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Paediatrics Flashcards

1
Q

What is the normal HR, systolic BP and RR for a child under 1?

A

HR - 110-160
SBP - 70-90
RR - 35-45

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2
Q

What is the normal HR, systolic BP and RR for a child aged 1-5?

A

HR- 95-140
SBP- 80-90
RR- 25-35

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3
Q

What is the normal HR, systolic BP and RR for a child aged 5-12?

A

HR- 80-120
SBP- 90-110
RR- 20-25

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4
Q

What infections are covered by the 6 in 1 vaccine?

A

Diptheria, Tetanus, Pertussis, Polio, Haemophilus influenza, Hep B

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5
Q

What vaccines are given at 2 months?

A

6 in 1
Pneumococcal
Rotavirus
Meningococcal B

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6
Q

What vaccines are given at 3 months?

A

6 in 1

Rotavirus

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7
Q

What vaccines are given at 4 months?

A

6 in 1
Pneumococcal
Meningococcal B

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8
Q

What vaccines are given at 12-13 months?

A

Hib/Men C
Pneumococcal
MMR
Men B

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9
Q

What vaccines are given at 3 years 4 months?

A

DTP and polio

MMR

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10
Q

What vaccine is offered to girls aged 11-13?

A

HPV

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11
Q

What vaccines are given to teenagers?

A

Tetanus, diptheria, polio

Meningococcal ACWY

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12
Q

When is considered precocious puberty?

A

Girls <8

Boys <9

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13
Q

When is normal range of puberty?

A

Girls- 8-13

Boys- 9-14

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14
Q

When is the average age of puberty?

A

Girls- 11

Boys- 11.5

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15
Q

What is considered delayed puberty?

A

Girls- >13

Boys- >14

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16
Q

What are the 3 stages of puberty in girls?

A

Thelarche - budding of breast tissue
Adrenarche - development of body hair and odour
Menarche - commencement of menstruation (usually about 2 years after thelarce)

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17
Q

How is puberty defined in boys?

A

Growth of testicles >4ml

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18
Q

What are the benefits of breast feeding for the mother?

A

Bonding
Reduces risk of breast cancer
Weight loss

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19
Q

What are the benefits of breastfeeding for the baby?

A

Transfer of IgA

Reduced lifetime risk of obesity, diabetes and atopy

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20
Q

What is the ratio of formula to water?

A

1 scoop per 30 ml of water that has been boiled and cooled

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21
Q

When should the process of weaning be started?

A

Around 6 months

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22
Q

When can full fat cows milk be introduced to infants?

A

From 1 year

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23
Q

What organisms cause the common cold?

A

Rhinovirus, RSV, coronavirus

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24
Q

How does the common cold present?

A

Sneezing, rhinorrhoea, mild fever, associated sore throat, AOM

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25
Q

How is the common cold managed?

A

Analgesia, rest, fluids

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26
Q

What are complications of the common cold?

A

Secondary bacterial infection, bronchitis

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27
Q

What is croup?

A

Acute laryngotracheobronchitis

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28
Q

What age group does croup affect?

A

6 months to 6 years

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29
Q

What is the commonest cause of croup?

A

Parainfluenza virus

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30
Q

How does croup present?

A

Viral prodome over a few days followed by barking cough, rasping stridor, hoarseness. Still able to eat and drink. If severe may be recession and cyanosis

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31
Q

How is croup diagnosed?

A

Mainly clinical signs

Can do AP neck x-ray

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32
Q

What does an AP neck x-ray show in croup?

A

Narrowing of trachea - steeple sign

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33
Q

How is croup managed?

A 
Steroids stat (dexamethasone/prednisolone)
If severe can give nebulised adrenaline, oxygen +/- intubation
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34
Q

What is a complication of croup?

A

Secondary bacterial tracheitis - thick mucopurulent exudate and pronounced tracheal tenderness

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35
Q

What is epiglottitis?

A

Acute bacterial infection of epiglottis

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36
Q

What ages does epiglottitis affect?

A

Ages 2-7

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37
Q

What causes epiglottitis?

A

Haemophilus Influenzae

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38
Q

How does epiglottitis present?

