Paediatrics Flashcards
1
Q
breathing difficulty DD
A
cough, wheeze, stridor, neck swelling, asthma, cf
2
Q
cough DD
A
croup, pneumonia, bronchiolitis, HF, acute asthma, TB, viral-induced wheeze, whooping cough, inhaled foreign body, GORD, post-nasal drip, tracheooesophageal fistula, passive smoking, cf
3
Q
croup presentation
A
barking cough (night), stridor, coryzal symptoms, hoarse voice
4
Q
pneumonia presentation
A
fever, cough, resp distress, chest/abdo pain, intercostal recession, crackles, consolidation signs, tachopnea, grunting
5
Q
bronchiolitis age
A
<2 y.o.
6
Q
bronchiolitis presentation
A
coryza, cough, SOB, resp distress, difficulty feeding, apnoea in young infants, wheezing, crackles, chest overexpansion
7
Q
HF arises from what congenital abnormality
A
L to R shunts: ASD, VSD
8
Q
acute asthma presentation
A
known asthmatic, Hx of atopy, wheeze, cough (worse at night/with exercise), SOB, increased work of breathing, fear
9
Q
TB presentation
A
TB contact, no BCG immunisation, haemoptysis, night sweats
10
Q
viral induced wheeze presentation
A
wheeze with URTI, may respond to bronchodilators
11
Q
viral induced wheese progression
A
some progress to asthma
12
Q
whooping cough aka
A
pertussis
13
Q
pertussis aka
A
whooping cough
14
Q
pertussis presentation
A
paroxysmal coughing spasms during expiration, followed by sharp intake of breath (whoop), apnoea in infants, V, skin colour change
15
Q
inhaled foreign body age group
A
toddlers
16
Q
inhaled foreign body presentation
A
Hx of choking, ux wheeze, sudden onset
17
Q
cough Hx
A
infection (pyrexia, LOA), recurrence, atopy, FH, PMH, prematurity
18
Q
cough O/E
A
resp distress (grunting, nasal flaring, intercostal recession, tachopnea), additional noises (wheeze, stridor, cough), consolidation (reduced air entry, crackles, bronchial breathing, dullness to percussion, reduced expansion), clubbing, chest deformity, congenital heart DZ, cyanosis, pyrexia, talking in full sentences, PEFR
19
Q
cough investigations
A
CXR, FBC, sputum culture, nasopharyngeal aspirate, pernasal swab, viral titres, blood cultures, Mantoux test, bronchoscopy
20
Q
viral causes of pneumonia
A
RSV, influenza, parainfluenza, adenovirus, Coxsackie virus
21
Q
bacterial causes of pneumonia
A
Strep pneumoniae, H influenzae, staph, Mycoplasma pneumoniae, GBS (newborn)
22
Q
bacterial pneumonia causative agents in underlying L DZ e.g. cf
A
Pseudomonas aeruginosa, Staph aureus
23
Q
pneumonia risk factors
A
congenital abnormality of bronchi, inhaled foreign body, immunosuppression, recurrent aspiration (tracheooesophageal fistula), cf
24
Q
widespread pneumonia aka
A
bronchopneumonia
25
first line Abx for CAP
amoxicillin
26
complications of pneumonia
pleural effusion, septicaemia, bronchiectasis, empyema, L abscess
27
cause of bronchiolitis
RSV, adenovirus, influenza, parinfluenza
28
RSV
winter epidemics, highly infectious
29
bronchiolitis indications for admission
poor feeding, apnoea, increasing resp distress, O2 requirement
30
bronchiolitis duration
7-10/7
31
bronchiolitis management
O2, bronchodilators, supportinve therapy
32
prophylaxis against bronchiolitis in high risk infants
monoclonal Ab, palivizumab, passive immunity
33
pertussis is caused by
Bordella pertussis
34
pertussis occurs in
young infants, those not fully vaccinated
35
pertussis diagnosis
clinical, lymphocytosis >20 is suggestive
36
pertussis cough duration
months
37
pertusis management
supportive
38
croup aka
acute laryngotracheobronchitis
39
acute laryngotracheobronchitis aka
croup
40
croup affects children aged
6 months - 1 year
41
croup cause
parainfluenza URTI
42
croup most common at what time of year
winter
43
signs of severe croup
increased work of breathing, cyanosis, restlessness
44
croup management
mild cases are self limiting, steroids may reduce severity of symptoms + therefore need for hospital admission, severe cases require intubation + ventillation
45
acute epiglottitis is caused by
H. influenzae
46
acute epiglittitis prevalence
rare, Hib vacination
47
acute epiglottitis presentaiton
young children, sepsis, inability/painful to swallow/talk, drooling, muffled voice
48
acute eppiglottitis management
immediate transfer to theatre for intubation
49
stridor DD
laryngeal anomalies, laryngomalacia, upper airway obstruciton, tracheal abnormality, vascular ring, croup, tonsillar abscess, anaphylaxis, epiglottitis, inhaled foreign body
50
laryngeal abnormalities may include
vocal cord paralysis (brain lesion/trauma), papilloma (vertical HPV transmission)
51
laryngomalacia is
a floppy larynx
52
laryngomalacia presentation
variable stridor from birth, sometimes biphasic, loudest when crying, disappears when setttled
53
laryngomalacia cause
prolapse of the aryepiglottic folds into upper larynx
54
course of laryngomalacia
resolves w/i few months
55
upper airway obstruction may include
severe micrognathia (Piere Robin S), pharyngeal cyst, haemangioma
56
tracheal abnormalities may include
subglottal stenosis (following prolonged intubation), tracheomalacia (recurrent lobar collapse)
57
vascular ring is
a congenital abnormality of the great vessels, worsens over t, feeding difficulties
58
vascular ring investigations
barrium swallow (indentation), high res CT (for Sx planning)
59
tonsillar abscess aka
quinsy
60
quinsy aka
tonsillar abscess
61
inhaled foreign body investigations
CXR, rigid bronchoscopy
62
stridor Hx
duration, intermittant, well vs sick baby, coryzal symptoms, choking, atopy Hx (anaphylaxis)
63
stridor O/E
severity, work of breathing, intercostal recession, degree of oxygenation, wheeze, hyperexpansion, rash, angioedema, murmur
64
epiglottitis investigations
don't do anything until airway secured, FBC, blood cultures
