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MCCEE > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the commonest Congenital heart disease?

A

VSD

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2
Q

Which congenital heart disease is associated with Turner?

A

CoA

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3
Q

Which congenital heart disease is associated with Down Syndrome?

A

ASD

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4
Q

What is the presentation of VSD?

A

Holosystolic murmur

LLSB

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5
Q

What is the presentation of ASD?

A

Systolic ejection murmur

USB

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6
Q

What is the treatment of ASD/VSD?

A 
Small: spontaneous closure  
Surgical management if 
- failed medical management 
- pulmonary HTN 
- large defects
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7
Q

What is the presentation of a PDA?

A

Continuous machinery murmur
Pounding peripheral pulse
Wide pulse pressure

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8
Q

Where does the blood flow in a PDA?

A

Aorta to pulmonary artery

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9
Q

What is the treatment of a PDA?

A

Indomethacin (NSAID)

If indomethacin fails/child > 6-8mo: surgery

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10
Q

Come IN and CLOSE the door

A

Give INdomethacin to CLOSEE the PDA

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11
Q

What is the presentation of CoA?

A

High BP In upper extremities
Low BP in lower extremities
Weak femoral pulses

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12
Q

What are signs of CoA on CXR?

A

3 sign

Rib notching

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13
Q

What is the commonest cyanotic congenital heart lesion in the newborn?

A

Transposition of Great Vessels

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14
Q

When does Transposition of great vessels present?

A

Within first few hours after birth

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15
Q

What is the anatomy of transposition of great vessels?

A

Aorta on R ventricle
Pulmonary vessels on L ventricle

Need ASD/VSD and PDA to be compatible with life

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16
Q

What are maternal RF for Transposition of great vessels?

A

Diabetic mother

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17
Q

Mnemonic for DiGeorge Syndrome

A 
Cardiac abnormalities (transposition)
Abnormal facies (retrognathia, micrognatia, long face)
Thymic aplasia 
Cleft palate 
Hypocalcemia 
22q11 deletion
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18
Q

What is seen on CXR of transposition of great vessels/

A

Egg shaped silhouette

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19
Q

What is the treatment of transposition of great vessel?

A

IV PGE1
Surgical correction
Balloon atrial septostomy if cannot do surgery in first few days of life

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20
Q

What is the commonest cyanotic congenital heart lesion in childhood?

A

Tetralogy of Fallot

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21
Q

What is the anatomy of a tetralogy of fallot?

A

RV outflow tract obstruction
Overriding aorta
VSD
RVH

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22
Q

What is the presentation of a tetralogy of fallot?

A

Cyanosis in first 2 years of life but not immediately
SOB
Fatiguability
Get spell relieved by squat

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23
Q

What is seen on CXR of tetralogy of Fallot?

A

Boot shaped heart

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24
Q

What is the treatment of tetralogy of Fallot?

A

Immediate PGE1 to keep PDA open
Surgical
consultation

Tet spells” oxygen, morphine,

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25
Q

What are features of Edward Syndrome?

A

Rocker-bottom feet
Micrognathia
Clenched hands
Prominent occiput

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26
Q

What is the genetic mutation in cystic fibrosis?

A

Autosomal recessive

CFTR gene mutation on Kr 7

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27
Q

What is the newborn presentation of cystic fibrosis?

A

Obstruction of distal ileum

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28
Q

What is the > 1yo presentation of cystic fibrosis?

A

FTT
Chronic sinopulmonary disease/sputum production
Recurrent pulmonary infections
Digital clubbing
Chronic cough
Nasap polyps
Pancreatic insufficiency: greasy stools, rectal prolapse

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29
Q

Whar are CF patients at risk of?

A

Fat soluble vitamin deficiency secondary to malabsorption

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30
Q

What is the treatment of CF?

A

Antibiotics to cover Pseudomonas
Pancreatic enzymes and fat soluble vitamins
High calorie high protein diet

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31
Q

What is the age of onset of intussusseption?

A

6 mo - 3 yo

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32
Q

What is the presentation of intussusseption?

A

non-bilious vomit
red currant jelly stool (late sign)
colicky pain
sausage shape RUQ mass

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33
Q

What is the sign on U/S for intussusseption?

A

target sign

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34
Q

What is the diagnostic test if high clinical suspicion of intussusseption

A

Air insufflation enema

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35
Q

What are the associations of pyloric stenosis?

