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Paediatrics Flashcards

1
Q

What is the most common pathogen causing respiratory infections in children?

A

Respiratory Syncytial Virus (RSV)

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2
Q

Which virus causes the common cold?

A

Rhinovirus

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3
Q

What is the treatment for tonsillitis?

A

10 day course of penicillin

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4
Q

What would you see on examination of the ear in otitis media?

A

Red, bulging, non reflective tympanic membrane

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5
Q

How to treat otitis media?

A

co-amoxiclav, analgesia

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6
Q

What are the symptoms of croup?

A

Barking cough, stridor, hoarseness

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7
Q

What is stridor?

A

A low pitched inspiratory sound caused by upper airways obstruction

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8
Q

What precededs croup?

A

Coryza and a fever

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9
Q

In what season does croup most commonly occur?

A

Autumn

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10
Q

What age would you expect a child with croup to be?

A

2

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11
Q

Treatment of croup

A
  1. Oral dexamethasone - 15mg/kg
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12
Q

What would you hear on auscultation in a patient with bronchiolitis?

A

Widespread wheeze and crepitations

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13
Q

What are the risk factors for bronchiolitis?

A

Premature birth, pre-existing lung pathology, immunosuppression

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14
Q

If you suspect upper airways obstruction (e.g. in croup and epiglottitis) what should you not do and why?

A

EXAMINE THE THROAT - may close airways fully

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15
Q

How will a child with epiglottitis look?

A

Drooling, sitting open mouthed and upright, not speaking or swallowing, tripod position

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16
Q

Treatment for epiglottitis?

A

IV Cefuroxime

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17
Q

How to tell the difference between croup and epiglottitis?

A
  1. No cough in epiglottitis vs barking cough in croup
  2. Drooling in epiglottitis
  3. High grade fever in epiglottitis
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18
Q

What bug causes whooping cough?

A

Bordetella pertussis

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19
Q

What is the treatment for whooping cough?

A

Erythromycin

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20
Q

What are the symptoms of whooping cough?

A

Inspiratory whoop in between coughs, severe cough which may end in vomiting, subconjunctival haemorrhage

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21
Q

What is the most likely cause of pneumonia in newborns?

A

Group B strep from mother’s genital tract

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22
Q

What are the symptoms of pneumonia?

A
  1. Fever
  2. Increased work of breathing
  3. Tachypnoea
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23
Q

LABAs e.g. …………. should always be used in conjunction with………?

A

Salmeterol, inhaled corticosteroids

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24
Q

Asthma add-on therapy in under 5s?

A

Montelukast

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25
Q

What are the features of a severe asthma attack?

A
  1. Silent Chest
  2. Sats <92%
  3. Cyanosis
  4. Fatigue and drowsiness
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26
Q

How to treat a severe asthma attack? (4)

A
  1. Oxygen
  2. Steroids
  3. B2 agonists
  4. Ipratropium bromide nebulised
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27
Q

What would you be worried about in a persistent wet cough?

A

Bronchiectasis

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28
Q

What changes happen in the heart at birth?

A

The foramen ovale (link between atria) closes

The ductus arteriosus (shunt between aorta and pulmonary arteries) closes

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29
Q

When will neonates present with heart failure?

A

When the ductus arteriosus closes at 1-2 days old

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30
Q

How will a neonate present with heart failure?

A

murmur, shock, cyanosis, acidosis, collapse

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31
Q

What makes you think a heart murmer is NOT benign?

A
  1. Diastolic
  2. Thrills
  3. Radiation
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32
Q

How to treat heart failure in neonates?

A

Prostaglandins to keep the ductus arteriosus open

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33
Q

What causes heart failure in neonates?

A

Coarcted aorta, aortic valve stenosis

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34
Q

What causes heart failure in infants?

A

VSD, AVSD

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35
Q

How does heart failure in infants present?

A

Breathlessness, pulmonary oedema

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36
Q

How to treat heart failure in infants?

A

Diuretics and catopril

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37
Q

What is the pathophysiology of kawasaki disease?

A

Vasculitis of the coronary arteries - causing clots and coronary aneurysms

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38
Q

Who gets kawasaki’s disease?

A

Boys under 5 years

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39
Q

What are the symptoms of Kawasaki’s?