65
persistent stridor investigations
microlaryngoscopy to assess larynx + vocal cords, barium swallow
66
neck swelling DD
mastoiditis, parotid gland = mumps, thyroid gland = thyroiditis, LN: cervical adenitis, infectious mononucleosis, lymphoma, atypical mycobacterium
67
mastoiditis presentation
tender, inflammation, swelling behind ear, ear pushed out, medical emergency
68
mastoiditis is a complication of
OM
69
complications of mastoiditis
meningitis, sinus thrombosis
70
mastoiditis management
IV ABx, Sx mastoidectomy
71
mumps presentation
swelling overlying angle of jaw, ear displaced up + out, ux or bx, fever, malaise, pain on swallowing sweet/sour liquids
72
thyroiditis presentation
ant midline swelling, smooth, diffusly enlarged, non-tender, insidious onset, hypo/hyper/euthyroid
73
thyroiditis investigations
T4, TSH, thyroid autoAb
74
cervical adenitis presentation
tender, swollen ant cervical chain LN, ux or bx, fever, sore throat, acutely unwell
75
cevical adenitis investigations
FBC (high WCC)
76
infectious mononucleosis presentation
fever, sore throat, large purulent tonsils, generalised lymphadenopathy, splenomegaly
77
infectious monmomucleosis causative agent
EBV
78
infectious mononucleosis investigations
blood film (atypical lymphocytes)
79
lymphoma presentation
firm, non-tender node, immobile, matted, malaise, night sweats, persistent fever, hepatosplenomegaly, weight loss
80
atypical mycobacterium is caused by
Mycobacterium avium intracellulare
81
atypical mycobacterium presentation
cervical lymphadenitis
82
atypical mycobacterium investigaitons
excision biopsy (diagnostic)
83
neck lump Hx
malaise, sore throat, fever, duration
84
thyroiditis Hx
tiredness, constipation, underachievement at school, hyperactivity, increased appetite, palpitations, heat intolerance
85
neck lump O/E
location, ear displacement, mobility, tenderness, other sites, dehydration, systemic illness
86
mastoiditis investigations
tympanocentesis (identify organ + drain infection)
87
lymphadenopathy investigations
FBC, EBV serology, throat culture, CXR, Mantoux, interferon-gamma release assay, biopsy
88
asthma triggers
viral illness, allergens, cold
89
long term sequealae of uncontrolled asthma
poor growth, chronic chest deformity, time off school, frequent acute exacerbations
90
asthma pathophysiology
genetic predisposition, environmental trigger causes bronchocontriction, mucosal oedema, excess mucus production, airway narrowing leads to SOB + wheeze
91
mild asthma
SOB, nil distress, PEFR reduced, sats >92%
92
moderate asthma
too SOB to talk/feed, RR >30~40/min HR >125~140bpm (>5~2-5 y.o.), PEFR <50% expected, <92% sats
93
severe asthma
PEFR <33% expected, <92% sats, silent chest/cyanosis, fatigue, drowsiness, confusion, hypotension
94
asthma Hx
cough, wheeze, triggers, t of day, how many acute exacerbations, severity, affect on life (limit activities, school), f of reliever Rx use, effectiveness, atopy
95
asthma investigations
PEFR, CXR, allergy tests, spirometry, height, weight, inhaler technique
96
asthma O/E
wheeze, silent chest, chronic chest deformity
97
asthma management
```
environmental control (passive smoking, house dust mites), education
1. SABA 2. inhaled corticosteroids 3. leukotrine antagonist/LABA (if 5-12 y.o.)
```
98
asthma diagnosis
based on clinical picture + response to bronchodilators
99
hospital managemento fo severe asthma exacerbation
high flow O2, regular salbutamol/ipratropium bromide (NEB/spacer), systemic corticosteroids
100
cf sequelae
nasal polyps, sinusitis, cough, purrulent sputum, pneumonia, chronic pseudomonas infections, bronchiectasis, chest deformity, eventual resp failure, finger clubbing, obstructive jaundice of the neonate (rare), biliary stasis, liver cirrhosis, salt loss, poor weight gain, short stature, malabsorption, pancreatic insufficiency, poor fat absorption, steatorrhoea, abdo distension, rectal prolapse, DIOS, DM, meconium ileus, male infertility, feaml sub fertility, delayed puberty
101
cf Hx
FH, failure to thrive, ravenous appetite, cough, wheeze, recurrent chest infections, recurrent sinusitis, bulky pale offensive stools (difficult to flush)
102
cf-related DM indication
fall in L function, weight loss
103
cf O/E
finger clubbing, malnutrition, poor weight gain, poor growth, delayed puberty, nasal polyps, chest deformity, crackles, hepatosplenomegaly (rare)
104
cf pathophysiology
abnormal CFTR channel leading to excessive secretions which block bronchioles, pancreatic exocrine failure, absence of vas deferens in males
105
management of cf
resp: bronchodilators, ABx, steroids, DNase EZ nebs, PT, immunisations (influenza, pneumococcal)
GI: pancreatic EZ capsules, high calorie diet, fat soluble vitamin supplements, dietician, salt supplementation, urodeoxycholic acid
optimisation of blood glucose is associated with improved L function, assisted conception
L/heart-L transplantation
106
cf diagnosis
newborn screening, genetic testing, sweat test
107
cf prognosis
life expectancy 40-50 y.o., FEV1 is best measure of DZ progression
108
sore throat DD
tonsillitis, cervical adenitis, infectious mononucleosis
109
fever DD
non-specific viral infection, viral URTI, OM, dehydration, tonsillitis, post immunisation, septic arthritis, meningococcal septicaemia, strep sepsis, TSS, malaria, influenza, chickenpox, measles, rubella, non-specific viral rash, pneumonia, UTI, post-Sx, Kawasaki's DZ, facticious
110
misleading pyrexia readings
taking T post-hot drink, deliberate manipulation of thermometer, excessive crying/exertion, overheading due to swaddling
111
OM presentaiton
tugging at ear, red tympanic membrane, fever, hearing loss, irritability
112
