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Paediatrics Flashcards

1
Q

What are the components of the APGAR score and when is it performed?

A 
Appearance
Pulse
Grimace
Activity
Respiration
Performed at 1st and 5th minute of life
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2
Q

Outline the components of APGAR that would score 0 for each domain

A 
Appearance: blue all over
Pulse: absent
Grimace: absent
Activity: absent
Respiration: absent
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3
Q

Outline the components of APGAR that would score 1 for each domain

A 
Appearance: blue in extremities, pink body
Pulse: less than 100
Grimace: only on aggressive stimulation
Activity: some flexion
Respiration: slow, irregular
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4
Q

Outline the components of APGAR that would score 2 for each domain

A 
Appearance: pink all over
Pulse: over 100
Grimace: cry on stimulation, coughs well
Activity: flexes arms and legs, resists extension
Respiration: strong cry
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5
Q

What are the ranges of a normal APGAR score?

A

8-10

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6
Q

List aetiology/risk factors for neonatal sepsis

A 
Ascending infection from mother (chorioamnionitis)
Group B Strep
E. coli
Coag -ve Staph
H. influenzae
Listeria
Pre-labour membrane rupture
Prematurity
Parenteral antibiotics used in mother
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7
Q

List clinical features of neonatal sepsis

A 
Seizure
Stiff limbs
Cyanosis
Cap refill greater than 3s
Temp less than 35.5 or over 37.5
Difficulty feeding
Severe chest indrawing
Resp rate over 60
Lethargy
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8
Q

Neonatal sepsis is defined as early onset if it occurs when?

A

First 48-72h of life, mainly due to bacteria acquired before and during delivery (Group B Strep)

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9
Q

What investigations would you order for neonatal sepsis?

A

Bloods: FBC, CRP, culture, glucose
Swab virology
LP for gram stain, cell count, protein, glucose
Urine and stool culture/microscopy

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10
Q

Outline management of neonatal sepsis

A

IV benzylpenicillin + gentamicin empirically

Vancomycin/teicoplanin/amoxicillin

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11
Q

List aetiology/risk factors for neonatal seizures

A

Reduced PaO2
Infection
Hypoglycaemia
CNS injury (haemorrhage, hydrocephalus)

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12
Q

Outline management of neonatal seizures

A 
ABCDE approach, turn on side
EEG and ECG monitoring
IV phenobarbitol
Phenytoin/clonazepam/lorazepam
Pyridoxine
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13
Q

Jaundice after 24h is usually physiological. Why?

A

Immature liver can’t process high Br
Increased RBC breakdown
Starts at day 2, peaks at day 5, resolves by day 10

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14
Q

Visible jaundice on day 1 of life is always pathological. True/False?

A

True

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15
Q

List causes of jaundice on day 1 of life

A

Rhesus haemolytic disease
ABO incompatibility
G6P deficiency
Spherocytosis

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16
Q

Define prolonged jaundice in a neonate

A

Lasts over 14 days in a term baby or 21 days in a preterm baby

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17
Q

List causes of prolonged jaundice in a neonate

A 
Infection
Exclusive breastfeeding
Hypothyroidism
Cystic fibrosis
Biliary atresia
Galactosaemia
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18
Q

List clinical features of neonatal jaundice

A 
Yellow tinge to skin/sclera
Drowsiness
Short feed
Altered tone
Seizures
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19
Q

What investigations would you do for neonatal jaundice?

A

Serum Br if less than 35w gestation or less than 24h old
Br using TCB if over 35w gestation or more than 24h old
FBC, blood groups and film
Coombs test (rhesus haemolysis)

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20
Q

Outline management of neonatal jaundice

A

Phototherapy using plasma Br treatment guide
IV Ig may be warranted
Exchange transfusion via umbilical vein/artery prevents further increase in Br

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21
Q

What is kernicterus?

A

Br -induced brain dysfunction

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22
Q

List clinical features of kernicterus

A 
Sleepy
Poor suck
"setting sun" lid retraction
Odd movements
Cerebral palsy
Deafness
Low IQ
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23
Q

What is the pathophysiology of rhesus haemolytic disease?