A

CRASH and burn:

  1. Conjunctivitis
  2. Rash
  3. Adenopathy - enlarged cervical lymph nodes
  4. Strabery tongue
  5. Hands and feet swell and get a rash
  6. Burn/fever
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40
Q

Treatment of Kawasaki’s?

A

IVIg and aspirin

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41
Q

What is the possible complication of aspirin in children?

A

Reye’s syndrome - brain and liver damage

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42
Q

What are the SEPSIS 6? (3 in, 3 out)

A
  1. Oxygen
  2. Fluids
  3. Antibiotics
  4. Lactate
  5. Urine output
  6. Blood cultures
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43
Q

Which antibiotic to use in suspected sepsis with CNS infection?

A

Cefotaxime

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44
Q

What are the symptoms of sepsis?

A
  1. Tachycardia
  2. Fever
  3. Tachypnoea
  4. Low blood pressure
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45
Q

What would you see in a lumbar puncture in bacterial meingitis?

A

VERY HIGH WHITE CELLS IN CSF

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46
Q

Treatment of meningitis in patients under 3 months?

A

IV Cefotaxime and amoxicillin

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47
Q

Treatment of meningitis in 3 months - 16 year olds?

A

Ceftriaxone

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48
Q

What is the treatment for encephalitis?

A

IV Acyclovir

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49
Q

What is the usual cause of encephalitis?

A

HSV - Herpes Simplex Virus

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50
Q

Fever, bulging fontanelles, loss of consciousness, seizure, behavioural change…. what do you think?

A

Encephalitis

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51
Q

How will the CSF look in bacterial meningitis?

A

Cloudy/turbid

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52
Q

If the CSF is high in protein and low in glucose, what is the cause of the meningitis?

A

Tuberculosis (really high and low) or bacterial meningitis

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53
Q

How is necrotising fasciitis treated?

A

Clindamycin and debridement of necrotic tissue

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54
Q

39 degree fever, diffuse rash, skin shedding, hypotension, fever, chills, vomiting, pain…. what are you thinking?

A

Toxic Shock Syndrome

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55
Q

What drugs are used to treat tuberculosis and duration of each drug?

A

RIPE

  1. Rifampicin (6 months)
  2. Isoniazid (6 months)
  3. Ethambutol (2 months)
  4. Pyrazinimide
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56
Q

Side effect of isoniazid?

A

Peripheral neuropathy

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57
Q

What qualities would an infection have that would make you worry about HIV?

A

SPUR: Serious, persistent, unusual and recurrent

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58
Q

A child presents with swollen parotid glands, hepatosplenomegaly, lymphadenopathy and thrombocytopenia - what might they have? How would you test for it?

A

HIV- DNA PCR

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59
Q

What are the clinical features of an IgE immune response?

A

Rash, facial swelling, anaphylaxis

Within 10 minutes of ingestion

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60
Q

What are the clinical features of a non IgE response to food?

A

Failure to thrive, abdominal pain, dairrhoea and vomiting

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61
Q

What is the distribution of eczema in infants?

A

Face and trunk

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62
Q

A pale patient with recurrent infections, epitaxis and bruising comes to you. What are you worried about? What is causing these symptoms?

A

Leukaemia

Bone marrow infiltration

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63
Q

Leukemia can cause reticuloendothelial infiltration, what symptoms will you get?

A

Hepatosplenomegaly, lymphadenopathy and mediastinal obstruction

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64
Q

Name 2 drugs used in the treatment of leukaemia?

A

Dexamethasone and vincristine

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65
Q

A headache worse in the morning, vomiting on waking and a personality change in children can be a sign of….?

A

Raised intracranial pressure e.g. in brain tumours

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66
Q

What are the signs of raised intracranial pressure in infants?

A

Tense fontaelles, head tilt and developmental delay

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67
Q

What drug reduces cerebral oedema?

A

Mannitol

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68
Q

What causes painless lymphadenopathy?

A

Hodgkin Lymphoma

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69
Q

A patient comes and has a palpable abdominal mass. What are your 2 differentials? How would you distinguish them? (Cancer)

A

Neuroblastoma: child is ill
Nephroblastoma: child is well

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70
Q

What are the symptoms of neuroblastoma?