tonsillitis presentation
sore throat, enlarged tonsils, smelly breath, dysphagia, fever, tender cervical lymphadenopathy
113
septic arthritis presentation
painful joint, swelling, effusion
114
influenza presentation
fever, cough, headache, anorexia, arthralgia
115
UTI presentation
f, dysuria, loin/suprarubic pain, V
116
Kawasaki's DZ criteria
fever >5/7 + 4 of: conjunctival injection, mucous membrane change (e.g. dry cracked lips, strawberry tongue), cervical lymphadenopathy, polymorphous rash, red oedematous palms/soles leads to skin peeling
117
fever Hx
duration, pattern, pain, malaise, anorexia, V, coryza, cough, rash, infected contacts, vaccinations, hydration
118
fever investigations
FBC, throat swab, blood culture, LP, urinalysis, CXR
119
fever O/E
check T'c (PO, axillary, PR), well vs unwell child, rash, tachopnea, tachycardia, dehydration, chest, throat, ears, CNS
120
fever management
treat cause, undress, cool with tepid water, paracetamol, ibuprofen
121
viral URTI presentation
coryza, acute pharyngitis, fever (v common 6-8/year)
122
tonsillitis causative agent
viral > bacterial
123
OM causative agents
Strep pneumoniae, H influenzae, viral
124
OM in > common in children with
Eustachian tube dysfunction
125
OM complications
conductive deafness, mastoiditis, secretory OM (glue ear)
126
cyanosis in the newborn may be a sign of
may be normal immediately after birth, RDS, congenital heart DZ
127
cyanosis in children DD
croup, asthma, resp failure, acute upper airway obstruction, choking
128
mec aspiration Hx
Hx of mec stained liquor, tachypnoea
129
mec aspiration is associated with
persistent pulmonary HTN - R to L shunting across the patent duct leading to cyanosis
130
RDS (resp distress S) causes
surfactant deficiency, prematurity, IUGR, pneumonia, pneumothorax, HF
131
signs of RDS
tachypnoea, intercostal recession, cyanosis, grunting
132
RDS on XR
ground glass appearance due to alveolar collapse
133
RDS management
optimise oxygenation, support breathing (CPAP, nasal prongs, ventilation), surfactant via endotracheal tube
134
heart defects causing cyanosis
R to L shunt across pulmonary duct, pulmonary HTN (leading to R to L shunt), pulmonary atresia, severe pulmonary stenosis, tricuspid atresia, Ebstein's anomaly, Tetralogy of Fallot (pulmonary stenosis), transposition of the great arteries, total anomalous pulmonary venous drainage, truncus arteriosus, massive VSD
135
transposition of the great arteries presentation
severe cyanosis + acidosis after birth, only mixing of circulations occurs via duct
136
transposition of the great arteries management
prostaglandin E2 (keep duct open), emergency atrial septostomy, Sx w/i 2/52 of life
137
Tetralogy of Fallot presentation
cyanosis, murmur, hyper-cyanotic spells (relieved by squatting down)
138
pulmonary narrowing leads to a R to L shunt
Tetralogy of Fallot
139
Tetralogy of Fallot management
Sx at 2-3/12 of age
140
AVSDs cause
HF, murmur, mild cyanosis
141
management of VSDs
Sx in infancy
142
resp failure features
SOB, tachypnoea, cyanosis, nasal flaring, grunting, intercostal recession, restlessness, confusion
143
resp failure causes
upper airway obstruction, lower airway, neurological, severe HF with pulmonary oedema, drug ingestion
144
Hx of mec stained liquor, tachypnoea may indicate
mec aspiration
145
surfactant deficiency, prematurity, IUGR, pneumonia, pneumothorax, HF are allrisk factors for
RDS
146
prostaglandin E2 (keep duct open), emergency atrial septostomy, Sx w/i 2/52 of life is the management for
transposition of the great arteries
147
Turner's S genotype
45, XO
148
features of Turner's S
short stature, shield chest, widely spaced nipples, webbed neck, bicuspid aortic valve, coarctation of the aorta, 1' amenorrhoea, cystic hygroma, high arched palate, short 4th MC, multiple pigmented naevi, lymphoedema in neonates
149
increased incidence in Turner's S
AI DZ: AI thyroiditis, Crohn's
150
fertility in Turner's S
sub/infertile
151
increased incidence of AI DZ: AI thyroiditis + Crohn's in
Turner's S
152
3 major congenital infections
rubella, toxoplasmosis, CMV
153
most common congenital infection in the UK
CMV
154
features of rubella
SN deafness, congenital cataracts, congenital heart DZ (PDA), glaucoma
155
features of toxo
cerebral calcification, chorioretinitis, hydrocephalus
156
features of CMV
growth retardation, purpuric skin lesions
157
other features of rubella
growth retardation, hepatosplenomegaly, purpuric skin lesions, 'salt + pepper' chorioretinitis, micropthalmia, cerebral palsy
158
other features of toxo
anaemia, hepatosplenomegaly, cerebral palsy
159
other features of CMV
SN deafness, encephalitis/seizures, pneumonitis, hepatosplenomegaly, anaemia, jaundice, cerebral palsy
160
Down S clinical features
upslanting palpebral fissures, epicanthic folds, Brushfield spots (iris), protruding tongue, small ears, round/flat face, flat occiput, single palmar crease, 'sandal gap', hypotonia, congenital heart defects, duodenal atresia, Hirschprung's DZ
161
cardiac complications of Down S
AV septal canal defects, VSD, secundum ASD, tetralogy of Fallot, isolated PDA
162
later complications of Down S
males infertile, females subfertile, LD, short stature, recurrent resp infections, hearing impairment (from glue ear), ALL, hypothyroidism, AD, atlantoaxial instability
163
von Willebrand DZ mode of inheritance
AD
164
gonadotrophin levels in Turner's S
elevated
165
roseola infantum aka
exanthem subitum, sixth DZ
166
roseola infantum is caused by
HHV6
167
roseola infantum typically affects children aged
6/12 - 2 years
168
features of roseola infantum
high fever (days), followed my maculopapular rash, febrile convulsions, diarrhoea, cough
169
