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Paediatrics Flashcards

1
Q

Primary prevention of childhood accidents

A

Sait gourds

Speed limits

Teaching road safety

Window safety chaeck

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2
Q

Secondary prevention of childhood accidents

A

Wear seatbelts

Cycle helmets

Smoke alarms

Laminated safety glass

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3
Q

Tertiary prevention

A

Teach parents 1st aid

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4
Q

Achondroplasia

  • Phenotype
  • pathology
  • RF
  • Surgical Tx
A

Short limbs/fingers
Large head with frontal bossing
Lumbar lordosis

Autosomal dominant mutation resulting in abnormal cartilage

Parental age at conception
FH (AD)

Limb lengthening with Ilizarov

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5
Q

Acute epiglottis

  • Organism
  • Features
  • What NOT to do
A

Hib

Rapid onset, High temp, Unwell, Stridor, Drooling saliva

Examine throat with tongue depressor (precipitation airway obstruction)

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6
Q

Apgar score

  • Used for?
  • 5 categories (0-2 points per category)
  • What is a good score
A

Assess health of a newborn baby

Pulse (present, over 100 = gd)
Resp (strong, crying)
Colour (pink)
Muscle tone (active movement)
Reflex (cries on stimulation)
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7
Q

What is a bad situation in Apgar?

A

Blue
Floppy
No breath
part rate under 60bpm

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8
Q

Severe Asthma attach

  • SpO2
  • PEF
  • Talking
  • HR
  • RR
  • Other
A

Less than 92%

PEF 33-50% of predicted

Too breathless to talk/feed

HR over 125
(over 140 if under 5)

Over 30

Use of accessory muscles

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9
Q

Life threatening a asthma

  • SpO2
  • PEF
  • Chest
  • RR
  • Other Observations
A

SpO2 under 92%

PEF under 33%

Silent chest

Poor resp effort

Agitation, Altered consciousness
Cyanosis

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10
Q

Moderate attack

  • SpO2
  • PEF
  • Other
A

SpO2 over 92%

PEF over 50%

No other severe features

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11
Q

Treating Acute asthma (mild-moderate)

A

Bronchodiltor: Salbutamol via spacer

  • 1 puff every 30-60s up to a max of 10 puffs
  • If symptoms not controlled by inhaler challenge then refer to hospital
  • 3-5 day steroid therapy for all exacerbation (Prednisolone)
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12
Q

5 Asthma Step Tx in children over 5

only first 4 steps before referral in under 5s

A

1: SABA
2: + Pediatric dose ICS
3: + Leukotriene receptor agonist
4: LABA instead of LTRA
5: SABA + MART (instead of ICS+LABA)

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13
Q

What is MART

A

Maintenance and receiver therapy

Combined ICS and LABA in single inhaler

Used for daily maintenance as well as relief of symptoms

(LABA must have a fast acting component e.g. Formoterol)

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14
Q

ADHD

  • epidemiology
  • mechanism
A

Boys more

Low levels of dopamine in frontal areas = low concentration Tx targets this)

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15
Q

ADHD

- diagnosis

A

Persistent features

5 of the following

cant follow instructions

reluctant to engage with mentally intense tasks

Easily distracted

difficulty completing taks

Unable to play quietly

Talk excessively

Often on the go

Interruptive

doesn’t wait turn

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16
Q

ADHD management

What to do before drug therapy

A

Look at needs of cold and how life affected (Paediatrician with behaviour disorder interest or CAMHS)

1st line: Non pharma

Drug therapy: Methylphenidate, Lisdeamphetamine
(Both cardiotoxic, do an ECG prior

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17
Q

Autism

  • Epidemiology
  • 3 features for diagnosis
  • Other features
A

75% male, usually before age of 3

1) Global impairment of language/communication
2) Imparied social relationships
3) Ritualistic and compulsive phenomena

Most have a decreased IQ
Remember this is a spectrum of disease

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18
Q

Autosomal Dominant Vs Autosomal Recessive. How to remember

A

AR thought of as metabolic

AD more structural

** there are some exceptions

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19
Q

Autosomal Dominant E.G

A 
Achondroplasia
ADPKD
Ehlers-Danlos
FAP
SPherocytosis
HNPCC
Huntingtons
Marfans
Von hippel Lindau
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20
Q

Autosomal Recessive E.G

A 
CAH
CF
Phenylketonuria
Sickle cell
Thalassaemias
Wilsons
Haemochromatosis
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21
Q

Bronchiolitis

  • def
  • epi
  • cause
  • when is it serious
A

Condition with acute bronchiolar inflammation

LRTI in under 1 (small airways). Higher incidence in winter.