A

Abdominal swelling/mass, bone pain, limp, malaise

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71
Q

You take a photo of a 2 year old and her eyes flash white. What condition does she have?You notice something else is wrong with her eye… what is it?

A

Retinoblastoma, she’s squinting

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72
Q

How long is the treatment for iron deficiency anaemia in infants?

A

Works in 3 days, lasts 3-6 months

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73
Q

What is the clinical picture in aplastic anaemia?

A

Features of pancytopenia:

  1. Anaemia due to reduced red cells
  2. Infection due tor educed white cells
  3. Bleeding and bruising due to reduced platelets
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74
Q

What is the inheritance pattern of haemophilia A and B?

A

X-Linked recessive

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75
Q

What indicates severe haemophilia?

A

Spontaneous bleeding into muscles/joint space

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76
Q

When does haemophilia present?

A

Age 1 ish - when children start walking/crawling as they are bumping into things and falling over

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77
Q

What is the inheritance pattern of von Willebrand disease?

A

Autosomal dominant

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78
Q

What is the difference in bleeds between haemophilia and vWB disease?

A

Bleeding is not spontaneous in von Willebrand

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79
Q

Which clotting factors are vitamin K dependant?

A

2, 7, 9 and 10

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80
Q

A 7 year old child comes in with easy bruising, and mucosal bleeding. They had a bad cold 2 weeks ago. Blood tests show low platelets. What is the most likely diagnosis?

A

Immune thrombocytopenia

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81
Q

When do children with hypermobility get painful limbs?

A

After exercise

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82
Q

When do growing pains occur?

A

At night

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83
Q

A child who had food poisoning last week presents with a swollen ankle and a low grade fever - what’s the diagnosis? What is the prognosis?

A

Reactive arthritis, good! Self limiting

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84
Q

A 2 year old child presents with a hot swollen tender joint. Their hip is flexed, abducted and externally rotated. What is the diagnosis? What would you see on FBC?

A

Septic arthritis

Raised white cells and inflammatory markers

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85
Q

What are the 3 criteria for diagnosing JIA?

A
  1. Persistant joint swelling > 6 weeks
  2. In the absence of infection
  3. In a child under 16
86
Q

Name one associated complication of JIA?

A

Uveitis

87
Q

What is the treatment for JIA?

A
  1. NSAIDs or analgesia

2. Methotrexate

88
Q

Name some advantages of breast-feeding

A
  • mother and child bonding
  • reduces risk of GI infection
  • ideal nurtition in the first 4-6 months
  • reduces risk of obesity, hypertension and diabetes in later life
89
Q

How many centile lines drop is mild and severe failure to thrive?

A 
2 = mild
3 = severe
90
Q

Where is the most common site for intussusception?

A

Ileum invaginating into caecum through ileal-caecal valve

91
Q

What is redcurrant jelly stool a sign of?

A

Mucous and blood = INTUSSUSCEPTION

92
Q

A child who isn’t eating well, with abdominal pain which started at the centre and now is in the iliac fossa… What is the treatment?

A

Appendectomy

93
Q

A pale child with a saussage shaped mass palpable in the abdomen has colicky pain, they are drawing their legs up in pain. Their vomit has bile in it… what’s wrong?

A

Intussusception

94
Q

If a child presents with bilious vomiting, tenderness and abdominal pain in the first 3 days of life what is the most likely cause?

A

Malrotation

95
Q

What test must you always perform in unexplained recurrent abdominal pain?

A

Urine microscopy and culture

96
Q

Abdominal pain associated with headaches is called….?

A

Abdominal migraine

97
Q

What is the triple therapy for a peptic ulcer?

A
  1. Proton Pump Inhibitor e.g. omeprazole
  2. Clarithromycin
  3. Amoxicillin
98
Q

What does bile-stained vomit indicate?

A

Intestinal obstruction e.g. intussusception

99
Q

How might oesophagitis and peptic ulcers present?

A

Haematemesis

100
Q

What causes projectile vomiting in the first few weeks of life?

A

Pyloric stenosis

101
Q

What are the clinical feautres of gastroenteritis?

A

Vomiting associated with fever and runny nose

102
Q

Why might a toddler be pooing out peas and carrots?