A

Sudden onset, drooling, unable to swallow, soft stridor, muffled voice, feverish, systemically upset, respiratory distress, adopts tripod position

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39
Q

What investigation would you do for epiglottitis and what would it show?

A

Lateral neck x-ray - thumb print sign

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40
Q

How is epiglottitis managed?

A

Do NOT wait for x-ray before initiating management
Do NOT examine throat
Call ENT/anaesthetics for rigid laryngoscopy and intubation
Antibiotics - IV ceftriaxone

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41
Q

What is bronchiolitis?

A

Acute lower respiratory tract infection

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42
Q

What age group is bronchiolitis seen in?

A

Under 1 years

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43
Q

What is the commonest cause of bronchiolitis?

A

RSV

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44
Q

How does bronchiolitis present?

A

History of cold, dry cough, worsening breathlessness, wheeze, cyanosis, intercostal recession, atelectasis

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45
Q

What does a CXR show in bronchiolitis?

A

Hyperinflation with patchy changes

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46
Q

How is bronchiolitis managed?

A

Supportive - oxygen, oral feeding limited, calpol

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47
Q

What are some common causes of pneumonia in children?

A

Strep pneumoniae, staph A, group A strep

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48
Q

How is non-severe bacterial pneumonia treated in children?

A 
<1 = co-amoxiclav
>1 = amoxicillin
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49
Q

How is severe bacterial pneumonia treated in children?

A

Co-amoxiclav +/- clarithromycin

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50
Q

What is whooping cough?

A

LRTI/acute bronchitis in children

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51
Q

What is the cause of whooping cough?

A

Bordatella Pertussis

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52
Q

How does whooping cough present?

A

1-2 weeks mild cold symptoms
2-6 weeks of paroxysmal cough with inspiratory whoop
2-4 weeks of lessening symptoms that take a whole month to resolve fully

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53
Q

How is whooping cough treated?

A

Clarithromycin (must be given within 21 days of onset)

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54
Q

What are the 3 key characteristics of asthma?

A

Reversible airflow obstruction
Airway hyper responsiveness
Bronchial inflammation

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55
Q

What are some symptoms of asthma?

A

Reversible airflow obstruction, wheeze, dyspnoea, nocturnal cough

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56
Q

What are some triggers of asthma?

A

Pollen, dust, feathers, exercise, viruses, cold air, chemicals

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57
Q

What is the initial investigation of choice for asthma?

A

Spirometry

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58
Q

What is the first line treatment for asthma in children?

A

SABA

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59
Q

What should be added to a SABA first line in children over 5?

A

Very low dose ICS

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60
Q

What should be added to a SABA first line in children under 5?

A

LTRA

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61
Q

SABA + very low dose ICS aged 6 - what next?

A

LABA

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62
Q

SABA + very low dose ICS + LABA - what next?

A

Increase steroid dose or add LTRA

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63
Q

What other therapies can be considered in childhood asthma?

A

Theophylline

Prednisolone

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64
Q

How is a severe asthma attack managed?

A 
Oxygen 
Salbutamol (inhaler/nebs)
Ipratropium bromide (neb)
Magneium sulphate (150mg in each neb)
Prednisolone (30-40mg if over 5, less if under)
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65
Q

What is osteogenesis imperfecta?

A

Defect in maturation and organisation of type 1 collagen

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66
Q

What are some symptoms of osteogenesis imperfecta and what is it an important differential for?

A

Multiple fragility fractures, short stature, deformities, blue sclera, deafness
NAI

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67
Q

What is skeletal dysplasia?

A

Short stature due to a genetic error (e.g. achondroplasia)

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68
Q

What is Duchenne MD?

A

X-linked recessive defect in dystrophin gene

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69
Q

How does Duchenne MD present?

A

Progressive proximal muscle weakness, calf pseudohypertrophy, Gowers sign positive

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70
Q

How is Duchenne MD diagnosed?

A

Increased serum CK, abnormalities on muscle biopsy

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71
Q

What is cerebral palsy?

A

Insult to an immature brain causing irreversible damage

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72
Q

What are some causes of cerebral palsy?