RSV in 80% (mycoplasma can also)

When assoc with prematurity (bronchopulmonary dysplasia), congenital heart defect or CF

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22
Q

Bronchiolitis

  • Features
  • Investigations
  • Referral to hospital
A

Coryza symptoms ± mild fever

Dry cough

Worsening breathlessness
(Feeding issues assoc commonly why admitted)

Wheeze/fine inspiratory crackles

Immunoflourescence of nasopharyngeal secretions may show RSV

Respiratory distress (chest recession, grunting) RR over 60
Difficulty feeding (breast, bottle)
Clinical dehydration
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23
Q

Management RSV

A

Humidified Oxygen vie head box if sat under 92%

NG feeding if struggling for food/liquid by mouth

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24
Q

RSV prophylaxis

  • Who
  • How
A

If Premature of Chronic lung disease
Significant congenital hart disease

Palivizumab

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25
Q

Concerning causes of bruising in infants/children

A

NAI ( multiple sites, look for grip marks etc)

Coag (Haemophilia, vWB, Liver disease)

Thrombocytopenia (ITP, Congenital infection, meningococcal septicaemia, ALL)

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26
Q

Caput secundum

  • desc
  • features
  • management
A

Oedema of scalp at presenting part of head (vertex typically)
Due to scalp pushing on cervix/use of ventouse

Soft swelling, crosses suture lines

Resolves in days - conservative

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27
Q

Cephalohaematoma

  • desc
  • what is it
  • common region
  • Time to resolve
A

Swelling on newborn head, typically parietal region, doesn’t cross suture lines.

Bleeding between periosteum and skull

up to 3 months to resolve

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28
Q

Cerebral palsy

  • What is it
  • Manifestations
A

Disorder of development due to non-progressive lesion in motor pathways of developing brain

Abnormal tone in infancy
Delayed motor milestones
abnormal gait
Feeding difficulties

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29
Q

Associated non-motor problem CP

A

Learning difficulties (60%)

Epilepsy (30%)

Squints (30%)

Hearing impairment (20%)

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30
Q

Causes of CP

A

Antenatal:
Congenital infection (CMV, rubella, Toxoplasmosis)
Cerebral malformation

Intrapartum: Birth asphyxia

Postnatal: intraventricular haemorrhage, meningitis, head trauma, Periventricular leukomalacia (white matter brain injury assoc with prematurity, poor white matter perfusion)

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31
Q

CP Classifications

A

Spastic (70%)

  • Hemiplegia
  • Diplegia
  • Quadriplegia

Dyskinetic (involuntary movements)

Ataxic

Mixed

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32
Q

CP management

A

MDT approach
Spasticity: DIazepam, intrathecal baclofen, Botulinum Toxin, Orthopaedic surgery

Anticonvulsants and analgesia where needed

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33
Q

Chicken pox

  • Cause
  • Shingles
A

Varicella zoster

Shingles: reactivation in dormant virus in dorsal horn. More due to herpes zoster

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34
Q

Chicken pox

  • Spread
  • Infectivity
A

Respiratory, can also be caught from shingles

Infective 4 days before rash until 5 days after rash appeared

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35
Q

Chicken Pox features

A

Fever
Itch, rash (maculopapular)
Mild systemic upset

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36
Q

Chicken pox Tx

A

keep cool
Calamine lotion
School exclusion (5 days from rash onset)

Immunocompromised/newborns (permpartum exposure) get Varicella zoster immunoglobulins (VZIG) and the IV acyclovir if chicken pox develop

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37
Q

Varicella zoster complications

A

Pneumonia
encephalitis
Haemorrhagic chicken pox

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38
Q

Types of child abuse

A

Physical
Emotional
Sexual Neglect
Fabrication of illnesses

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39
Q

Observations of neglect

A

Persistent infestations (e.g. scabies/lice)

Tooth decay

Fail to attend followup

Failure to suitably dress child

Poor hygiene, inadequate food provision, Unsafe living env

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40
Q

Sexual abuse

A

Anogenital discomfort

Preg in young women 13-15

Anogenital warts/Hep B in young child

STI in child under 12

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41
Q

Physical abuse

A

bruising, Fractures (rib, fractures at diff stages of healing)
Torn frenulum
Burns

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42
Q

Factors pointing towards child abuse

A

Story inconsistent with injury

Repeated A&E attendance

Late presentation

Frightened, frozen, withdrawn

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43
Q

Social milestones

6w
3m
6m
9m

A

6w: Smiles
3m: Laughs
6m: Not shy
9m: Shy, everything taken to mouth

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44
Q

Feeding

  • 12-15 month
  • 3yr
  • 5yr
A

drinks form cup and uses spoon

Spoon + Fork

Knife + fork

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45
Q

Play

  • 9 month
  • 18 month
  • 4 yr
A

Plays peek-a-boo, waves bye

Plays alone

Plays with others

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46
Q

Newborn screening

A

Hearing (otolaryngologists-acoustic emissions)

Heel-prick (day 5-9)

  • Hypothyroid
  • Phenylketonuria
  • CF
  • MCADD
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47
Q

Mumps:

- Features

A

Fever, Malaise, Muscle pain, Parotitis (‘earache’)

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48
Q

Rubella features

A

Pink rash on face before spreading over body

Lymphadenopathy: Suboccipital, postauricular

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49
Q

Scarlet fever

  • Cause
  • features
A

Reaction to erythrogenic toxins from Group A haemolytic strep (pyogenes)