A

Toddler’s diarrhoea - intestines are not fully mature, children grow out of this by age 5

103
Q

What would you be worried about if there was no meconium? (first stool)

A

Hirschsprung’s disease, cystic fibrosis

104
Q

What causes Hirschsprung disease?

A

Absent nerve plexus in smooth muscle, no peristalsis, bowel contents do not move

105
Q

What is the treatment for Hirschsprung’s disease?

A

Resection of the area that lacks nerve fibres

106
Q

What is Potter Syndrome? What can cause it?

A

Compression of the foetus due to severe oligohydramnios (low amniotic fluid)
Renal agenesis

107
Q

Name 3 features of Potter syndrome

A
  • low ears
  • beaked nose
  • limb deformities
108
Q

what are the clinical features of autosomal dominant PKD?

A

haematuria
hypertension
kidney failure in adulthood
Cysts grow on kidneys between normal parenchyma

109
Q

Where will an obstruction cause bilateral hydronephrosis?

A

Obstruction at the bladder neck or urethra

110
Q

A male baby presents with bilateral hydronephrosis. What would you do?

A

Urgent ultrasound (48 hours) to rule out posterior urethral valves

111
Q

Which organism causes UTI in boys?

A

Proteus

112
Q

A child with bacteriuria, fever and abdominal pain has what kind of UTI?

A

Upper - pyelonephritis

113
Q

Best way to get a urine sample in infants?

A

Clean catch

114
Q

Treatment of a UTI in < 3 month olds

A

IV Cefotaxime

115
Q

Treatment of a UTI in > 3 month olds and children with upper UTI

A

oral co-amoxiclav 7 days

116
Q

Treatment of children with cystitis?

A

3 days trimethoprim

117
Q

What is the triad for nephrotic syndrome?

A
  1. Oedema
  2. Hypoalbuminaemia
  3. Proteinuria
118
Q

What is the treatment for steroid resistant nephrotic syndrome?

A

salt reduction, diuretics, ACE inhibitors

119
Q

A 5 year old boy who has just had a cold comes with haematuria, a trunk-sparing rash, aching joints and abdominal pain. What’s the problem?

A

Henoch-Schonlein Purpura

120
Q

What is Henoch-Schonlein purpura?

A

Small vessel vasculitis

121
Q

Describe the normal gross motor development in a 9 month old?

A

Can pull themselves up to stand

122
Q

Describe the age when a child should be able to walk?

A

1 year

123
Q

If a child can lift their head on their tummy, grasp an object, laugh and smile spontaneously, what is their developmental age?

A

3 months

124
Q

If a child can bang cubes together, pull to sstand, say “dada” and wave bye-bye, what is their developmental age?

A

9 months

125
Q

If a child can walk up steps, built a 2 cube tower,, form 2 word sentences - what is their developmental age?

A

2 years

126
Q

When can a child build an 8 cube high tower?

A

Age 3

127
Q

What is the “median age” of developing a skill?

A

when 50% of children can do the skill

128
Q

When should a squint disappear?

A

12 weeks

129
Q

When do children develop normal visual acuity?

A

4 years old

130
Q

What is the difference between impairment and disability?

A

Impairment is the abnormal function or loss of physical function, disability is the restriction due to the impairment

131
Q

What is the most common cause of cerebral palsy?

A

Vascular occlusion/stroke before birth

132
Q

What causes 10% of cerebral palsy?

A

hypoxia during birth (hypoxic-ischaemic encephalopathy)

133
Q

Name some other less common causes of CP?

A

meningitis, maternal infection e.g. rubella, hypoglycaemia

134
Q

What movements occur in dyskinetic CP?

A

Uncontrolled movements:

  1. chorea
  2. athetosis: slow writhing movements which occur distally e.g. splaying fingers
  3. dystonia
135
Q

What conditions are associated with quadriplegic spastic CP?

A

microcephaly, seizures and severe intellectual impairment

136
Q

What is hemiplegic CP?

A

When the arm and leg on one side is affected - child tip toe walks on the affected side and shows asymmetric hand function

137
Q

Is it normal to have asymmetric hand function before 12 months?

A

Not usually, may bea sign of hemiplegic cerebral palsy

138
Q

Who is more at risk of conductive hearing loss?