A

First born infant
Boy
Formula fed
Maternal erythromycin ingestion

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36
Q

What is the presention of pyloric stenosis?

A

Non-bilious vomit
After a feed
Projectile vomit
Palpable olive mass

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37
Q

What is the age of onset of pyloric stenosis?

A

3 weeks - 6 weeks

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38
Q

What laboratory finding for pyloric stenosis?

A

Hypochloremic hypokalaemic metabolic alkalosis

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39
Q

Treatment of pyloric stenosis?

A

Initially:

  • NPO
  • IV access
  • Correct dehydration and acid-base abnormalities
  • Pyloromyotomy
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40
Q

What is the cause of Meckel’s Diverticulum?

A

Omphalomesenteric duct fails to obliterate

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41
Q

What is the presentation of Meckel’s diverticulum and age of onset?

A

< 2 yo
Painless rectal bleeding
Usually incidental finding

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42
Q

Rule of 2 for Meckel

A 
2% of population 
Symptomatic by age 2 
2 x more common in boys 
2 types of tissues" gastric, pancreatic 
2 inches long
2 feet from iliocecal valve
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43
Q

Investigation of choice for Meckel?

A

Scintigraphy scan

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44
Q

Whar ia Hurschsprung disease?

A

Lack of ganglion cells in distal colon

Decreased motility due to unopposed smooth muscle tone

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45
Q

What diseases is Hurschsprung disease associated with?

A

Male
Down Syndrome
Waardenbur syndrome
MEN 2

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46
Q

Presentation of Hurschsprung disease?

A

Failure to pass meconium in first 48 hours of birth
On Physical exam: explosive stool after rectal exam
Lack of stool in rectum
Abnormal sphincter tone

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47
Q

Investigation of choice for Hurshsprung?

A

Barium enema

Rectal biopsy confirms diagnosis

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48
Q

Presentation of malrotation?

A

Bilius vomit

First month of life

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49
Q

What is the characteristic appearance of malrotation on imaging?

A

Bird beak appearance

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50
Q

Treatment of malrotation?

A

NG tube insertion to decompress intestine
IV fluid hydration
Emergent surgical repair

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51
Q

What are risk factors for necrotizing enterocolitis?

A

Low birth weight
Premature infant
Hypotension
Enteral feed: formula

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52
Q

What portion of the bowel undergoes necrosis in NEC?

A

Terminal ileum/proximal colon

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53
Q

Presentation of necrotizing enterocolitis?

A 
First few days of life
Feeding intolerance 
Delayed gastric emptying 
Abdominal distension 
Bloody stools

Can complicate to shock, intestinal perforation, abdominal erythema

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54
Q

What is the investigation for NEC?

What is the pathomneumonic finding?

A

Plain abdominal radiograph

Pneumatosis intestinalis

55
Q

Treatment of pneumatosis intestinalis?

A

Supportive treatment: NPO, orogastric tube for gastric decompression
Correct dehydration
Electrolyte abnormality

56
Q

What are the complications of NEC?

A

Strictures

Short bowel syndrome

57
Q

What are the risks of Kawasaki’s disease?

A

Aneurysmal expansion

MI

58
Q

What investigations are done for Kawakasi’s

A

ESR, CRP
Platelets: thrombocytopenia
Echocardiogram baseline

59
Q

Treatment of Kawasaki?

A

High dose ASA

IVIG

60
Q

Clinical manifestations of Kawasaki?

A

WARM CREAM
Fever

NEED 4/5
Conjuctivitis bilateral
Rash: polymorphous 
Erythema on palms and soles 
Adenopathy: cerival, unilateral 
Mucous membrane changes: strawberry tongue
61
Q

Presentation of Juvenile idiopathic arthritis

A

Morning stiffness
< 16 yo

95% cases resolve by puberty

62
Q

Treatment of juvenile idiopathic arthritis?

A

NSAID

63
Q

Pathogens causing otitis media?

A

H. influenza
Strep. pneumonia
M. catarrhalis

64
Q

Treatment of otitis media?

A

High dose amoxicillin (80-90) x 10 days

65
Q

Complications of otitis media?

A

Perforation
Mastoiditis
Meningitis
Cholesteatoma

66
Q

Which organism causes bronchiolitis?

A

RSV

67
Q

Which organism causes croup?