Fever, Malaise, Strawberry tongue, tonsilitis

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50
Q

Hand, Foot and Mouth

  • Cause
  • Features
A

Coxsakie virus

Sore throat, Fever, Vesicle in mouth, on plasma and soles of feet

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51
Q

Patau syndrome

  • Chr
  • Features
A

Trisomy 13

Microcephaly, small eyes, Cleft lip/Palate, Polydactyly

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52
Q

Edwards

  • Chr
  • Features
A

E for Edwards and Eighteen - trisomy 18

Low-set ears, rocker bottom feet, overlapping of fingers

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53
Q

Prader- Willi features

A

Hypotonia
Hypogonadism
Obesity

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54
Q

Coeliac in children

  • Cause
  • Complication
A

Sensitivity to gluten (Anti-tissue Transglutaminae)

Villous atrophy and malabsorption

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55
Q

When do children present with coeliac

A

Around Age of 3 - when cereals introduced

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56
Q

Coeliac in children genetics

A

HLA- DQ2/DQ8 in up to 95%

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57
Q

Features of coeliac in children

A

Coincide wit introduction of cereals

Failure to thrive
Diarrhoea
Abdo distension
Anaemia
May go undiagnosed
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58
Q

Coeliac diagnosis

A

Jejunal biopsy = subtotal villous atrophy, crypt hyperplasia, intraepithelial lymphocytes

Anti-endomysial and anti-gliadin antibodies

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59
Q

Acyanotic congenital heart defects (left to right)

A

VSD (most common, 30%)
ASD
Patent ductus arteriosus

Other:
Coarctation of aorta
Aortic stenosis

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60
Q

Cyanotic Congenital Heart defects

A

Tetralogy of Fallot (initially left to right until Eisenmenger’s)

Transpositioning of great arteries

Tricusp atresia

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61
Q

Congenital Rubella Features

A 
Sensorineural deafness
Cataracts
Glaucoma
Heart disease (e.g. PDA)
Cerebral palsy (less common)
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62
Q

Diagnosis of constipation (2+ out of)

A

Fewer than 3 stools a week

Type one on Bristol chart (rabbit droppings)

Overflow (loose, smelly, passed without sensation)

Pain/Bleeding with bowel movements

Straining

Appetite improves with stool

Hx of constipations

Painful bowel movements

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63
Q

Constipation causes

A

Idiopathic

Dehydration
Low fibre
Medications (opiates)
Anal fissure
Hypothyroidism
Hirschprung's
Hypercalcaemia
LEarning difficulty
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64
Q

Red flags for secondary cause of constipation

A

Constipation like symptoms from birth (meconium over 48hrs from birth)

Ribbon stools

Weakness in legs, locomotor delay

Abdo distension

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65
Q

Amber flags for secondary cause of constipation

A

Faltering growth

Disclosure/evidence suggesting possible child abuse

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66
Q

What needs assessment prior to Tx constipation?

what features to look for?

A

Faecal impaction

Severe constipation (Long since opened bowels, pain)

Palpable mass in abdo

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67
Q

Treatment of impaction

A

Movicol Paediatric plan (glycol 3350+)

If no disimpaction after 2 weeks then give stimulant (Senna - Sennokot)

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68
Q

Constipation maintenance therapy

A

Diet: not used alone, ensure enough fluids and fibre

1st line movicol

Add stimulant laxative if no response

Add Lactulose to Senna if movicol not tolerated

Continue meds until a regular bowel habit is establishes then reduce dose gradually

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69
Q

Cows milk protein allergy

  • Features
  • Pathology
  • Tx
A

Regurgitation/vomit, diarrhoea, atopic eczema, colic (crying, irritable), wheeze

Both immediate (IgE: Allergy) and Delayed (non-IgE: intolerance) reactions

Skin prick, IgE (RAST) for cow’s milk protein.

Hydrolysed milk 1st line

Usually resolves by1-2 yrs age. Challenge according to milk ladder

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70
Q

Croup

- Def, Epidemiology & Cause

A

URTI in infants and older toddlers

Parainfluenza majority of cases

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71
Q

Croup Features

A

Stridor
Barking cough (worse at night - lower endogenous steroid)
fever
Coryzal symtpms

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72
Q

Signs of severe croup (Should be admitted)

A

Frequent barking cough

Prominent stridor (inspiratory and expiratory)

Sternal recession

Distress, agitation or lethargy (Hypoxaemia)

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73
Q

Management of Croup

In Emergency?

A

Single dose oral Dexamethasone
(0.15mg/kg)

High flow O2, Nebulised adrenaline

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74
Q

Nitrogen washout test

  • What does it test
  • What is diagnostic
A

100% O2 given and then ABG done

Distinguishes cardiac from non cardiac cyanosis

A pO2 of less than 15kPa indicates congenital heart disease

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75
Q

CF

  • Genetics, defect & effect
  • Organs
  • Carrier rate
A

Autosomal recessive

Cystic fibrosis transmembrane conductance regulator gene (CFTR) Chr 7

Defective Cl transport = viscous secretions

Lungs, pancreas, bowel (obstruction), Fertility

1 in 25

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76
Q

CF organisms that may colonise

A

Staph aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergilus

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77
Q

CF diagnosis

A

Screening (Monospot blood test): Immunoreactive trypsinogen

IF +ve screening:
High sweat chloride
(over 60mEq/L)