A

RhD- delivers RhD+ baby and may produce anti-D IgG against RhD (isoimmunisation) if blood mixes
In subsequent pregnancy, these antibodies may attack a RhD+ foetus

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24
Q

List aetiology/risk factors for rhesus haemolytic disease

A

Threatened miscarriage
Antepartum haemorrhage
Mild trauma
Amniocentesis, CVS

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25
List clinical features of rhesus haemolytic disease
``` Jaundice on day 1 of life Yellow vernix Heart failure Hepatosplenomegaly Bleeding CNS dysfunction Kernicterus Stiff, oedematous lungs Hydrops fetalis ```
26
Outline management of rhesus haemolytic disease
``` Keep baby warm Exchange transfusion Phototherapy Anti-D Ig for Rh- mother Hydrops fetalis: ventilate if required, vitamin K ```
27
What is neonatal respiratory distress syndrome?
Increased work of breathing due to insufficient surfactant, potentially leading to respiratory failure
28
List aetiology/risk factors for neonatal respiratory distress syndrome
``` Prematurity Maternal diabetes Males 2nd twin C-section delivery ```
29
List clinical features of neonatal respiratory distress syndrome
``` Worsening tachypnoea (RR over 60) Increased effort, grunting Cyanosis Nasal alae flaring Intercostal recession ```
30
Outline management of neonatal respiratory distress syndrome
Wrap warmly, incubator Monitor ABG's, give O2, support ventilation Prenatal betamethasone/dexamethasone may prevent RDS Give surfactant via ET tube
31
What is necrotising enterocolitis (NEC)?
Necrosis of bowel mucosa
32
List aetiology/risk factors for NEC
Prematurity Weight less than 1500g Enteral feeds Mucosal injury
33
List clinical features of NEC
Abdominal distention PR blood/mucus Tenderness +/- perforation Shock
34
What investigations would you do for NEC?
Faecal culture Abdo and lateral XR shows loops of bowel Crossmatch blood
35
Outline management of NEC
``` Stop oral feeds, continue breastmilk Probiotics may help Barrier nursing Metronidazole + penicillin + gentamicin or cefutaxime + vancomycin Laparatomy if progressive distention/perforation ```
36
What would be a sign of potential meconium aspiration?
Baby born in meconium-stained amniotic fluid
37
Define prematurity
Birth occurring before 37 weeks' gestation Pre-term: 32-37w Very pre-term: 28-31w Extremely pre-term: 23-27w
38
List aetiology/risk factors for prematurity
``` Previous preterm birth Multiple pregnancy Smoking + illicit drugs during pregnancy Early pregnancy (within 6 months of last one) Infection Cervix/uterus//placenta pathology Injury, trauma Maternal diabetes/hypertension Pre-eclampsia ```
39
Outline general management of a premature birth
Monitor airway and breathing Keep warm - incubator, baby bag, radiant heater, skin-skin contact Resuscitation if over 23 weeks Low-pressure CPAP
40
How is a baby defined as being small for gestation?
Birthweight less than 2.5kg | Does vary
41
List aetiology/risk factors for being small for gestation
``` Constitutionally small Intrauterine growth restriction Malformation Twin pregnancy Maternal disease ```
42
What is Hirschsprung's disease?
Congenital absence of ganglia in a segment of colon
43
List clinical features of Hirschsprung's disease
Infrequent narrow stools GI obstruction Megacolon Faeces felt per abdomen
44
What investigations would you do for Hirschsprung's disease?
Barium enema Sigmoidoscopy, biopsy of aganglionic segment Stain for ACh-esterase
45
How is vomiting described in midgut malrotation/volvulus?
Bilious "fairy liquid green" vomit
46
What is gastroschisis?
Paraumbilical evisceration of abdominal contents
47
What is exomphalos?
Ventral defect of umbilical ring causing herniation of abdominal viscera
48
List clinical features of diaphragmatic hernia