A

Parainfluenza

68
Q

What age does bronchiolitis present?

A

< 2 yo

69
Q

Presentation of Bronchiolitis?

A

Tachypnoea
Hypoxia
Crackles or coarse breath sounds
+/- wheeze

70
Q

Treatment of bronchiolitis?

A

Supportive with oxygen

71
Q

Presentation of croup?

A

Inspiratory stridor

Barking cough

72
Q

Which sign on Neck film is seen for croup?

A

Steeple sign

73
Q

What is the treatment of mild, mod, severe croup?

A

Mild: outpatient cool mist therapy and fluids
Moderate: Supp. O2, IM CSC, nebulized racemic epinephrine
Severe: Hospital, neb racemic epinephrine

74
Q

What is the causative organism of epiglottitis?

A

H. influenza type b

75
Q

Presentation of epiglotittis?

A 
Acute onset fever 
Dysphagia
Drooling 
Neck hyperextension 
Tripod position to maximise air entry
76
Q

Treatment of epiglotittis?

A

Endotracheal intubation

IV abx: ceftriaxone, cefuroxamine

77
Q

Which bacteria cause meningitis in neonate?

A

Group B step
Listeria
E Coli

78
Q

Which virus causes meningitis?

A

Enterovirus

79
Q

Which bacteria cause meningitis in infant?

A

N meningitidis
H. influenza
Strep pneumo

80
Q

Which investigations are done to diagnose meningitis?

A

CT to rule out raised ICP if patient high risk

LP: glucose, protein, gram stain, culture

81
Q

What is the treatment of meningitis?

A

Neonate: ampicillin and cefotaxime

older child: ceftriaxone

82
Q

What is the presentation of a peritonsilar abscess?

A

Hot potato voice
Trismus
Drooling
Uvula displacement

83
Q

Which organism causes peritonsilar abscess?

A

Gp A strep

84
Q

What is treatment of peritonsilar abscess?

A

Incision and drainage
Abx
+/- tonsillectomy

85
Q

Symptoms of pertussis?

A

< 6mo
Paroxysmal cough
Posttusive emesis
Apnea

86
Q

Treatment of pertussis?

A

Hospitalize if < 6mo
Azythromycin x 10
Close contact must get prophylaxis

87
Q

What is the gold standard ix of pertussis?

A

Nasopharyngeal culture

88
Q

What does APGAR stand for?

A

Activity: movement, arms and legs flexed, none
Pulse: > 100, < 100, none
Grimace: Active, some flexion of extremities, flaccid
Appearance: pink, pink bod blue extremities, blue/pale
Resp: vigorous cry, slow irregular resp, absent

89
Q

Other things associated with tracheoesophageal fistula ?

A 
VACTERL 
Vertebral 
Anal 
Cardiac 
Tracheal 
Renal 
Limb
90
Q

Presentation of tracheoesophageal fistula?

A

Polyhydramnios in utero
Increased oral secretions
Cannot feed
Aspiration pneumonia

91
Q

How is tracheoesophageal fistula diagnosed?

A

NG tube coil in oesophagus

92
Q

What is the presentation of diaph. hernia?

A

Respiratory distress
Sunken abdomen
Bowel sounds in thorax

93
Q

Diagnosis of diaph. hernia?

A

U/S in utero

Confirmed at birth on CXR

94
Q

What is gastroschisis?

A

Herniation of intestine through abdominal wall next to umbilicus with no sac

95
Q

What is the treatment of gastroschisis?

A

Wrap exposed bowel with saline soaked gauze and wrap in plastic after birth
Surgical repair

96
Q

What is an omphalocele

A

Herniation of abdominal viscera through abdominal wall at the umbilicus into a sac covered in peritonium and amniotic membrane

97
Q

What congenital abnormalities is omphalocele present with?

A

Beckwith-Wiedmann Syndrome

Trisomy

98
Q

What is treatment of omphalocele?

A

C-section to prevent sac rupture
Keep sac covered with petroleum and gauze
Surgical correction
NG suction to prevent abdominal distension

99
Q

What is duodenal atresia?

A

Complete/partial failure of the duodenal lumen to recanalize

100
Q

Presentation of duodenal atresia?

A

Bilious emesis within hours after first feed

Polyhydramnios in utero

101
Q

What is seen on AXR with duodenal atresia?