Genetic testing (blood or salivary sample)

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78
Q

CF Features

A

Meconium ileus
Recurrent chest infections

Malabsorption (Steatorrhoea, Failure to thrive)

Male infertility, female sub fertility, DM, Short, Rectal prolapse (bulky stools), nasal polyps

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79
Q

CF management

A

Regular (2X a day) chest physio

High calorie diet, inc high fat + vit supps

Pancreatic enzymes with meals

Heart and lung transplant

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80
Q

Referral

A

Doesn’t smile at 10 weeks

Cant sit unsupported at 12 weeks

Cannot walk at 18 months

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81
Q

Fine/gross motor problems possible cause

A

CP

e.g. hand preference, global motor impairment

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82
Q

Speech and language problems cause

A

Hearing

Env deprivation

General developmental delay

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83
Q

Developmental dysplasia of the hip:

  • Def
  • RF
  • Testing/diagosis
  • Tx
A

Improper formation of hip acetabulum

Female
Breech birth
FH
1st born
Oligohydramnios

Barow (dislocate) & Ortolani (relocate) femoral head
USS if clinical suspected

Most will stabilise by 3-6 weeks
Pavlic harness (flexion, abduction orthosis)

Older children may need surgery

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84
Q

Fine motor milestones

  • 6 months
  • 9 months
  • 12 months
A

Hold in palmar grasp
Pass objects from one hand to the other

Point with finger, early pincer

Good pincer grip

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85
Q

Brick building

Tower of 2
Tower of 3
Tower of 6
Tower of 9

A

15 months

18 months

2 years

3 years

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86
Q

Gross motor milestones

3 months
6 months
7-8 months
9  months
13-15 months
2 years
A

Little/No head lag on being pulled up, good head control

Rolls front to back

Sits without support

Pulls to stand, crawl

Walks unsupported (refer at 18 mnths)

Runs, stairs with hand rail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Speech and hearing milestones

3 months
6 months
9 months 
12 months
2.5 years
3 years
A

Turns to sound

Double syllable ‘adah’ ‘erleh’

mama and dada, understand “no”

Responds to own name

Vocal over 200

short sentences

88
Q

Common cause of gastroenteritis in children

A

Rotavirus

89
Q

Hydration status categories in children

A

Clinical dehydration

Clinical shock

90
Q

What is seen in clinical dehydration

A 
Decrease urine output
Dry mucosa
Tachycardia/tachypnoea
Sunken eyes
Normal peripheral pulses 
Normal cap refill
Warm extremities
91
Q

What is seen in clinical shock

A

Decreased Level of consciousness

Cold extremities

Pale/Mottled skin

Tachycardia/Tachypnoea

Weak peripheral pulses & hypotension

Prolonged cap refill

92
Q

Who is at inc risk dehydration

A 
Younger than 1
low birth weight
diarrhoea (6+ stools in 24 hrs)
vomit (3X in 24 hours)
infants who have stopped breast feeding
93
Q

Fluid bolus in dehydration

A

Crystalloid

20ml/kg over 10 min in children

94
Q

Fluid maintenance

A

Hourly fluid maintenance:

First 10 Kg 4ml per kilo
Second 10 Kg 2ml per kilo
Above 20 Kg 1ml per kilo

95
Q

Causes og chronic diarrhoea in children

A

Most common: Cows milk intolerance (lactose)

Coeliac

96
Q

Down syndrome features

  • Face/Head
  • Organs
  • Other
A

Epicanthic folds
Protruding tongue, small ears, round face, flat occiput

Hirschprung’s, Duodenal atresia, Congenital heart defects

Single palmar crease, Hypotonia,

97
Q

Cardiac complications Down’s

A

VSP

ASP (secundum - enlarged foramen ovale. Most common Congenital heart defect)

Tetralogy of Fallot

PDA

98
Q

Later complications of Down’s syndrome

A

Subfertility/Infertile(men)
- sperm or preg problems

Learning difficulties
Resp infections
ALL
Alzheimer’s

99
Q

RF for Down syndrome

A

Maternal age, esp over 35

100
Q

Downs pathophys

A

Dislocation or translocation of Chr 21

101
Q

Eczema

  • Pres and prognosis
  • distribution
A

Typically presents before 6 months. clears in 50% baby 5 years and 75% by 10 years of age

Infants: Face and trunk
Older: Flexor surfaces and creases

102
Q

Eczema Tx

A

Avoid irritants
Emollients (large amounts)
Topical steroids

103
Q

Febrile convulsion

  • def
  • when
  • type of seizure & how long
A

seizure provoked by fever

usually in early viral infection as temp rises rapidly
Usually brief (under 5 min)
Tonic-Clonic

104
Q

Link of febrile seizure to epilepsy

A

A RF for epilepsy

105
Q

Fetal alcohol features

A

Thin vermillion (hypoplastic upper lip)