HHV6 causes
roseola infantum
170
high fever (days), followed my maculopapular rash, febrile convulsions, diarrhoea, cough are features of
roseola infantum
171
mode of inheritance of haemophilia A, B
X-linked recessive
172
mode of inheritance of retinoblastoma
AD
173
tumour suppressor gene vs oncogene
tumour suppressor gene = loss of function leads to increased risk of ca
oncogene = gain of function leads to increased risk of ca
174
loss of function of this type of gene leads to increased risk of ca
tumour suppressor
175
gain of function of this type of gene leads to increased risk of ca
oncogene
176
fine motor 3/12
reaching, fixes + follows 180'
177
fine motor 6/12
palmar grip, hand to hand
178
bricks 18/12
tower of 3
179
bricks 2 years
tower of 6
180
bricks 3 years
tower of 9
181
drawing 18/12
circular scribbles
182
drawing 2 years
verticle line
183
drawing 3 years
circle
184
drawing 4 years
cross
185
drawing 5 years
square + triangle
186
speech + hearing 3/12
turns to sound
187
speech + hearing 6/12
babbling
188
speech + hearing 9/12
mama, dada, understands 'no'
189
speech + hearing 1 year
1 word, responds to name
190
speech + hearing 2 years
combines 2 words
191
speech + hearing 3 years
short sentences, questioning, colours, counting
192
birth vaccinations
BCG, hep B (if risk factors)
193
<1 y.o. vaccines
diptheria, tetanus, whooping cough, polio, HiB, rotavirus, pneumococcal, Men B
194
>1 y.o. vaccines
MMR, flu vaccine, HPV, Men ACWY
195
chicken pox features
initial fever, itchy rash (starts head/trunk, spreads), macular, then papular, then vesicular, mild systemic upset
196
measles features
prodrome = irritable, conjunctivitis, fever
Koplik spots = white spots (grains of salt) on buccal mucosa, rash starts behind ears then to whole body, discrete maculopapular rash becomes blotchy + confluent
197
mumps features
fever, malaise, m pain, parotitis (earache, pain on eating), ux to bx
198
rubella features
pink maculopapular rash face initially spreads to body, 3-5/7 fades, suboccipital + postauricular lymphadenopathy
199
erythema infectiosum aka
fifth DZ, slapped cheek S
200
BCG, hep B (if risk factors) vaccines given
at birth
201
diptheria, tetanus, whooping cough, polio, HiB, rotavirus, pneumococcal, Men B vaccines given
<1 y.o.
202
MMR, flu vaccine, HPV, Men ACWY vaccines given
>1 y.o.
203
erythema infectiosum caused by
parovirus B19
204
erythema infectiosum features
lethargy, fever, headache, 'slapped cheek' rash spread to proximal arms + extensor surfaces
205
scarlet fever caused by
reaction to erythrogenic toxins produced by group A haemolytic strep
206
scarlet fever features
fever, malaise, tonsillitis, 'strawberry' tongue, fine punctate erythema rash (sandpaper texture), sparing face, late desquamation
207
hand, foot + mouth DZ caused by
coxsackie A16 virus
208
hand, foot + mouth DZ features
mild systemic upset (sore throat, fever), oral, palm + sole vesicles
209
initial fever, itchy rash (starts head/trunk, spreads), macular, then papular, then vesicular, mild systemic upset are features of
chicken pox
210
prodrome = irritable, conjunctivitis, fever
Koplik spots = white spots (grains of salt) on buccal mucosa, rash starts behind ears then to whole body, discrete maculopapular rash becomes blotchy + confluent are features of
measles
211
fever, malaise, m pain, parotitis (earache, pain on eating), ux to bx are features of
mumps
212
pink maculopapular rash face initially spreads to body, 3-5/7 fades, suboccipital + postauricular lymphadenopathy aer features of
rubella
213
fifth DZ, slapped cheek S aka
erythema infectiosum
214
parovirus B19 causes
erythema infectiosum
215
lethargy, fever, headache, 'slapped cheek' rash spread to proximal arms + extensor surfaces are features of
erythema infectiosum
216
reaction to erythrogenic toxins produced by group A haemolytic strep causes
scarlet fever
217
fever, malaise, tonsillitis, 'strawberry' tongue, fine punctate erythema rash, sparing face, late desquamation are features of
scarlet fever
218
coxsackie A16 virus causes
hand, foot + mouth DZ
219
mild systemic upset (sore throat, fever), oral, palm + sole vesicles are features of
hand, foot + mouth DZ
220
mode of inheritance of osteogenesis imperfecta
AD
221
mode of inheritance of G6PD deficiency
X-linked R
222
tetralogy of Fallot CVS abnormalities
pulmonary stenosis
VSD
RVH
overriding aorta
223
pulmonary stenosis, VSD, RVH, overriding aorta describe
tetralogy of Fallot
224
mode of inheritance of Gilbert's S
AR
225
mode of inheritance of vit D R rickets
X-linked D
226
cf gene mutation is on
ch 7
227
ductus arteriosus travels between
aorta + pulmonar artery
228
PDA is classed as
an acyanotic congenital heart defect
229
uncorrected PDA can lead to
late cyanosis in lower extremities aka differential cyanosis
230
risk factors for PDA
premature babies, born at high altitude, maternal rubella infection in 1st trimester
231
features of PDA
subclavian thrill, continuous 'machinery' murmur, loudest under L clavicle, large V, bounding collapsing pulse, wide pulse P, heaving apex beat
232
management of PDA
indomethacin (closes connection), Sx if another heart defect present too
233
congenital vessel running between aorta + pulmonar artery
ductus arteriosus
234
late cyanosis in lower extremities aka differential cyanosis are complications of untreated
PDA
235
premature babies, born at high altitude, maternal rubella infection in 1st trimester are risk factors for
PDA
236
subclavian thrill, continuous 'machinery' murmur, large V, bounding collapsing pulse, wide pulse P, heaving apex beat are features of
PDA
237
indomethacin is the management of
PDA
238
age range of children that get scarlet fever
2-6 y.o.