A

Downs kids, cleft palate and atopic children

139
Q

Give some features of downs syndrome

A

Flat occiput, sandle gap between toes, single palmar creases, small mouth and ears

140
Q

Name 2 conditions of trisomy (nod DS) and a feature of each,

A

Edward’s (18): prominent occiput, clenched hands with overlapping fingers
Patau (13): cleft palate, polydactyly, absent eyebrows

141
Q

What is the most common heart defect in Turner’s syndrome?

A

Coarction of the aorta

142
Q

What is the treatment for Turner’s syndrome?

A

Growth hormone and oestrogen replacement

143
Q

What is uniparental disomy?

A

The activity of a gene depends on the parent it was inherited from

144
Q

Give an example of uniparental disomy on chromosome 15?

A

Prader Willi if Paternal gene is abnormal

Anglemann if Materna; gene is abnormal

145
Q

Give 5 ways a preterm infant is stabilised.

A 
Surfactant therapy
Humidifed incubator
Borad spectrum antibiotics
CPAP
Catheters and IV lines
Minimal handling
146
Q

Name 3 ways of treating Respiratory Distress Syndrome (RDS)

A
  1. Surfactant therapy
  2. CPAP
  3. Raised ambient oxygen
147
Q

Who is most at risk of RDS?

A

28 week or less premature, boy more than girls

148
Q

What are infants with RDS also at risk of due to ventilation?

A

Pneumothorax

149
Q

A bounding pulse and systolic murmur are signs of what in a new baby?

A

Patent Ductus Arteriosus

150
Q

How much fluid does a preterm baby need?

A

60-90ml/kg in day 1

Day 2 increase by 20-30ml/kg

151
Q

A preterm infant with difficulty feeding, bile stained vomit, distended abdomen and fresh blood in the stool has what?

A

Necrotising enterocolitis

152
Q

What are the X-ray features of necrotising enterocolitis?

A

Distended bowel, intramural gas

153
Q

A newborn baby has an unstable temperature, bradycardia, resp distress and abdominal distension, what could be going on?

A

Neonatal sepsis

154
Q

What to do if you suspect neonatal sepsis?

A

Sepsis scree, CXR, FBC

155
Q

Bulging fontanelles in neonates and hyperextension of the neck and back are signs of….?

A

Neonatal meningitis

156
Q

What antibiotics are used to treat neonatal meningitis?

A

Ampicillin and cefotaxime

157
Q

What are the risk factors for neonatal infection? (3)

A

Prolonged rupture of amniotic membranes
preterm babies
maternal fever

158
Q

How would a baby get a listeria monocytogenes infection?

A

Through the placenta if the mother eats unpasteurised milk, or soft cheese

159
Q

What is meconium staining of the liquor a sign of?

A

Listeria infection

160
Q

What do you use to treat HSV infectino?

A

Acyclovir

161
Q

What is the red cell lifespan in neonates?

A

70 days

162
Q

What type of bilirubin is present in neonatal jaundice?

A

UNconjugated

163
Q

What is the “never event” risk of neonatal jaundice?

A

Kernicterus: infiltration of unconjugated bilirubin into thebasal ganglia

164
Q

What is the sign where a baby arches their back due to kernicterus?

A

Opisthotonos

165
Q

Name 3 haemolytic disorders causing neonatal jaundice?

A

Rhesus haemolytic disease, ABO incompatibility, G6PD Deficiency

166
Q

What should all unwell, vomiting, feverish babies have?

A

Urine microscopy

167
Q

What is the treatment for UTI in infants?

A

Admission needed, IV cefuroxime

168
Q

What bug is most likely to cause osteomyelitis? What is the treatment?

A 
Staph aureus (skin colonisation)
IV cefuroxime followed by oral flucloxacillin
169
Q

Name the bug: gram negative diplococci in a child with fever and a purple rash…

A

Neisseria meningitides

170
Q

What is the treatment for severe vs non-severe pneumonia?

A

IV benzyl penicillin if severe, oral amoxicillin if mild

171
Q

What’s wheeze?

A

A polyphonic expiratory sound caused by the narrowing of small and medium airways

172
Q

name 3 causes of wheeze

A
  1. Persistant infantile wheeze
  2. Viral episodic wheeze
  3. Asthma
173
Q

What do you give to a preterm baby whos blood glucose has dropped?