Absent filtrum

Learning difficulties

Microcephaly

Growth retardation

Epicanthic folds

106
Q

How is fever risk stratified in children

A

Green
Amber
Red

107
Q

What should be assessed in all children with fever

A

Temperature
Heart rate
Resp rate
Cap refill

108
Q

Features of Amber (intermediate risk

A

Pallor
Not responding to social cues/Dec activity

Nasal Falring, tachypnoea (over 40 Breaths a min)

O2 sats less than 95%

Tachycardia over 140bpm
Cap refill over 3 s
Dry mucous membrane reduced urine
Temp over 39
Non-weight bearing limb
109
Q

Features of red (high risk)

A

Pale/mottled/blue
No response to social cues
Not rousable
Weak

Grunting, Tachypnoea, RR over 60, Chest recessions/accessory muscle use

Reduced skin turgor, inc cap refill

Temp over 39, non-blanching rash, Blueing fontanelle, Neck stiffness, focal neurology, status epileptics

110
Q

Management of an ‘Amber’ child

A

Safety net: know who to call/where to bring if gets worse

111
Q

Management of a ‘red’ child

A

Urgent admission/referral to paediatrics

112
Q

What is common cause of GORD in infants

A

Overfeeding with bottle

113
Q

What are Gastroschisis and Exomphalos

A

Disorders of anterior abdo wall development

114
Q

What is Responsible for growth spurt

A

GH

115
Q

When to give CT head in children

A

Lost consciousness over 5 min

NIA suspected

Vomiting

Amnesia

Focal signs

Dangerous mechanism of injury

116
Q

Most common causes of headache in children

A

Most common = Migraine with aura (Ibuprofen)

Tension (2nd)

117
Q

Cause of conductive hearing loss

A

Secretory otitis media

Down’s syndrome

118
Q

Cause of Sensorineural hearing loss

A

Congenital infection (Rubella)
Acquired: meningitis, head injury
Cerebral palsy

119
Q

Hirschprungs:

  • Cause
  • Pres
  • Assoc
A

Aganglionic segment. Failed development of Auerbach/Meissners plexuses

Failure/delay to passing meconium
Older: Constipation, abdo distension

More in Males., Downs

120
Q

Causes of hypertension in children

A

Renal vascular/parenchymal disease
Coarctation of aorta
Phaemchromocytoma
CAH

121
Q

Hypospadias

  • def
  • location
  • tx
A

Ventral urethral meatus

Usually distal

Surgical correction before age of 2 (uses foreskin)

122
Q

Causes of hypotonia

A

Downs
Prader-Willi
Hypothyroidism
Cerebral Palsy (may precede spasticity)

Guillain Barre
Myathenia gravis

123
Q

Immunisation at birth

A

BCG

Hep B

124
Q

Immunisation 2 / 3s / 4 months

A

6-1 vaccine (diphtheria, tetanus, whooping cough, polio, Hit, Hep B)

Oral Rotavirus

Pneumococcal conjugate vaccine

Men B

125
Q

Immunisation 12-13 month

A 
Hib
Men C
MMR
Pneumococcal conjugate
Men B
126
Q

2-8 years Immunisation

A

Flu vaccine

127
Q

Immunisation 3-4 years

A

‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)

MMR

128
Q

Immunisation 12-13 y.o. girls

A

HPV vaccination

129
Q

What vaccine given in university Freshers

A

Men ACWY

130
Q

Infant colic

A

Excessive crying in infant under 3 month

occurs in 20%, cause unknown

131
Q

What Features in a physiological murmur

A 
Soft-blowing
Postural variation
No Radiation
No thrill
No added sounds (clicks)
No other symptoms
132
Q

Intraventricular haemorrhage

  • Adult/Premature/Neonates
  • Complication
  • Tx
A

Intraventricular bleeding

Traumatic head injuries
Spontaneous due to blood clot
Birth trauma/delicate neonatal CNS

Hydrocephalus

Supportive, Intraventricular thrombolysis,
VP shunt in hydrocephalus

133
Q

Intussusception

  • Desc
  • Common site
  • Features
A

Telescoping of one portion of bowel into distal bowel

Ileo-caecal

Abdo colic pain, Vomiting, Red-currant jelly, Sausage shaped mass in Right lower quadrant

134
Q

Intussusception

  • Investigation
  • Tx
A

USS (target shaped mass)

Air insufflation

Surgery if 1st line fails and signs of peritonitis

135
Q

Jaundice in Newborn

  • When always pathological (what causes)
  • when physiological and mech
A

First 24 hours
(Rhesus haemolysis, ABO heamolysis, Spherocytosis, G6PDD)

2-14 days physiological as fatal Hb replaced by adult

136
Q

In prolonged neonatal jaundice what is worry?

Tx?