A

Genetics, malformations, IU infection, hypoxia at birth

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73
Q

What are some types of cerebral palsy?

A

Spastic, ataxic, athetoric

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74
Q

What is spina bifida?

A

Failure of primary neural tube to close in 1st 6 weeks of gestation

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75
Q

What is the mildest form of spina bifida?

A

Spina bifida occulta

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76
Q

What is polio?

A

Viral infection affect anterior horn cells resulting in LMN defect

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77
Q

What is Erb’s Palsy?

A

Upper brachial plexus damage (C5+6)

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78
Q

How does Erb’s palsy present?

A

Internal rotation of the humerus - waiters tip

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79
Q

What is Klumpke’s palsy?

A

Lower brachial plexus damage (C8+T1)

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80
Q

How does Klumpke’s palsy present?

A

Paralysis of intrinsic hand muscles. Can also cause Horner’s syndrome due to sympathetic nerve disruption

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81
Q

What is developmental dysplasia of the hip?

A

Dislocation/subluxation of the femoral head in the perinatal period

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82
Q

What are some risk factors for DDH?

A 
Female sex
Positive family history
Breech
1st born
Downs syndrome
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83
Q

What are signs of DDH?

A

Shortening of limb, asymmetrical thigh and groin creases

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84
Q

What tests should be done in the newborn examination to check for DDH?

A

Barlows (dislocating the hip - click)

Ortolanis (relocating the hip - clunk)

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85
Q

How is DDH investigated?

A

USS hip

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86
Q

How is DDH treated?

A

Pavlick Harness - keeps hips in flexion and abduction

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87
Q

What is transient synovitis?

A

Self limiting inflammation of the synovium commonly occurring after an URTI

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88
Q

What age and sex is transient synovitis commonest in?

A

Ages 2-10

Boys

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89
Q

What is the commonest cause of hip pain in kids?

A

Transient synovitis

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90
Q

How is transient synovitis treated?

A

NSAIDs + rest

91
Q

What is Perthes disease?

A

Idiopathic osteochondritis of the femoral head

92
Q

How does Perthes present?

A

Hip pain which may be referred to the knee
Limping
Loss of internal rotation
Positive Trendellenberg

93
Q

How is Perthes treated?

A

Usually self limiting

Avoidance of physical activity

94
Q

What does an X-ray show in Perthes?

A

Flattening of the femoral head

95
Q

What is SUFE?

A

Femoral head slips inferiorly to the femoral neck

96
Q

Who does SUFE usually affect?

A

Overweight adolescent boys

97
Q

How does SUFE present?

A

Pain felt either in groin or solely in the knee (via the obturator nerve)

98
Q

How is SUFE treated?

A

Surgery to pin the femoral head

99
Q

What is Osgood-Schlatter?

A

Tibial apophysitis - inflammation of the tendons attachment to the bone

100
Q

How does Osgood-Schlatter present?

A

Pain tenderness and swelling over tibial tubercle

Seen in sport teenagers

101
Q

How is Osgood-Schlatter treated?

A

Rest, ice, analgesia, physio

102
Q

What is patellar tendonitis?

A

Inflammation of patellar tendon - commonly seen in teenage boys

103
Q

How does patellar tendonitis present?

A

Chronic anterior knee pain worse after running. Tenderness under patella

104
Q

How is patellar tendonitis treated?

A

Rest, physio

105
Q

What is chondromalacia patellae?

A

Softening of the knee cartilage commonly seen in teenage girls

106
Q

How does chondromalacia patellae present?

A

Anterior knee pain typically on walking up and downs stairs and rising from prolonged sitting

107
Q

How is chondromalacia patellae treated?

A

Physiotherapy

108
Q

What is osteochondritis dissecans?

A

Cracks in the articular cartilage and in underlying subchondral bone

109
Q

How does osteochondritis dissecans present?

A

Poorly localised pain, effusion and occasional locking after exercising

110
Q

How is osteochondritis dissecans treated?

A

Rest, NSAIDs, microfracture removal, osteoarticular transfer

111
Q

What is talipes equinovarus?

A

Clubfoot - abnormal alignment of talus, calcaneus and navicular

112
Q

What are some risk factors for club foot?