A

Double bubble sign

102
Q

Commonest cause of resp failure in preterm infant?

A

RDS

103
Q

What is the cause of RDS?

A

Surfactant deficiency leading to poor lung compliance

104
Q

CXR findings of RDS?

A

Ground glass appearance

Air bronchogram

105
Q

Treatment of RDS?

A

CPAP or intubation and mechanical ventilation

Artificial surfactant

106
Q

How do you treat mothers who are at risk of preterm delivery to prevent RDS?

A

< 30 weeks: CSC

107
Q

What is the age group of febrile seizures?

A

6mo - 5 yo

108
Q

What are the symptoms of lymphoma?

A 
Bone pain with limp 
Refusal to bear weight 
Fever (from neutropenia)
Anemia 
Ecchymoses 
Petechiae 
Hepatosplenomegaly
109
Q

When can tumour lysis syndrome present?

A

After treatment of cancers with high cell turnover

hyperkalemia, hyperphosphate, hyperurecemia, hypocalcemia

110
Q

What is the age of onset of Neuroblastoma and Wilms

A

< 2yo

2-5yo

111
Q

Presentation of neuroblastoma

A

Non tender abdominal mass that crosses the midline
Horner syndrome
HTN
Opsoclonus/myoclonus

112
Q

How is neuroblastoma diagnosed?

A

FNA of tumour : blue tumour cells with rosette pattern

Elevated 24 hour urine catecholamine

113
Q

Which syndrome is Wilm’s tumour associated with?

A 
WAGR
Wilms tumor 
Aniridia 
Genitourinaty abnormalities 
Mental retardation
114
Q

Presentation of Wilms tumour?

A

Asymptomatic nontender abdominal mass that does not cross the midline

115
Q

Where does Ewing’s Sarcoma originate from?

A

Sarcoma associated with chromosome 11:22 translocation

116
Q

What is the presentation of Ewing Sarcoma?

A

Midshaft of long bones

Systemic symptoms of fever, anorexia, fatigue

117
Q

What is seen on CXR of Ewing Sarcoma?

A

Leukocytosis, raised ESR

Lytic bone lesion with onion skin

118
Q

What is the presentation of osteosarcoma?

A

Metaphyses of long bones
Local pain
Swelling
RARE to have systemic symptoms

119
Q

What is seen on CXR of Osteosarcoma?

A

Raised ALP

Sunburst lytic bone lesion

120
Q

Cause of Duchenne Muscular Dystrophy?

A

X-linked recessive disorder

Dystrophin deficiency

121
Q

When is DDH seen?

A

Firstborne girl

Breech position

122
Q

What is the treatment of DDH at different ages
< 6mo
6-15 mo
15-24 mo

A

Splint with Pavlik harness

Spica cast

Open reduction followed by spica cast

123
Q

Perthe’s disease what is it and age of onset?

A

Osteonecrosis of femoral head

4-10 yo

124
Q

What is the presentation of Perthe’s Disease?

A

Painless limp
Antalgic gate
Thigh muscle atrophy
Limited abduction and internal rotation

125
Q

What is the treatment of Perthe’s Disease?

A

Observation

Good prognosis if: < 6 yo, full ROM, reduced femoral head involvement, stable joint

126
Q

What is a SUFE?

A

Displacement of the femoral epiphysis from the femoral neck through the growth plate

127
Q

In which children does SUFE present?

A

Obese children

Age 10-16

128
Q

What is the presentation of SUFE?

A

Painful limp

Inability to weight bear

129
Q

What is the treatment of SUFE?

A

Immediate surgical screw

No weight bearing

130
Q

Until what age is strabismus normal?

A

3 mo

131
Q

What is the presentation of a child with lead poisoning?

A 
Intermittent abdominal pain 
Peripheral neuropathy (wrist or foot drop)
132
Q

What is seen on blood smear of lead poisoning?

A

microcytic hypochromic anemia
basophilic stippling
+/- sideroblastic anaemia

133
Q

What is the treatment of lead poisoning?

A

< 45 and asx: retest at 1-3 mo
45-69: chelation therapy (EDTA inpatient)
> 70: chelation therapy (EDTA and BAL)

134
Q

Facts about hypertrophic cardiomyopathy in pediatrics

A

Autosomal dominant
Close relatives affected
Worsens with age
Should participate in exercise

MCCEE (16 decks)

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