Difficult resus at birth Respiratory distress syndrome Bowel sounds in hemithorax Cyanosis
49
List aetiology/risk factors for cryptorchidism
``` Prematurity Small for dates Family history Hormone imbalance Maternal alcohol/analgesics/smoking Gestational diabetes Incomplete migration during embryogenesis ```
50
Outline management of cryptorchidism
Orchidopexy (fix within scrotum) early on in life
51
What is the commonest intra-abdominal tumour of childhood?
Wilm's nephroblastoma
52
What is congenital adrenal hyperplasia?
Increased androgens cause decrease in 21-hydroxylase, causing decrease in cortisol and increase in ACTH, leading to hyperplasia and overproduction of cortisol precursors
53
List clinical features of congenital adrenal hyperplasia
``` Ambiguous genitalia Vomiting Dehydration Precocious puberty Hypospadius Cryptorchidism ```
54
What would levels of Na and K be like in congenital adrenal hyperplasia?
Hyponatraemia | Hyperkalaemia
55
Which drugs are used in adrenocortical crisis?
Fludricortisone | Hydrocortisone
56
What are orofacial clefts?
Failure of maxillary and premaxillary processes to fuse during week 5 Usually causes cleft lip and/or palate
57
List aetiology/risk factors for orofacial clefts
``` Genes Benzodiazepines Anti-epileptics Rubella Trisomy 18 ```
58
List clinical features of foetal alcohol syndrome
``` Microcephaly Short palpebral fissure Hypoplastic upper lip Absent philtrum Small eyes Reduced IQ, learning difficulty Cardiac malformations Growth retardation Epicanthic folds ```
59
List the main acyanotic congenital heart defects
``` Ventricular septal defect Atrial septal defect Patent ductus arteriosus Coarctation of aorta Aortic stenosis Aortopulmonary window ```
60
List the main cyanotic congenital heart defects
Tetralogy of Fallot | Transposition of the great vessels
61
List clinical signs of ventricular septal defect
Harsh loud pansystolic "blowing" murmur Thrill Left ventricular hypertropgy
62
List clinical signs of atrial septal defect
``` Pulmonary flow murmur Widely fixed split S2 Cardiomegaly Globular heart (primum defect) RVH +- incomplete RBBB ```
63
List clinical signs of patent ductus arteriosus
``` Systolic pulmonary "machinery" murmur Collapsing pulse Thrill Increased S2 Failure to thrive ```
64
List clinical signs of coarctation of aorta
Systolic murmur at left back Radiofemoral delay Increased BP in arms Rib-notching on XR
65
What are the components of tetralogy of Fallot?
Ventricular septal defect Right ventricular hypertrophy Pulmonary stenosis/RVOT obstruction Overriding aorta
66
List clinical signs of tetralogy of Fallot
Ejection systolic murmur Boot-shaped heart on XR R-L shunt Cyanosis
67
Which virus causes measles and what is the incubation time?
RNA paramyxovirus | Incubation 7-21 days
68
List clinical features of measles
Conjunctivitis Koplik spots: "grain of salt" spots on buccal mucosa Rash behind ear on days 3-5 Rash spreads confluently down body Neck spasms May lead to fits, meningitis, encephalitis, deafness
69
Outline management of measles
Isolate, ensure adequate nutrition Continue breastfeeding Treat secondary infection Immunisation is 80% effective
70
Which virus causes mumps and what is the incubation period?
RNA paramyxovirus | Incubation 14-21 days
71
List clinical features of mumps
Infective 7d before + 9d after parotid swelling Malaise Painful parotid swelling Fever
72
Which virus causes rubella and what is the incubation time?
RNA virus | Incubation 3-4 weeks
73
List clinical features of rubella
Infective 5d before + 5d after rash Macular rash Suboccipital lymphadenopathy
74
Which virus causes erythrovirus infection?
Parovirus B19
75
List clinical features of erythrovirus
``` Mild acute infection Malar erythema (slapped cheek appearance) Glove + stocking rash Arthralgia Aplastic crisis ```
76