A

Male sex
Family history
Breech
Oligohydramnios

113
Q

How is club foot treated?

A

Ponseti technique

114
Q

How does eczema often present in children?

A

On the face and extensors

115
Q

What is cradle cap?

A

Sebhorrhoeic dermatitis - non-itchy yellow scale

116
Q

What is nappy rash?

A

Contact dermatitis - confluent erythema with sparing of the skin around where nappy is

117
Q

How is nappy rash treated?

A

Frequent nappy changes, dry baby well post bath, topical steroid + antifungal, barrier cream

118
Q

What causes molluscum contagiosum?

119
Q

How does molluscum contagiusum present?

A

Itchy pink/white umbilicated pearly papules

120
Q

What causes impetigo?

A

Staph Aureus

121
Q

How does impetigo present?

A

Straw coloured lesions with a yellow crust

122
Q

What is Epidermolysis Bullosa?

A

Genetic condition resulting in easy blistering of the skin due to epidermis separating from dermis

123
Q

What causes rubella?

A

Rubella virus

124
Q

How does rubella present?

A

Pink, discrete, maculopapular rash starting on face and spreading to rest of body
Assosicated sub-occipital lymphadenopathy

125
Q

How is rubella treated?

A

Supportive - rest, fluids, analgesia

Notify public health

126
Q

What causes Mealses?

A

Measles virus

127
Q

How does Measles present?

A

Maculopapular rash starting on face and spreading, lasting 6-8 days.
Koplik spots in the mouth are pathognomonic - look like grains of sugar on the mucosa

128
Q

How is Measles treated?

A

Supportive - rest, fluids, analgesia

Notify public health

129
Q

What causes Roseola Infantum?

A

Human Herpes Virus 6

130
Q

How does Roseola Infantum present?

A

Usually a high spiking fever, followed by a rose coloured maculopapular rash on the trunk that spreads periperally

131
Q

How is Roseola Infantum treated?

A

Supportive

132
Q

What causes Scarlet fever?

A

Group A strep

133
Q

How does Scarlet fever present?

A

Sandpaper like rash in neck and chest. Red face but peri-oral pallor. Strawberry tongue.

134
Q

How is Scarlet fever treated?

A

Penicillin V

135
Q

What causes glandular fever?

A

Epstein Barr Virus

136
Q

How does glandular fever present?

A

Widespread erythematous rash, exudative pharyngitis, tender lymph nodes, hepatosplenomegaly

137
Q

What causes Erythema Infectiosum?

A

Parvovirus B19

138
Q

How does Erythema Infectiosum present?

A

Bilateral macular erythema on face, maculopapular rash with lacy erythema on trunk, fever

139
Q

How is Erythema Infectiosum treated?

A

Supportive

140
Q

What causes chicken pox?

A

Varicella Zoster

141
Q

How does chicken pox present?

A

Intensely itchy rash that starts with macules and progresses into papules and vesicles that burst and crust over

142
Q

How is chicken pox treated?

A

Supportive

143
Q

What causes Hand, Foot & Mouth disease?

A

Coxsackie virus

144
Q

How does Hand, Food and Mouth present?

A

Viral prodome

Painful vesicles on hands, feet and mouth. Greyish in colour.

145
Q

What is Henoch-Schonlein Purpura?

A

Small vessel vasculitis associated with IgA

146
Q

What is the triad of symptoms of HSP?

A

Palpable purpuric rash
Arthritis
Colicky abdo pain

147
Q

How is HSP treated?

A

Most resolve themselves within 6 weeks

Steroids + NSAIDs for symptoms

148
Q

What causes Idiopathic thrombocytopenia?

A

IgG autoimmunity

149
Q

How does ITP present?

A

Post infective purpura, petechiae and mucosal bleeding

150
Q

When does pyloric stenosis occur?

A

Within the first 12 weeks of life - commoner in boys

151
Q

How does pyloric stenosis present?

A

Projectile vomiting occuring after feeds. Vomit is non-bilius and milky. May be constipated due to dehydration

152
Q

What investigations should you do for pyloric stenosis?