239
scarlet fever transmission
droplet
240
scarlet fever diagnosis
throat swab
241
scarlet fever management
PO penicillin V (don't wait for results), azithromycin in PenA, return to school after 24h, notifiable DZ
242
threadworm aka
Enterobius vermicularis, pinworm
243
symptoms of threadworm
perianal itch esp at night
244
most common cause of diarrhoea in children
rotavirus
245
McCune-Albright S features
precocious puberty, cafe-au-lait spots, polyostotic fibrous dysplasia, short stature
246
mode of inheritance of Alport's S
X-linked D
247
LH and testosterone in Kleinifelter's S
LH high, testosterone low
248
Kleingelter's S aka
1' hypogonadism
249
PO penicillin V (don't wait for results), azithromycin in PenA, return to school after 24h, notifiable DZ is the management of
scarlet fever
250
Enterobius vermicularis aka
threadworm, pinworm
251
rotavirus is the most common cause of
diarrhoea in children
252
LH and testosterone in Kallman's S
LH low, testosterone low
253
LH and testosterone in androgen insensitivity S
LH high, testosterone N/high
254
LH and testosterone in testosterone secreting tumour
LH low, testosterone high
255
Kallma'sn S aka
hypogonadotrophic hypogonadism
256
LH high, testosterone low
Kleinfelter's S
257
1' hypogonadism aka
Kleinfelter's S
258
LH low, testosterone low
Kallman's S
259
hypogonadotrophic hypogonadism aka
Kallman's S
260
LH high, testosterone N/high
androgen insensitivity S
261
LH low, testosterone high
testosterone secreting tumour
262
features of Kleinfelter's S
tall, lack of 2' sexual characteristics, small firm testis, infertile, gynaecomastia (increased incidence of breast ca), elevated gonadotrophin levels
263
features of Kallman's S
ansomnia, delayed puberty, hypogonadism, cryptorchidism, low sex hormones, LH/FSH inappropriately low/N
264
androgen insensitivity genotype + phenotype
46 XY, phenotypically female
265
features of androgen insensitivity S
1' amenorrhoea, undescended testes (groin swelling), breast development
266
management of androgen insensitivity S
counselling (raise child as female), bx orchidectomy, oestrogen therapy
267
Edward's S ch abnormality
trisomy 18
268
Edward's S features
micrognathia, low set ears, rocker bottom feet, overlapping of fingers
269
tall, lack of 2' sexual characteristics, small firm testis, infertile, gynaecomastia (increased incidence of breast ca), elevated gonadotrophin levels are features of
Kleinfelter's S
270
ansomnia, delayed puberty, hypogonadism, cryptorchidism, low sex hormones, LH/FSH inappropriately low/N are features of
Kallman's S
271
46 XY, phenotypically female
androgen insensitivity S
272
1' amenorrhoea, undescended testes (groin swelling), breast development are features of
androgen insensitivity S
273
micrognathia, low set ears, rocker bottom feet, overlapping of fingers are features of
Edward's S
274
trisomy 18
Edward's S
275
most common acyanotic congenital heart defects
VSD, ASD, PDA, coarctation of the aorta, aorrtic valve stenosis
276
most common cyanotic congenital heart defects
tetralogy of Fallot, TGA (transposition of the great arteries), tricuspid atresia
277
homocysteinuria features
fine fair hair, LD, seizures, downward lens dislocation, VTE risk, malar flush, livedo reticularis
278
features of Patau S
microcephalic, small eyes, cleft lip/palate, polydactyly, scalp lesions
279
fine fair hair, LD, seizures, downward lens dislocation, VTE risk, malar flush, livedo reticularis are features of
homocysteinuria
280
ch abnormality in Patau S
trisomy 13
281
microcephalic, small eyes, cleft lip/palate, polydactyly, scalp lesions are features of
Patau S
282
trisomy 13
patau S
283
Pierre-Robin S features
micrognathia, post displacement of tongue, cleft pallate
284
Pierre-Robin S v similar to
Treacher-Collins S
285
diff between Treacher-Collins S + Pierre-Robin S
TCS is AD therefore +ve FH
286
micrognathia, post displacement of tongue, cleft pallate are features of
Pierre-Robin S
287
mnagement of Kawasaki's DZ
high dose aspirin, IV Ig, ECHO
288
complications of Kawasaki's DZ
coronary a aneurysm
289
aspirin is usually CI in children due to
Reye's S
290
Reye's S is
a rapidly progressing encephalopathy
291
symptoms of Reye's S
V, personality change, confusion, seizures, LOC
292
Reye's S associated with
aspirin use, recent viral infection, inborn errors of metabolism
293
high dose aspirin, IV Ig, ECHO is the management for
Kawasaki's DZ
294
coronary a aneurysm is a complication of
Kawasaki's DZ
295
aspirin use in children, recent viral infection, inborn errors of metabolism are associated with
Reye's S
296
tricuspid atresia is when
there's an absence of a tricuspid valve therefore no blood can travel RA to RV, leading to hypoplastic RV, ASD + VSD must also be present
297
William's S features
short stature, LD, friendly, extrovert, transient neonatal hypercalcaemia, supravalvular aortic stenosis
298
short stature, LD, friendly, extrovert, transient neonatal hypercalcaemia, supravalvular aortic stenosis are features of
William's S
299
Prada-Willi S features
hypotonia, hypogonadism, obesity
300
hypotonia, hypogonadism, obesity are features of
Prada-Willi S
301
patellar subluxation presentation
medial knee pain (due to lateral subluxation of the patella), knee may give way
302
medial knee pain, knee may give way is the presentation of
patellar subluxation
303
fragile X S features
LD, macrocephaly, long face, large ears, macroorchidism
304
LD, macrocephaly, long face, large ears, macroorchidism are features of
fragile X S
305
Noonan S
webbed neck, pectus excavatum, short stature, pulmonary stenosis
306
measles is caused by
measles virus, RNA paramyxovirus
307
measles treansmission
droplet
308
complications of measles
encephalitis, subacute sclerosing panencephalitis, febrile convulsions, giant cell pneumonia, keratoconjunctivitis, corneal ulceration, diarrhoea, appendicitis, myocarditis
309
encephalitis, subacute sclerosing panencephalitis, febrile convulsions, giant cell pneumonia, keratoconjunctivitis, corneal ulceration, diarrhoea, appendicitis, myocarditis are complications of
measles
310
Wilms' tumour typrically presents at
< 5 y.o.
