57
Q

What is the organism that causes whooping cough?

A

Bordetella Pertussis

Gram negative coccobacillus

58
Q

What are the symptoms/stages of whooping cough?

A

Catarrhal stage:

  • runny nose, conjunctivitis, wheeze
  • lasts one to two weeks

Paroxysmal stage:

  • Coughing with whoop and vomiting
  • May have apnoeas following coughing spasms
  • up to three months

Convalescence:

  • Resolution of symptoms
  • around two weeks
59
Q

What is the management for whooping cough?

A

Admit if less than 6 months old or if severe breathing difficulties

Prescribe antibiotics to patient and close contacts:

  • less than 1 month old = clarithromycin
  • greater than 1 month old = clarithromycin or azithromycin
  • pregnant = erythromycin
60
Q

What should patients be advised regarding staying off school with whooping cough?

A

Stay off school for 5 days after starting antibiotics

OR

Three weeks after onset of cough

… whichever is sooner

61
Q

How can the causes of ataxia be classified?

A

Acute or Chronic

Intermittent or Progressive

62
Q

An enlarged 4th ventricle with cerebellar hypoplasia. The patient has an increased head circumference, ataxia and signs of raised ICP.

A

Dandy-Walker syndrome

characterised by the enlarged 4th ventricle and cerebellar hypoplasia

63
Q

An autosomal recessive condition that leads to degeneration of cerebellar tracts and dorsal columns displaying progressive ataxia, lower limb weakness, loss of deep tendon reflexes and many more signs.

A

Friedrich ataxia

64
Q

A non-progressive brain lesion within the developing brain that develops during the antenatal, neonatal or early postnatal period. Impacts upon cognition, sensory, motor, communication and psychological domains.

A

Cerebral Palsy

65
Q

Categories and examples of cerebral palsy causes?

A

Antenatal = cerebral malformation/dysgenesis or congenital infection

Intrapartum = Hypoxic-ischaemic encephalopathy (birth asphyxia)

Post-natal = Intraventircular haemorrhage, head trauma, cerebral ischaemia

66
Q

Types of cerebral palsy?

A

Spastic
Dyskinetic
Ataxic

67
Q

A cerebral palsy demonstrating velocity-dependent increased tonic stretch reflexes with clonus. It can be classified as monoplegic, hemiplegic, diplegic or quadraplegic.

A

Spastic cerebral palsy

68
Q

A cerebral palsy demonstrating involuntary, recurring, stereotyped movements with varying tone.

A

Dyskinetic cerebral palsy

69
Q

A cerebral palsy demonstrating hypotonia, poor balance and coordination as well as a tremor.

A

Ataxic cerebral palsy

70
Q

What investigations would you like to order for a patient demonstrating signs of cerebral palsy?

A

MRI brain
Congenital infection screen
Metabolic screen

71
Q

Who from the MDT would you involve in the management of a patient with cerebral palsy?

A

Movements: OTs, PTs, SALT
Development: Social worker, teacher, developmental psychologists
Health: Paediatricians, orthopaedics, neurology, audiology, ophthalmology

72
Q

What is the treatment for a breath holding spell?

A

Reassurance

Most kids grow out of them

73
Q

An arthritic type picture affecting less than 4 joints?

A

oligoarthritis

74
Q

An arthritic type picture affecting more than 5 joints?

A

polyarthritis

75
Q

Treatment for JIA?

A

DMARDs = methotrexate/sulphasalazine
NSAIDs = ibuprofen
oral corticosteroids = prednisolone

76
Q

Teenager with limited hip movement, external rotation but decreased internal rotation.
Antalgic gait, pain down to knee.

A

Slipped upper femoral epiphysis

77
Q

Management of slipped upper femoral epiphysis?

A

Don’t walk
Pain killers
Ortho referral for surgical fixation with pin

78
Q

Interruption of blood supply to femoral head leading to necrosis

A

Perthes disease

79
Q

What are risk factors for developmental dysplasia of the hip?

A 
Oligohydramnios
Breech position
Prematurity
Great than 5kg birth weight
Positive family history
Spinal problems
80
Q

What is the Barlow test?

A

flex and adduct baby legs and push posteriorly on knee

81
Q

What is ortolani test?

A

flex, anterior pressure on thigh and abduct - should feel a clunk

82
Q

When are a baby’s hips checked for hip dysplasia?

A

within 72 hours of birth

again at 6 week check

83
Q

Management for a child less than 6 months old with developmental dysplasia of the hip?

A

Pavlik’s harness

84
Q

Management for a child older than 6 months or if first-line management didn’t work?

A

Closed reduction (anaesthetic and cast with imaging) for 12 weeks

85
Q

Management for a child in which 2nd-line treatment didn’t work?

A

open reduction

86
Q

What’s the problem if developmental dysplasia of the hip is not treated?

A

Arthritis of the hip –> pain and movement issues later in life

87
Q

Inflammation of the patellar tendon at the tibial tubercle with pain below the knee

A

Osgood-schlatter (apophysitis of the tibial tubercle)

88
Q

What investigations for Duchenne Muscular Dystrophy?

A

Creatine Kinase (massively elevated)
Biopsy (lack of dystrophin)
EMG
Genetics (Xp21)

89
Q

What signs of Duchenne Muscular Dystrophy?

A 
Gower's sign - lying then rolling onto front and using knees to get back up
Trendelenburg gait
Calf pseudohypertrophy (fat/connective tissue replaces muscle)
90
Q

What age does Duchenne Muscular dystrophy tend to present?

A

3 years old

91
Q

Prognosis of Duchenne Muscular dystrophy?

A

life expectancy of 20s/30s

92
Q

Common causes of neonatal conjunctivits?

A

Staph Aureus
Neisseria Gonorrhoea
Chlamydia Trachomatis
Chemical irritants

93
Q

Common causes of infant/young child conjunctivitis?

A

Staph aureus
Streptococcus pneumoniae
Haemophilus influenza
Moxarella

94
Q

Treatment of neonatal conjunctivitis?

A

Chloramphenical eyedrops
chlamydia = erythormycin and tetracycline
Gonococcus = penicillin eye irrigation

95
Q

Treatment of infant/young child conjunctivitis?

A

Fusidic acid/chloramphenicol/neomycin

96
Q

Signs/symptoms in periorbital vs orbital cellulitis?

A 
periorbital = basically normal eye movements/reflexes/vision etc
Orbital = inflamed conjunctiva/sclera, impaired reflexes/vision
97
Q

Management of periorbital/orbital cellulitis?

A

peri=oral, orbital=broad spec IV
ENT team to r/o sinus involvement
ophthalmology input

98
Q

Management of retinoblastoma?

A

Chemo/radiotherapy

If local involvement - enucleation (removal of eye!)

99
Q

Management of congenital adrenal hyperplasia?

A

Hydrocortisone (lifelong) oral
If salt-wasting CAH –> fludrocortisone
Surgery for virilised genitalia

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