A

Abdo exam - may palpate an ‘olive sized mass’

USS if unable to feel

153
Q

How is pyloric stenosis treated?

A

Surgically - Ramstedts Pyloromyomotomy

154
Q

What can cause GORD in children?

A

Liquid diet, horizontal position, low LOS pressure

155
Q

How does GORD present?

A

Regurgitation, irritability, failure to thrive, Sandifers syndrome, laryngitis, heartburn

156
Q

How is GORD investigated?

A

Diagnosis usually clinical - can do endoscopy/oesophageal pH

157
Q

How is GORD treated?

A 
Feed in prone position
Sit upright after feeds
Thicken feeds (Carobel)
Antacids (Gaviscon)
Ranitidine
158
Q

What is intussusception?

A

Telescoping of the bowel causing obstruction, commonly at the terminal ileum

159
Q

Who does intussusception commonly occur in?

A

Infants aged 6-18 months

160
Q

How does intussusception present?

A

Spasms of colic, bile stained yellow vomit, red jelly stools, palpable sausage like mass

161
Q

What does a USS show in intussusception?

A

Target sign

162
Q

How is intussusception managed?

A

Pneumatic reduction

163
Q

What is malrotation and volvulus caused by?

A

Absent attachments of small bowel mesentery leading to instability and allows other organs to wrap around each other

164
Q

How does malrotation present?

A

Bile stained vomit, circulatory collapse, tender abdomen

165
Q

How is malrotation/volvulus managed?

A

Surgery - surgical emergency

166
Q

What is the commonest surgical emergency in kids?

A

Appendicitis

167
Q

How does appendicitis present?

A

Vague abdo pain then pain in RIF. Pain worse on movement, flexing of knees, abdominal guarding, McBurneys sign positive

168
Q

What is mesenteric adenitis?

A

Inflammation of mesenteric lymph nodes, usually secondary to infection

169
Q

How does mesenteric adenitis present?

A

Fever, acute onset RIF pain,

170
Q

What does USS show in mesenteric adenitis?

A

Enlarged mesenteric lymph nodes

171
Q

How is mesenteric adenitis managed?

A

Supportive care

172
Q

What are some causes of gastroenteritis?

A

Viral - rotavirus
Bacterial - campylobacter, Ecoli, c diff
Parasitic - giardiasis

173
Q

What is an abdominal migraine?

A

Episodic abdominal pain lasting over 1 hour. Patient well inbetween episodes

174
Q

How is abdominal migraine treated?

A

Acute - rest, analgesia, sumitriptain

Prevention - Pizotifen, propranolol

175
Q

What is Toddlers diarrhoea?

A

Benign and self limiting condition that resolves by ages 5-6

176
Q

How does Toddlers diarrhoea present?

A

Up to 12 stools per day, visible lumps of undigested food in stool. No abdominal symptoms. Thriving child

177
Q

How is Toddlers diarrhoea managed?

A

Reassurance. Can use loperamide occasionally

178
Q

How does cows milk intolerance present?

A

Chronic diarrhoea

179
Q

How is cows milk intolerance managed?

A

Continue milk free diet with challenge tests every 6 months

180
Q

How does coeliac disease present in children?

A

Diarrhoea, pale stool, bloating, growth failure, anaemia

181
Q

How is coeliac disease diagnosed?

A

Anti TTG screening test
Endoscopy with biopsy shows crypt hyperplasia with flattened villi
Kids can be diagnosed solely on bloods if TTG 10x normal level

182
Q

What conditions is coeliac associated with?

A

Autoimmune conditions, Downs syndrome, Turners Syndrome

183
Q

What causes cyanotic heart disease?

A

Deoxygenated blood mixing with systemic circulation

184
Q

What condition is associated with ostium primum ASD?

A

Downs syndrome

185
Q

How does a ventricular septal defect present?

A

Breathlessness, recurrent chest infections, pansystolic murmur

186
Q

What is coarctation of the aorta?

A

Narrowing of the aorta at the ductus arteriosis

187
Q

What is coarctation of the aorta associated with?

A

Turners syndrome

188
Q

How does coarctation of the aorta present?