311
features of Wilms' tumour
abdo mass, painless haematuria, flank pain, anorexia, fever
312
abdo mass, painless haematuria, flank pain, anorexia, fever are features of
Wilms' tumour
313
chondromalacia patellae is
softening of the cartilage of the patella
314
chondromalacia patella is common in
teenage girls
315
features of chondromalacia patellae
ant knee pain when walking up/down stairs, rising from prolonged sitting
316
management of chondromalacia patellae
PT
317
softening of the cartilage of the patella describes
chondromalacia patellae
318
ant knee pain when walking up/down stairs, rising from prolonged sitting are features of
chondromalacia patellaei
319
intussusception usually affects
6-18/12 olds, boys > girls
320
intussusception features
paroxysmal abdo colic pain, draw knees up, turn pale, V, blood stained stools (red current jelly), sausage mass in RLQ
321
intussusception investigations
US
322
management of intissusception
reduction by air insufflation, Sx
323
Meckel's diverticulum rule of
2's: 2% of population, 2 ft from ileocaecal valve, 2 in long
324
paroxysmal abdo colic pain, draw knees up, turn pale, V, blood stained stools (red current jelly), sausage mass in RLQ are features of
intussusception
325
presentation of Meckle's diverticulum
abdo pain, PR beeding, intestinal obstruction (2' to omphalomesenteric band, volvulus, intussuption)
326
management of Meckle's diverticulum
Sx
327
abdo pain, PR beeding, intestinal obstruction (2' to omphalomesenteric band, volvulus, intussuption) is the persentation of
Meckle's diverticulum
328
DDH risk factors
female, breech, FH, 1st born child, oligohydramnios, >5kg, congenital calcaneovalgus foot deformity
329
Barlow test
attempts to dislocate the articulated femoral head, flexed knees, push into bed
330
Ortolani test
attempts to relocate a dislocated femoral head, abduction, external rotation of hips
331
investigations if suspect DDH
US
332
management of DDH
spontaneous resolution, harness, Sx
333
female, breech, FH, 1st born child, oligohydramnios, >5kg, congenital calcaneovalgus foot deformity are risk factors for
DDH
334
attempts to dislocate the articulated femoral head, flexed knees, push into bed describes
Barlow test
335
attempts to relocate a dislocated femoral head, abduction, external rotation of hips describes
Ortolani test
336
bronchiolitis invesitgations
immunofluorescence of nasopharyngeal secretions (may show RSV)
337
Hirschsprung's DZ is caused by
an aganglionic section of bowel due to developmental failure of the parasympathetic nervous plexuses
338
Hirschsprung's DZ presentation
failure/delay to pass mec, constipation, abdo distension
339
Hirschsprung's DZ associations
DS, males
340
an aganglionic section of bowel due to developmental failure of the parasympathetic nervous plexuses is the cause of
Hirschsprung's DZ
341
failure/delay to pass mec, constipation, abdo distension are features of
Hirschsung's DZ
342
Osgood-Schlatter DZ presentation
sporty teenager, tenderness + swelling over tibial tubercle
343
sporty teenager, tenderness + swelling over tibial tubercle describes
Osgood-Schlatter DZ
344
pyloric stenosis presents
2-4/52 of life (up to 4/12)
345
presentation of pyloric stenosis
projectile V (30' post-feed), constipation, dehydration, palpable mass in upper abdo
346
metabolic changes in pyloric stenosis
hypochloraemic, hypokalaemic alkalosis
347
management of pyloric stenosis
Ramstedt pyloromyotomy
348
projectile V (30' post-feed), constipation, dehydration, palpable mass in upper abdo describes
pyloric stenosis
349
Ramstedt pyloromyotomy is the proceedure used to correct
pyloric stenosis
350
when to refer for gross motor delay
12/12 if not seated usupported, 18/12 if not walking
351
APGAR score assesses
Appearance (colour), Pulse, Ggrimace (reflex irritability), Activity (m tone), Respiratory effort (/10)
352
APGAR score values
0-3 = v low, 4-6 = moderate low, 7-10 good
353
acute limp <3 years old management
urgent hospital appointment
354
causes of a limping child
transient synovitis, septic arthritis/osteomyelitis, juvenile idiopathic arthritis, trauma, DDH, Perthes DZ, slipped upper femoral epiphysis
355
features of septic arthritis/osteomyelitis
unwell child, high fever, painful, immobile leg, swelling/redness later
356
features of juvenile idiopathic arthritis
painless limp, salmon-pink rash, bx, pyrexia, lymphadenopathy, arthritis, uveitis, anorexia, weight loss
357
feature of Perthes DZ
4-8 y.o., AVN of femral head, progressive pain, hip stiffness, reduced ROM (hip)
358
features of slipper upper femoral epiphysis
10-15 y.o., posterioinferior displacement
359
transient synovitis features
acute onset, accompanies viral infections, well child, mild fever, boys > girls, 2-12 y.o.
360
unwell child, high fever, painful, immobile leg, swelling/redness later
septic arthritis/osteomyelitis
361
painless limp, salmon-pink rash, bx, pyrexia, lymphadenopathy, arthritis, uveitis, anorexia, weight loss
juvenile idiopathic arthritis
362
4-8 y.o., AVN of femral head, limp
Perthes DZ
363
10-15 y.o., posterioinferior displacement, limp
slipped upper femoral peiphysis
364
limp, acute onset, accompanies viral infections, well child, mild fever, boys > girls, 2-12 y.o.