A

Biliary atresia (lack of biliary ducts)

Raised conjugated bilirubin (Liver has conjugated)

Surgery

137
Q

JIA

  • Clinical features
  • Investigations
A 
Pyrexia
Rash (salmon pink)
Lymphadenopathy
Arthritis
Uveitis
Anorexia/weight loss

ANA positive
RF -ve

138
Q

Kawasaki disease

  • disease type
  • Important complication
A

Vasculitis predominantly seen in children

Coronary artery aneurysms

139
Q

Kawasaki disease

  • Features
  • Diagnosis
A

High grade fever, Red/cracked lips, strawberry tongue, cervical lymphadenopathy, red palms/soles eventually peel

Clinical diagnosis, no specific investigation

140
Q

Kawasaki disease Management

A

High dose aspirin (one of few indications for this in children - Reyes risk)

IV Ig

Echo (for coronary aneurysms

141
Q

Chondromalacia patellae

  • pathology
  • Who
  • pres
  • Tx
A

Softening of cartilage of patella

Teenage girls

Anterior knee pain (esp up and down stairs)

Physio = good response

142
Q

Osgood-Schlatter

  • Who
  • Pres
A

Sporty teen

Pain, tenderness, swelling over tibial tubercle

143
Q

Limp in child, Obese

A

Slipped upper femoral epiphysis

femoral head displaced posteriorly

144
Q

Limp, child unwell/fever

A

Septic arthritis/osteomyelitis

145
Q

Measles

  • Virus type
  • Spread
  • Features
A

RNa

Droplet spread

1) Prodrome: irritable, fever, conjunctivitis
2) Koplik spots (white spots on buccal mucosa) - before rash
3) Rash: starts behind ears then to whole body (maculopapular)

146
Q

Measles

  • Ix
  • Tx
  • Complications
A

IgM to Measels

supportive, notifiable disease

Encephalitis, febrile convulsion, myocarditis

147
Q

Meckel’s Diverticulum

  • What is it
  • Rule of 2’s
A

Congenital remnant of vitelline duct. Diverticulum off small intestine

2% pop, 2ft from ileocaecal, 2 inches long

148
Q

Meckel’s Diverticulum Usually asymptomatic, but possible pres:

A 
Abdo pain (mimic appendicitis)
Rectal bleeding
Intestinal obstruction (volvulus, intussusception)
149
Q

Meckel’s Diverticulum Tx

A

Surgical removal (resection and re-anastomosis)

150
Q

Meningitis investigations

A

LP (unless raised ICP signs) and PCR

Blood cultures and PCR if no LP

151
Q

What signs of inc ICP CI LP?

A 
Focal neurological signs
Papilloedema
Bulging fontanelle
DIC
Cerebral herniation (resp impairment)
152
Q

Management of meningitis:

  • 4 Catergories.
  • How are contacts tx
A

Antibiotics: IV cefotaxime (+ Amoxicillin if under 3m)

Steroids: Ddx given if H.Influenzae

Fluids: treat shock with colloid

Cerebral monitoring: monitor resp, may need mechanical ventilation

Ciprofloxacin

153
Q

Meningitis cause:

  • Neonatal - 3m
  • Up to 6yr
  • Over 6
A

GBS (from mother, esp prem, PRM)
E.coli
Listeria

Neisseria meningitidis
Strep Pneumoniae
Haemophilus influenzae

Neisseria meningitidis
Strep Pneumoniae

154
Q

Mitochondrial disease

  • Inheritance
  • Disease types
A

Inherited only from affected mothers (fathers don’t contribute any cytoplasm)

Rare neurological diseases

155
Q

MMR

  • Type of vaccinator and against what
  • When given
  • CI
A

Live vaccine against measles, mumps and rubella

2 doses:
12-15 months and also 3-4 years

Preg, Immunosuppression, allergy, another live vaccine within 4 weeks

156
Q

Napkin rash
Irritant dermatitis

Vs

Candida

A

Dermatitis: most common. irritant effect of urinary ammonia&faeces, Creases spared

Erythematous rash involving flexures. Charecteristic satellite lesions
(Tx: imidazole)

157
Q

Napkin rash general management

A

Use disposable nappies
Expose napkin to air when poss
Mild steroid (1% hydrocortisone) in severe

158
Q

NEC

  • Why important
  • Initial pres
  • Ix + what shown
A

One of leading causes of death in prematurity

Feeding intolerance, abdo distension bloody stools

Abdo x-ray

  • dilated bowel loops
  • Bowel wall oedema, pneumonitis intestinal (intramural gas)
  • air both inside and outside bowel wall
159
Q

NEC pathophys

A

Intestinal immaturity (poor barrier function, immune defence, motility)
Abnormal bacterial colonisation And/Or hypoxic ischaemic injury
And/Or
Formula feeding

= NEC

160
Q

NEC complication

A

Abdo perforation, peritonitis, death

161
Q

NEC Tx

A

Stop oral feeding

Abx: Cefotaxime, Vancomycin

162
Q

What is tested for in Heel-Prick (Guthrie) test

A

Immunoreactive trypsinogen (CF)

Sickle cells

TSH (congenital hypothyroidism

Phenylketonuria - amino acid metabolism error can impair brain development

163
Q

Nephrotic syndrome

  • triad
  • peak incidence
  • cause in most
A

Peripheral oedema, Proteinuria, Hypoalbuminaemia

2-5 yrs

Minimal change disease

90% respond to high dose steroids

Other features: hyperlipidaemia, hypercoagulable

164
Q

Newborn resus

A

1) dry baby and maintain temp
2) assess tone, resp and heart rate
3) 5 inflation breaths (to keep lungs open)
4) reassess chest
5) if HR under 60 compression and ventilation 3:1