A

IV 10% Dextrose

174
Q

What is the treatment for jaundice?

A

Phototherapy, exchange transfusion

175
Q

What may a child sitting in the tripod position have?

A

Epiglottitis

176
Q

What pathogen commonly causes infection in patients with CF? What antibiotic is used to treat it?

A

Psuedomonas auruginosa, pipercillin

177
Q

Give 2 examples of a cephalosporin - when would they be indicated?

A

Cefotaxime and ceftriaxone

Sepsis

178
Q

A strawberry tongue and sandpaper rash is a classic presentation of…?

A

Scarlet fever

179
Q

What does APGAR stand for?

A

Appearance, pulse, grimace, activity and respiratory effort

180
Q

When should the APGAR be tested?

A

At 1, 5 and 10 minutes of age

181
Q

What is unique about the presentation of pertussis in infants?

A

Instead of a “whoop” there may be periods of apnoea

182
Q

Describe the symptoms of Acute Lymphoid Leukaemia?

A

Hepatosplenomegaly, bruising, anaemia

183
Q

How might anaemia present in a child?

A

Soft murmer and shortness of breath on exertion

184
Q

After oral dexamethasone for croup, if the child is not improving what is the next line of treatment?

A

Oxygen and nebulised adrenaline

185
Q

What is the ratio of compressions:ventilations in child resuscitation?

A

15:2

186
Q

What causes slapped cheek syndrome?

A

Parvovirus

187
Q

What is characteristic about the fever in Kawasaki’s?

A

High grade >39 and not responsive to antipyrexials

188
Q

What would you hear in a baby with a PDA?

A

A continuous machinery urmur

189
Q

What is the treatment for PDA?

A

Ibuprofen which is an anti-prostaglandin

190
Q

What is the first line treatment for constipation in children?

A

Movicol

191
Q

What are the 4 cardiac abnormalities in Tetralogy of Fallot?

A
  1. A large VSD
    1. Overriding of the aorta (aorta directly over the VSD instead of the left ventricle)
    2. Right ventricular outflow obstruction/pulmonary stenosis

Right ventricular hypertrophy

192
Q

When and how would tetralogy of fallot present?

A

1-2 months after birth with cyanosis and an ejection systolic murmur

193
Q

What is the classic x-ray finding of tetralogy of fallot?

A

Boot shaped heart

194
Q

A baby presents at 2 days of life with collapse, absent femoral pulses, metabolic acidosis and hepatomegaly - what is the diagnosis?

A

Coarctation of the aorta

195
Q

What do infantile spasms look like?

A

repeated flextion of the head/trunk followed by extension of arms

196
Q

Another name for croup is

A

laryngotracheobronchitis

197
Q

What are the triad of features in shaken baby syndrome?

A

retinal haemorrhage
encephalopathy
subdural haematoma

198
Q

What is ebstein’s anomaly? What causes it?

A

low insertion of tricuspid valve
large atrium and small ventricle
Lithium exposure in utero

199
Q

What would you see on x-ray in meconium aspiration syndrome?

A

patchy infiltrations

atelectasis (collapse of lung)

200
Q

What may congenital rubella lead to?

A

Sensorineural deafness

cataracts

201
Q

What are the chracteristic features of toxoplasmosis infection?

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

202
Q

What are the chracteristic features of cytomegalovirus infection?

A

growth retardation

purpuric skin lesions

203
Q

What is in the 6-1 vaccine and when is it given?

A

diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
Given at 2, 3 and 4 months

204
Q

A child under 3 months has a fever - what should you do?

A

Refer for paediatric assessment that day

205
Q

What is the barlow’s test for developmental dysplasia of the hip?

A

Try to dislocate an articulated femoral head

206
Q

“goign out to the bar.. .and you ought to come home” refers to what?

A

Barlow’s test - dislocate the hip

Ortalani test - return the dislocated hip

207
Q

Blood in the stool of a preterm baby probably indicates…

A

Necrotising enterocolitis

208
Q

What metabolic abnormality do you see in pyloric stenosis?

A

Hypochloremia
hypokalaemia
metabolic alkalosis

209
Q

How does perthes disease present?

A

progressive hip pain, limp and stiffness

210
Q

What is the complication of using lithium in pregnancy?

A

Ebstein’s abnormailty

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