transient synovitis
365
neonatal assessment if passed mec in utero plus
RR >60, grunting, HR <100/>160, cap refil >3, T'c >38, O2 sats <95%, central cyanosis
366
RR >60, grunting, HR <100/>160, cap refil >3, T'c >38, O2 sats <95%, central cyanosis warrents neonatal assessment in the presence of
in utero mec
367
Perthes DZ management
< 6y.o. good prognosis w/o intervention
| > 6y.o. Sx
368
risk factors for slipped upper femoral epiphysis
obesity, short stature
369
red flag constipation symptoms
from birth/1st weeks of life, >48h mec, ribbon stools, faltering growth, abdo distension, leg weakness, locomotor delay
370
management of paediatric constipation
1. diet/lifestyle changes + movicol 2. stimulant
371
venous hum murmur is due to
turbulent flow in great v returning to the heart, benign
372
venous hum murmur heard as
continuous blowing noise under clavicles
373
Still's murmur is heard as
low pitched sound at lower L sternal edge
374
characteristics of innocent ejection murmurs
soft, short, posture variation, localised, not diastolic, no thrill, no added sounds, asymptomatic
375
turbulent flow in great v returning to the heart, benign
venous hum murmur
376
low pitched sound at lower L sternal edge
Still's murmur
377
continuous blowing noise under clavicles
venous flow murmur
378
jaundice in 1st 24h is
always pathological
379
causes of 1st 24h jaundice
Rh/ABO haemolytic DZ, hereditary spherocytosis, G6PD
380
physiological jaundice occurs
2-14/7 post birth
381
causes of prolonged jaundice
biliary atresia, hypothyroidism, galactosuria, UTI, breast milk jaundice, congenital infections (CMV, toxo)
382
investigations in prolonged jaundice
conjugated (biliary atresia) + unconjugated billirubin, TFTs, Coombs' test, FBC, blood film, urine MC&S, urine reducing sugars, U+E, LFTs
383
Rh/ABO haemolytic DZ, hereditary spherocytosis, G6PD are causes of
jaundice in the 1st 24h
384
biliary atresia, hypothyroidism, galactosuria, UTI, breast milk jaundice, congenital infections (CMV, toxo) are causes of
prolonged jaundice
385
mesenteric adenitis presentation
central abdo pain, URTI
386
malrotation presentation
high caecum at midline, complicated by volvulus leading to bile stained V
387
malrotation is a feature of
exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia
388
exomphalos is
weakness of the baby's abdominal wall
389
necrotising enterocollitis presentation
abdo distension, passage of bloody stools
390
risk factor for necrotising enterocollitis
prematurity, emperical ABx beyond 5/7
391
transient synovitis management
rest, analgesia, it's self-limiting
392
nocturnal enuresis is defined as
involuntary discharge of urine by day/night/both in a child >5 y.o. in the absence of congenital/acquired defects of the NS/urinary tract
393
potential underlying causes of nocturnal enuresis
constipation, DM, UTI
394
management of nocturnal enuresis
fuids (just advice, don't restrict), diet, toileting behaviour, reward system
< 7 y.o. enuresis alarm
>7 y.o. desmopressin
395
threadworm management
single dose mebendazole for household + hygine advice
396
thyroglossal cyst presentation
ant triangle, midline, below hyoid, thin walled, anechoic on USS
397
branchial cyst presentation
ant to sternocleidomastoid, near angle of the mandible, anechoic on USS
398
dermoid cyst presentation
midline of neck, external angle of eye, post to pinna, suprahyoid, heterogeneous on imaging, multiple inclusions e.g. hair follicles
399
cystic hygroma presentation
post to sternocleidomastoid, painless, fluid filled, hypoechoic on USS
400
infantile haemangioma presentation
either trianges, rapidly growing, spontaneously regress,
401
ant triangle, midline, below hyoid, thin walled, anechoic on USS
thyroglossal cyst
402
ant to sternocleidomastoid, near angle of the mandible, anechoic on USS
branchial cyst
403
midline, suprahyoid, heterogeneous on imaging
dermoid cyst
404
post to sternocleidomastoid, painless, fluid filled, hypoechoic on USS
cystic hygroma
405
either trianges, rapidly growing, spontaneously regress,
infantile haemangioma
406
mild croup
occasional barking cough, no stridor at rest, no/mild recessions, well child
407
moderate croup
f barking cough, stridor at rest, recessions at rest, no distress
408
severe croup
prominent inspiratory stridor at rest, marked recessions, distress, agitation, lethargy, tachycardia
409
occasional barking cough, no stridor at rest, no/mild recessions, well child
mild croup
410
f barking cough, stridor at rest, recessions at rest, no distress
moderate croup
411
prominent inspiratory stridor at rest, marked recessions, distress, agitation, lethargy, tachycardia
severe croup
412
necrotising enterocilitis on AXR
dilated bowel loops, , bowel wall oedema, pneumatosis intestinalis (intramural gas), portal venous gas, pneumoperitoneum, Rigler's sign (air inside + outside of bowel), football sign (air outlining the falciform ligament)
413
precocious puberty is defined as
<8 y.o. in femailes, <9 y.o. in males
414
congenital diaphragmatic hernia is characterised by
herniation of the abdominal viscera into the thoracic cavity due to incomplete formation of the diaphragm
415
consequences of congenital diaphragmatic hernia
pulmonary hypoplasia, pulmonary HTN, resp distress
416
herniation of the abdominal viscera into the thoracic cavity due to incomplete formation of the diaphragm are characteristics of
congenital diaphragmatic hernia
417
pulmonary hypoplasia, pulmonary HTN, resp distress are consequences of
congenital diaphragmatic hernias
418
transient lactose intollerance is a common complication of
viral gastroenteritis
419
time points to assess APGAR score
1, 5, 10 mins
420
gastroschisis describes
a congenital defect in the ant abdo wall lat to the umbilical cord
421
exomphalos vs gastroschisis
exomphalos = abdo contents are covered in an amniotic sac formed by amniotic membrane + pertioneum
422
omphalocele refers to
a defect in the umbilicus itself
423
features of foetal alcohol S
small head, flattened philtrum, thin upper lipf
424
types of nappy rash
irritant dermatitis, Candida dermatitis, seborrhoeic dermatitis, psoriasis, atopic eczema
425
features of irritant dermatitis nappy rash
most common cause, irritant effect of urinary ammonia + faeces, creases are charcteristically spared
426
Candida dermatitis nappy rash features
erythematous rash, involves flexures, characteristic satellite lesions
427
seborrhoeic dermatitis nappy rash features
erythematous rash with flakes, ?coexistant scalp rash
428
psoriasis nappy rash features
less common, erythematous scaly rash, also present elsewhere on skin