165
Q

Noctural enuresis:

  • Possible causes
  • Tx (behavioural, short term control)
A

UTI, Constipation, T1DM

Star charts
Desmopression

166
Q

Primary Vs Secondary enuresis

A

Primary: never been continent

Secondary: previously continent

167
Q

Causes of obesity in children

A

Lifestyle by FAR the most

secondary:

  • Downs
  • Cushings
  • Prader-Willi
  • GH deficiency
168
Q

Consequences of obesity in children

A

Ortho: slipped femoral epiphyses

Psych: poor self esteem, bullying

Sleep apnoea

Long-term:
Inc incidencee T2DM and IHD

169
Q

Where is BCR ABLE oncogene seen typically

A

CML

170
Q

What is an oncogene

A

Cancer promoting gene derived from mutated normal gene

Only one mutation needed

171
Q

TSG

A

Tumour supressor genes repress cellular proliferation

Mutation inactivates

Two mutations = no suppression of cellular division

172
Q

TSG Eg

A

p53

Retinoblastoma

BRCA 1&2

173
Q

Paediatric BLS

A

Check responsive

Shout for help

Open airway (look/listen/feel for breathing)

5 rescue breaths

Check circulation

15 chest compressions:breaths

174
Q

Other Associations with oesophageal atresia

A

Trachea-Oesophageal fistula
Polyhydramnios
VACTERL

175
Q

Perthes’ Disease

  • def
  • who
  • Features
A

Degenerative condition of hip due to avascular necrosis of femoral head (epiphyseal) due to impaired blood supply

5 x more in Boys, 4-8 years

Hip pain develops over weeks, reduced ROM,

176
Q

Perthes diagnosis

A

Xray:

  • Early: widening joint space
  • Late: decreased femoral head size/flattening
177
Q

Perthes Complications

A

OA

Premature fusion of growth plates

178
Q

Perthes Managemnt

A

Keep femoral head within acetabulum (casts, braces)

Over 6 yrs: Surgical. Operate on severe deformities

179
Q

Phenyketonuira:

  • Genetics
  • Enzyme + role
  • High phenylalanine causes ..
  • Heel-Prick result
  • Manage
A

Autosomal recessive

Phenyalanine hydroxylase (breaks down phenylalanine)

Learning difficulties and seizures

Hyperphenylalaninaemia

Diet restrictions of amino acid rich foods

180
Q

Pneumonia in children

- Treatment

A

Amoxicillin 1st line

181
Q

Prader-Willi

  • Chr
  • Features
A

Long arm of chromosome 15

Hypotonia during infancy
Short
dysmorphic features
Hypogonadism/infertility
Childhood obesity
Behavioural problems in adolescence
182
Q

Precocious puberty

  • who normally
  • what is
  • Central/true Vs False
A

Girls
puberty before the age of 8

Central = premature activation of hypothalamic-pituitary-gonadal axis (high FSH/LH)

False = FSH&LH low, due to excess sex hormone

Usually idiopathic or familial and follow a normal course of puberty

183
Q

Puberty

- Age in boys/girls

A

Males: testicular growth 12 yrs (over 4ml)
Growth spurt at 14

Females: Treat dev at 11, menarche at 13 (11-15)

184
Q

Pyloric stenosis

  • When pres
  • Cause
  • Epi
A

2nd-4th week with vomiting

hypertrophy of circular muscles of the pylorus

4X more in men

185
Q

Pyloric stenosis:

  • Features
  • Diagnosis
  • Tx
A

Projectile vomiting (30min after feed)
Constipation and dehydration
Palpable mass in upper abdo (olive)
Hypochloraemic, hypokalaemia alkalosis from persistent vomiting

USS to diagnose

Ramstedt pylorotomy to Tx

186
Q

Retinoblastoma

  • Def
  • when diagnosed
  • Pathophys
A

Most common ocular malignancy in children

18 months

Loss of functions of Rb TSG on Chr 13

187
Q

Retinoblastoma

  • Features
  • Tx
  • Prognosis
A

Absent red-reflex (replaced with white pupil - Leukocoria)

Strabismus (inward misalignment of eye)
visual problems

External be a, radiation, chemo, photocoagulation, enucleation

90% survive into adulthood

188
Q

Scarlet fever:

  • what causes
  • who
  • Spread
A

Reaction to toxins produced by Group A strep (Pyogenes)

Children aged 2-6

Respiratory spread (droplet)

189
Q

Scarlet fever:

  • Features
  • Management
A 
Fever
Malaise (N&V, headache)
Sore throat
Strawberry tongue
Fine punctate rash (pinhead, sandpaper)
Desquamation around fingers and toes

Oral penecillin V (phenoxymethylpenicillin)
Azithromycin if allergic

190
Q

Scarlet fever usually mild, may be complicated by…

A

Otitis media (most common)

Rheumatic fever (Group A strep)

Acute glomerulonephritis (immunisation complex mediated)

191
Q

Shaken baby

  • Triad
  • Cause
A

1) Retinal haemorrhage
2) Subdural haematoma
3) Encephalopathy

Intentional shaking of a child 0-5 years old

192
Q

RF for sudden infant death syndrome (largest killer in 1st year of life)