Which virus causes hand, foot and mouth disease?
Coxsackie virus A16 | Enterovirus 71
77
List clinical features of hand foot and mouth disease
Mildly unwell Vesicles on palms, soles and mouth No crusting
78
Which syndrome involves trisomy 21?
Down's syndrome
79
List clinical features of Down's syndrome
``` Flat facial profile Excess neck skin Dysplastic ears Muscle hypotonia Widely spaced toes High arched palate Simian palmar crease Brushfield spots on iris ```
80
Which syndrome involves trisomy 18?
Edward's syndrome
81
List clinical features of Edward's syndrome
``` Rigid baby, limbs flexed Low-set ears Receding chin Proptosis Rockerbottom feet Cleft Umbilical/inguinal hernia Short stature Fingers cannot be extended ```
82
What is the karyotype of Klinefelter's syndrome?
XXY or XXYY
83
List clinical features of Klinefelter's syndrome
``` Small firm testes Small penis Reduced cognition Reduced libido Gynaecomastia Delayed/reduced sexual maturation ```
84
Which syndrome involves trisomy 13?
Patau syndrome
85
List clinical features of Patau's syndrome
``` Cleft Microcephaly Omphalocele Hernias Congenital heart defects Dextrocardia Capillary hemangiomata Polycystic kidneys Flexion contractures Narrow fingernails ```
86
What is the karyotype of Turner's syndrome?
XO
87
List clinical features of Turner's syndrome
``` Short stature Hyperconvex nails Wide carrying angle Inverted nipples Broad chest Ptosis, nystagmus Webbed neck Coarctation of aorta Absent/rudimentary gonads Delayed/absent puberty ```
88
List aetiology/risk factors for acute bronchiolitis
RSV Mycoplasma Parainfluenza Adenovirus
89
List clinical features of acute bronchiolitis
``` Coryza before cough Fever Tachypnoea Wheeze Intercostal recession Poor feeding Dehydration Cyanosis ```
90
Outline management of acute bronchiolitis
Neb salbutamol +/- dexamethasone may help Oxygen NG tube support
91
Which organism causes whooping cough?
Bordetella pertussis
92
List clinical features of whooping cough
Apnoea Bouts of coughing worse at night or after feed Vomiting Cyanosis Inspiratory whoop Subconj haemorrhage if persistent coughing No fever or wheeze
93
What investigations would you do for whooping cough?
Nasal swab culture PCR and serology Lymphocytosis typically seen
94
Outline management of whooping cough
Erythromycin School exclusion Vaccination prophylaxis
95
What is cystic fibrosis?
Autosomal recessive mutation in CFTR gene on c7 that codes cAMP Na-Cl channel, causing impaired exocrine function and increased viscosity of secretions
96
List clinical features of cystic fibrosis
``` Meconium ileus as neonate Recurrent chest infections Clubbing Steatorrhoea Failure to thrive Malabsorption Short stature Delayed puberty ```
97
What investigations would you do for cystic fibrosis
Cl sweat test over 60 mmol/l | Immune reactive trypsin neonatal screen
98
Outline management of cystic fibrosis
Chest physiotherapy, postural drainage Increase calories and fat intake Treat organisms/bacterial colonisation Pancreatic enzyme supplements
99
List features of acute severe asthma
``` Too breathless to talk/feed Use of accessory muscles to breathe RR over 30 (over 40 if under 5yo) HR over 120 (over 140 if under 5yo) PEF less than 50% predicted SPO2 92% ```
100
List features of life-threatening asthma
``` Silent chest Poor expiratory effort Altered consciousness, confusion Cyanosis PEF less than 33% predicted SPO2 92% ```
101
List clinical features of pyloric stenosis
``` Vomiting after feed, projectile NOT bilious Constipation/starvation tools Always hungry Olive-sized pyloric mass ```
102
What metabolic disturbance may occur in pyloric stenosis?
Hypochloraemic hypokalaemic alkalosis
103
Outline management of pyloric stenosis
NG tube | Pyloromyotomy
104
What is intussusception?
Small bowel telescopes by invagination, usually at ileo-caecal region