429
atopic eczema nappy rash features
other areas of skin affected
430
nappy rash: most common cause, irritant effect of urinary ammonia + faeces, creases are charcteristically spared
irritant dermatis
431
nappy rash: erythematous rash, involves flexures, characteristic satellite lesions
Candida dermatitis
432
nappy rash: erythematous rash with flakes, ?coexistant scalp rash
seborrhoeic dermaititis
433
nappy rash: less common, erythematous scaly rash, also present elsewhere on skin
psoriasis
434
vesicoureteric reflux is
the abnormal backflow of urine from bladder into ureters + kidneys
435
vesicoureteric reflus predisposes to
recurrent UTIs
436
the abnormal backflow of urine from bladder into ureters + kidneys
vesicoureteric reflux
437
persistent fever/serious recurent infections DD
occult abscess (e.g. dental), atypical pneumonia, hepatitis, UTI, osteomyelitis, HIV, infectious mononucleosis, TB, IE, IBD, collagen vascular DZ, neoplastic DZ, facticious fever
438
IE symptoms
heart murmur, fever, malaise, anorexia, clubbing, splinter haemorrhages, splenomegaly
439
symptoms of collagen vascular DZ
remitting fever, systemic juvenile chronic arthritis (Still's DZ)
440
PUO in children
prolonged fever, >1/52 in young children, 2-3/52 in adolescents
441
if fever >5/7 suspect
Kawasaki's DZ
442
IE in childrent often occurs as a complication of
congenital heart DZ, indwelling central venous catheters (PTN, chemo)
443
most common IE organism in children
Strep viridans
444
IE management
6/52 IV ABx
445
common osteomyelitis causative organisms
Staph a, H. influenzae, enterobacter, Strep pyogenes
446
recommendations for PTs with splenectomy/hyposplenism
pneumococcal vacination, penicillin prophylaxis
447
HIV presentation in children
failure to thrive, recurrent oral candidiasis, diarrhoea, hepatosplenomegaly, severe bacterial infections
448
heart murmur, fever, malaise, anorexia, clubbing, splinter haemorrhages, splenomegaly are symptoms of
IE
449
remitting fever, systemic juvenile chronic arthritis (Still's DZ) are symptoms of
collagen vascular DZ
450
suspect Kawasaki's DZ if fever duration >
5/7
451
failure to thrive, recurrent oral candidiasis, diarrhoea, hepatosplenomegaly, severe bacterial infections may be the presentaion of
HIV in children
452
headache causes
tension headache, eye strain, migraine, sinusitis, dental caries, raised ICP, infection, analgesia headache, HTN
453
tension headache symptoms
band of P, worse later in day, precipitated by stress
454
migraine presentation
throbbing, sometimes ux, episodic, can be f, N, V, FH, visual auras (halos, zig-zag lines)
455
sinusitis presntation
bony tenderness, nasal congestion
456
raised ICP presentation
worse in am, worse lying down, V, papilloedema, focal neuro signs, HTN, bradycardia, blured vision
457
analgesia headache presentation
f use of NSAIDs/paracetamol
458
diagnostic criteria for migraine
episodic occurence, completely well between attacks, aura, throbbing headache, sometimes ux, +ve FH, impairment of function during attack, 1-72h duration
459
management for migraines
simple analgesia (paracetamol, NSAIDs), antiemetics, sleep hygine, avoiding trigger foods (cheese, chocolate, citrus fruit, nuts, caffeinated drinks), migraine diary, B-blockers/pizotifen (severe cases)
460
tension headache management
reassure, rest, sympathy, simple analgesia
461
cluster headache presentation
sudden onset, ux, periorbital pain, clusters of a few times/d for a few weeks, redness, orbital swelling, tears
462
cluster headaches are exacerbated by
alcohol
463
cluster headache management
s/c or nasal triptans (serotonin agonist) = acutely, CaCh blockers to prevent recurrences
464
benign intracranial HTN should be considered in
chronic headache, obesity, older child, papilloedema, N brain imaging
465
band of P, worse later in day, precipitated by stress describes
tension headache
466
throbbing, sometimes ux, episodic, can be f, N, V, FH, visual auras (halos, zig-zag lines) describes
migraine
467
bony tenderness, nasal congestion describes
sinusitis
468
worse in am, worse lying down, V, papilloedema, focal neuro signs, HTN, bradycardia, blured vision describes
raised ICP headache
469
sudden onset, ux, periorbital pain, clusters of a few times/d for a few weeks, redness, orbital swelling, tears describes
cluster headache
470
chronic headache, obesity, older child, papilloedema, N brain imaging describes
benign intracranial HTN
471
types of fits, faints + funny turns
apnoea, febrile convulsion, breath holding spells (cyanotic), reflexic anoxic spells (pallid), infantile spasms, hypoglycaemia, metabolic conditions, epilepsy, syncope, hyperventillation, cardiac arrhythmias
472
febrile seizures presentation
6/12-5 y.o., sudden rise in T'c, lasts a few mins
473
breath holding spells (cyanotic) presentation
older babies/toddlers, precipitated by crying (pain, anger)
474
apnoea presentation
found limp/twitching, <6/12, no precipitating event
475
consider underlying cause in apnoea
reflux, sepssis, arrhythmia
476
reflex anoxic spell (pallid) presentation
precipitated by minor injury, pale, collapses, rapid recovery, may be eye rolling, incontinence, clonic stiffening
477
infantile spasm presentation
form of myoclonic epilepsy, jacknife spasms, clusters, developmental regression
478
types of epilepsy
simple absence, partial epilpesy, complex partial epilepsy, myoclonic epilepsy
479
simple absence epilepsy presentation
fleeting vacant look
480
partial epilepsy presentation
twitching/jerking of face/arm/leg
481
complex partial epilpsy presentation
altered/impaired consciousness, strange sensations, semi-purposeful movements (chewing, sucking), may have postictal phase
482
myoclonic epilepsy presentation
shock-like jerks, sudden falls, known neuro disabilty
483
syncope presentaiton
precipitated by pain/emotion/prolonged standing, blurred vision, lightheadedness, sweating, nausea, resolves on lying down
484
hyperventillation presentation
precipitated by excitement, excessive deep breathing
485
breath holding spells (cyanotic) management
reassure, don't change behaviours, will grow out of them (usually by 18/12)
486
reflex anoxic spell (pallid) management
reassure, put child in recoery position, disappear before school age
487
fever >5/7 + 4 of: conjunctival injection, mucous membrane change (e.g. dry cracked lips, strawberry tongue), cervical lymphadenopathy, polymorphous rash, red oedematous palms/soles leads to skin peeling
criteria for Kawasaki's
488
features suggestive fo hyponatraemia
jittery, increased m tone, hyperreflexia, convulsions, drowsiness, coma