A 
Prone sleeping
Parental smoking
Prematurity
Bed sharing
Over wrapping (hyperthermia)
193
Q

Sudden infant death syndrome protective factors

A

Breastfeeding
Room sharing
Use of dummies

194
Q

Slipped femoral epiphysis

  • Who
  • What
  • When commonly
  • Pres
A

10-15 year old obese boys

Postero-inferior displacement femoral head

Acute presentation following trauma OR Chronic persistent symptoms

Hip, Groin, Medial thigh or knee pain
Lost internal rotation of hip

195
Q

Surfactant deficient lung disease (RDS)

  • who
  • cause
A

Premature infants

Insufficient surfactant production and structural immaturity of lungs

196
Q

RDS risk
- 26-28 weeks
30-31 weeks
- When surfactant produced and role

A

50%

25%

Around 28 weeks

Helps reduce surface tension of lungs

197
Q

RF for RDS

A

Prematurity
Male
Diabetic mother
C-section

198
Q

SDLD (RDS) clinical features & CXR features

A

Tachypnoea, intercostal recession, expiratory grunting, cyanosis

199
Q

Surfactant deficiency lung disease management

A

Maternal corticosteroids to induce lung maturation (given with nifidepine/terbutaline tocolytics)

Oxygen, assisted ventilation

Exogenous surfactant (Exosurf)

200
Q

Tetralogy of Fallot

  • type of congenital heart disease
  • four features
A

Cyanotic

1) VSD
2) Over-riding aorta
3) Pulmonary stenosis (determines cyanosis degree)
4) Right ventricular hypertrophy

201
Q

TOF other features

A

Ejection systolic murmur (pulmonary stenosis)

CXR: boot shaped heart, ECG: RVH

202
Q

TOF management

A

surgical repair (2-stage procedure)

203
Q

Complication of TOF

A

Eisenmengers (need heart & lung transplant)

204
Q

TSG EGs

A 
p53
APC (colorectal)
BRCA 1&2 (Breast, ovary)
NF1
Rb
205
Q

Turner syndrome

  • Genetic abnormality
  • Features
  • Inc risk of..
A

45XO

Short, primary amenorrhoea, webbed neck, bicuspid aorta, coarctation of aorta

AI disease (Thyroiditis, Crohn’s)

206
Q

Undescended testis

  • Complications
  • Tx
A

Infertility
Torsion
Testicular cancer

Orchidopexy: move to scrotum (done at around 1yr age)

207
Q

UTI in children

  • diff to adult manage
  • Organism
  • Predisposing factors
A

Should always be investigated for underlying cause and kidney damage

E.coli (80%)

Infrequent voiding, constipation (obstructive)
Vesicoureteric reflux
Poor hygiene: wiping back to front (girls)

208
Q

UTI in children

  • who
  • pres
  • urine collection
  • Tx
A

Boy more until 3m

poor feeding, vomiting
Abdo pain, dyuria, frequency, haematuria

Upper UTI: loin pain, temp over 38

Clean catch (best), pads, invasive (suprapubic aspiration)

Under 3m = referral
LUTI: Trimethoprim
UUTI: Cephalosporin, co-amoxiclav

209
Q

Vesicoureteric reflux

  • def
  • complication
  • pathophys
  • Ix & diagnosis
A

abnormal back flow of urine from bladder into the ureter/kidney

UTI, renal scarring in 35%

Lateral displacement. More perpendicular (rather than angle) = shorter intramural course of ureter.

Micturating cystogram for diagnosis

DMSA scanner renal scarring

210
Q

Whooping cough

  • Cause
  • immunisation times & problem
A

Gram -ve Bortadella pertussis

2,3,4 months then 3-5 years
(Pregnancy vaccination campaign as newborns vulnerable)

Immunisation and infection don’t provide lifelong immunity

211
Q

Whooping cough presentation & diagnosis & complications

A

2-3 days of coryza before:

cough bouts: may cause vomiting, central cyanosis

inspiratory whoops (forced inspiration against glottis)

symptoms 10-14 weeks

Ix
Nasal swabs, PCR and serology, marked lymphocytosis

Comp:
subconjunctival haemorrhages, pneumonia, Bronchiectasis, seizures

212
Q

Whooping cough management

A

Oral macrolide: Clarithromycin or erythromycin (to reduce spread of disease, doesn’t alter symptoms)

213
Q

Wilm’s tumour

  • what
  • who
  • pres
A

Nephroblastoma

Children under 5

abdo mass (can cause constipation like symptoms), painless haematuria
Anorexia
fever

214
Q

Wilms tumour Tx

A

Nephrectomy, chemotherapy, Radiotherapy

Prognosis: 80% cure rate.

215
Q

Why no aspirin in children

A

Reyes syndrome (Brain and Liver dysfunction)

216
Q

Who is affected in X-linked recessive

A

Only males
male to male transmission never seen, can only have unaffected sons or carrier daughters

Goes on the principle that affected father X heterozygous mother = VERY rare

217
Q

Septic screen

A

CXR
Urine & blood culture
LP

Final (26 decks)

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