A

CCF, collapse, weak/absent femoral pulses, hypertension in upper limbs

189
Q

What is tetraology of fallot?

A

Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

190
Q

What are Fallots spells?

A

Episodes of cyanosis due to spasm of subpulmonary muscle

191
Q

What is transposition of the great vessels?

A

Right ventricle gives rise to aorta
Left ventricle gives rise to pulmonary artery
Incompatible with life

192
Q

What is the commonest cause of a heart murmur in children?

A

Innocent murmur

193
Q

‘Pansystolic murmur heard loudest on the lower left sternal edge with parasternal thrill’

194
Q

‘Ejection systolic murmur heard best at the upper left sternal edge with a fixed splitting of S2’

195
Q

Ejection systolic murmur heard best between the shoulder blades associated with weak femoral pulses and a radio-femoral delay

A

Coarctation of aorta

196
Q

Continuous machine like murmur heard best below the left clavicle

A

Patient ductus arteriosis

197
Q

What is a febrile convulsion?

A

Infantile seizures that develop as a result of a febrile illness

198
Q

At what age do febrile convulsions usually occur?

A

Between 6 months and 6 years - peak incidence around 18 months

199
Q

How does a simple febrile convulsion present?

A

Generalised tonic clonic seizure, duration <5 mins, completely recovery within an hour

200
Q

How does a complex febrile convulsion present?

A

Focal onset, lasting over 10 mins, recurrent seizures in one febrile illness, febrile status epilepticus

201
Q

What is the risk of recurrence of febrile seizures?

202
Q

What increases the risk of recurrence of febrile seizures?

A

Age below 18 months
Family history
Low grade and short duration of fever
Multiple seizures

203
Q

What is the risk of epilepsy?

A 
Simple = 2%
Complex = 6-8%
204
Q

How should a parent manage a febrile convulsion?

A

Stay calm, protect child from harm
Check nothing in mouth
Once seizure over put child into recovery position
Be aware that child may be sleepy for 1 hour

205
Q

What rescue medication can be given to parents?

A

Rectal diazepam or buccal midazolam

Should be given if seizure lasts more than 5 mins

206
Q

What is the triad of symptoms associated with ADHD?

A

Impulsivity
Inattention
Hyperactivity

207
Q

What are risk factors for ADHD?

A

Prematurity, LBWW, brain damage, alcohol/smoking/drug use during pregnancy

208
Q

What are some psychological therapies for ADHD?

A

Parent training

Social skills training

209
Q

What is the first line pharmacological management of ADHD?

A

Stimulants - methylphenidate, dexamfetamine

210
Q

What is second line pharmacological management of ADHD?

A

Non-stimulants - atomoxetine

211
Q

What are the two key areas of difficulty in ASD?

A

Persistent deficits in social communication and interaction

Restricted, repetitive patterns of behaviour, interests and activities

212
Q

What symptoms may people with ASD have?

A

Problems with social cues, fixed thinking style, inflexible thinking, need for routine, odd prosody, echolalia, video speak, sensory issues, may be coexistant LD, behavioral issues

213
Q

Is there a treatment for the core symptoms of autism?

214
Q

What pharmacological therapies can be given for aggression in autism?

A

Risperidone/aripiprazole short term

215
Q

What pharmacological therapies can be given for other symptoms of autism?

A

Antianxiety drugs, anti-depressants, melatonin

216
Q

What is the ratio of chest compressions to breaths in children?

217
Q

What should be given before starting chest compressions in paediatric BLS?

A

5 rescue breaths

218
Q

What should you use for chest compressions in a child under 1?

219
Q

If a child over 1 is choking what should you do?

A

5 back blows

220
Q

If a child is under 1 and choking what should you do?

A

5 abdominal thrusts

221
Q

What is Kawasaki disease?

A

Vasculitis commonly seen in children

222
Q

How does Kawasaki disease present?

A 
High grade fever lasting >5 days
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles which later peel
223
Q

How is Kawasaki disease managed?

A

High dose aspirin
IV Immunoglobulins
Echocardiogram

224
Q

Why is an echocardiogram done in Kawasaki disease?

A

Because coronary artery aneurysm is one of the main complications

Finals Revision (22 decks)

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