105
List clinical features of intussusception
``` Abdo colic pain Episodic crying Drawing legs up, pale-looking Blood-stained "redcurrant jelly" faeces +- vomiting Sausage-shaped mass felt ```
106
Outline management of intussusception
Air insufflation works in most | Laparoscopic resection/laparotomy
107
List typical causes of bruising in neonates and infants
``` Haemorrhagic disease of newborn Haemophilia Thrombocytopenia ITP Birth trauma Congenital infection (Rubella) Accidental/non-accidental injury ```
108
What is fragile X syndrome?
Stretch of CGG repeats in FMR-1 gene on Xq27 results in cognitive impairment
109
List clinical features of fragile X syndrome
``` Learning difficulty Large, low set ears Big jaw Long, thin face High arched palate Big testes Hypoonia Autism ```
110
List clinical features of Noonan syndrome
``` Ptosis Webbed neck Pectus excavatum Short stature Pulmonary stenosis Down-slanting eyes Cardiac defects ```
111
List the main causes of bacterial meningitis
Neonates: E. coli, Listeria, Group B Strep Children: H. influenza Young adults: N. meningitidis Adults: Strep. pneumoniae
112
List clinical features of meningitis
``` Unusual crying, poor feeding, vomiting Tense fontanelles Stiff neck (after 18mo), photophobia Opisthotonus Pink maculo purpuric rash Sepsis, shock, seizures Kernig sign: resistance to extending knee with hip flexed Brudeinski sign: hip flexion on bending head forward ```
113
What investigations would you do for meningitis?
Lumbar puncture FBC, U+E, blood + urine culture, stool virology Gram stain
114
What would CSF show in bacterial meningitis? (describe appearance, cells, glucose and protein levels)
Appearance: turbid Cells: polymorphs Glucose: less than 1/2 of blood Protein: raised
115
What would CSF show in viral meningitis? (describe appearance, cells, glucose and protein levels)
Appearance: clear Cells: mononuclear cells Glucose: more than 1/2 of blood Protein: low
116
What would CSF show in TB meningitis? (describe appearance, cells, glucose and protein levels)
Appearance: turbid/viscous Cells: mononuclear cells, variable polymorphs Glucose: less than 1/2 of blood Protein: moderately raised
117
Outline management of meningitis
``` ABCDE, O2, fluids Benzylpenicillin before hospital Ceftriaxone + dexamethasone IV + ampicillin if Listeria Chloramphenicol if cef-allergic + gentamicin if E. coli ```
118
What is a febrile convulsion?
Single seizure typically lasting less than 20 mins, usually occurring in a child with preceding febrile illness/temp rise
119
Outline management/advice for febrile convulsion
Lie prone Paracetamol syrup Consider blood tests if worrying signs Lorazepam/diazepam if unresolving
120
What organ is represented by a "sail sign" on a neonatal XR?
Wide mediastinum enables identification of the thymus
121
List all the respiratory conditions you can think of that may cause respiratory distress in a neonate
``` Respiratory distress syndrome Bronchopulmonary dysplasia Meconium aspiration Transient tachypnoea of the newborn Infection Pneumothorax Pulmonary hypoplasia Congenital diaphragmatic hernia ```
122
How does hypothermia lead to hypoglycaemia in a neonate?
Increased metabolic rate Increased uptake of glucose Increased use of glycogen stores HYPOGLYCAEMIA
123
How does hypoglycaemia lead to hypoxia in a neonate?
Reduced surfactant production Increased work of breathing Respiratory distress HYPOXIA
124
How does hypothermia lead to hypoxia in a neonate?
``` Increased metabolic rate Reduced O2 consumption Increased resp rate O2 demand greater than supply Anaerobic respiration Metabolic acidosis HYPOXIA ```
125
When does intraventricular haemorrhage typically occur in neonates?
Day 1 of life | May present within 72 hours

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