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Paediatrics Flashcards

1
Q

What are the typical blood gas findings for a baby with pyloric stenosis?

A

Hypochloraemic, hypokalaemic metabolic alkalosis with base excess

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2
Q

What does a “double bubble” appearance on abdominal x ray indicate?

A

Duodenal atresia

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3
Q

Target like papules on the skin are indicative of what?

A

Erythema multiforme
Arise due to a hypersensitivity reaction due to infection or medications
Large asymptomatic and self-limiting

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4
Q

What are some duct dependent lesions?

A

Coarctation of the aorta
Hypoplastic left heart syndrome
Critical aortic stenosis

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5
Q

What are some features of heart failure in a neonate/ infant?

A 
Faltering growth
Breathlessness, especially on feeding
Hepatomegaly
Recurrent chest infections
Tachyonoea
Tachycardia
Poor feeding
Enlarged heart
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6
Q

How would an infant with heart failure due to a large VSD be treated?

A

Diuretics
ACEi
Additional calorie input
Surgery at 3-6 months

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7
Q

What are the features of ADHD?

A

Inattention (e.g. forgetful, easily distracted, won’t listen to instructions, loses things)
Hyperactivity and impulsivity (talks excessively, always “on the go”, runs and climbs when not appropriate, won’t eat their turn etc)

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8
Q

What is important to monitor for a patient on methylphenidate?

A

Growth (as it is an appetite suppressant, hence can impair growth)
Also baseline ECG before starting due to potential cardiotoxicity

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9
Q

How would you manage a baby with gastro-oesophageal reflux?

A

Decrease feed volume and increase feed frequency
If breast fed: alginate e.g. infant gaviscon after each feed
If formula fed: 1-2 week trial of feed thickener, and if that fails stop and add alginate to formulae
If no improvement after 2 weeks, add antacid eg ranitidine, omeprazole

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10
Q

What is the inheritance pattern of haemophilia?

A

X-linked recessive

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11
Q

What is the most common congenital cause of stridor in infants?

A

Laryngomalacia

Usually self resolves by 2 years old

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12
Q

A 6 month old has a history of episodes of flexion of its head/ arms and trunk and arm extension up to 50 times before stopping. What is the most likely diagnosis?

A 
West syndrome (infantile spasms)
Tx with vigabitrin and ACTH
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13
Q

What drug is first line in West syndrome?

A

Vigabitrin

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14
Q

What are some risk factors for congenital hip dysplasia?

A

Female, oligohydramnios, birth weight >5kg, breech, family history

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15
Q

What tests are done to examine a baby for congenital hip dysplasia?

A

Barlow test: to dislocate an articulated femoral head

Ortolani test: to relocate a dislocated femoral head

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16
Q

What imaging is used for Perthes disease?

A

X Ray

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17
Q

What is the management of Perthes disease?

A

Stabilise with cast/ brace
Observe if under 6
Oder children will probably need surgery

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18
Q

What is the inheritance pattern of Duchenne muscular dystrophy?

A

X linked recessive

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19
Q

How may a boy with Duchenne muscular dystrophy present?

A

Delayed walking
Waddling gait
Gower’s sign
Calf pseudohypertrophy (calves enlarged due to fibrous tissue)

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20
Q

How would you confirm a diagnosis of suspected Duchenne muscular dystrophy?

A

Raised creatine kinase
Genetic testing for dystrophin gene mutation
Muscle biopsy

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21
Q

What is kernicterus?

A

Irreversible bilirubin induced bran dysfunction

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22
Q

What investigation is used to diagnose vesico-reflux?

A

Micturating cystourethrogram

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23
Q

What is a micturating cystourethrogram and what is it used to diagnose?

A

Vesico-ureteric reflux
Injecting contrast into the child’s bladder via a catheter and then taking a series of x-rays to etermine whether it is refluxing into the ureters

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24
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

Adults FSGS, systemic illness eg diabetes, HSP

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25
What are the features of nephrotic syndrome?
Hypoalbuminaemia Proteinuria Oedema Hypercholesterolaemia
26
How is nephrotic syndrome managed?
Course of steroids (initially high, then wean down) 8-12 weeks Encourage healthy diet with no added salt and no high protein Prophylactic penicillin V due to infection predisposition
27
What are some features of Down syndrome?
``` Brachycephaly Hypotonia Epicanthic folds Flat nasal bridge Short stature High arched palate and protruding tongue Inwards and short little finger Single palmar crease Brushfield spots Small low set ears Learning difficulty ```
28
What are some medical conditions that people with trisomy 21 are more at risk of?
``` Congenital heart defect (AVSD) Duodenal atresia, hirschprungs Congenital hypothyroidism ALL Hearing and visual problems Early onset Alzheimer’s ```
29
What are Brushfield spots?
Small white spots on the iris that are characteristic of Down syndrome
30
What are some features of Turners syndrome?
``` Short stature Webbed neck Shield shaped chest Wide space nipple Puffiness of hands and feet Low hair line ```
31
How is Turners syndrome managed?
Conservative: psychological support, educational supportive eg sitting at front of class if poor hearing Medical: growth hormone, Oestrogen therapy for puberty
32
What is the chromosome abnormality in Klinefelter syndrome?
47, XXY
33
DiGeorge syndrome leads to what symptoms?
CATCH-22 (deletion on chromosome 22 causing... Cardiac abnormalities (often TOF) Abnormal faces Thymus aplasia (lack of T cells so immunocompromised) Cleft palate Hypocalcaemia
34
At what age should a child be able to smile?
6 weeks | Refer at 10 weeks if not
35
What is the limit age for sitting unsupported?
9 months
36
What is the limit age for a child feeding the self with a spoon?
18 months
37
What is the triad of signs in ADHD?
Impulsivity Hyperactivity Inattention
38
Which if nephrotic or nephritic syndrome will show hypercholesterolaemia?
Nephrotic syndrome | Due to response of liver to hypoalbuminaemia, so cholesterol production also increases
39
What rate is an insulin infusion given at for a patient presenting with DKA?
0.1 units/kg/hour
40
Hand foot and mouth disease is caused by which organism?
Cocksackie virus
41
A sausage shaped abdominal mass and red current jelly stools are characteristic signs of which condition?
Intussuscpetion
42
Transposition of the great arteries and tetralogy of fallot are both cyanosis heart lesions, but how does the timing of their presentation differ?
TGA presents soon after birth | Tetralogy presents at 1-2 months of age (shunt becomes R to L, “tet spells”)
43
Which condition is the most common cause of pulmonary hypoplasia?
Diaphragmatic hernia | Can also be caused by oligohydramnios
44
Barlow and Ortolani tests are used to aid the diagnosis of what?
Congenital hip dysplasia Confirmed with USS Barlows dislocats, ortolanis relocates
45
What is the most common cause of gastroenteritis in children?
Rotavirus
46
What are the 4 primitive reflexes?
Grasp Moro Walking Rooting
47
At approximately what age does a child start crawling?
9 months
48
What is the triad seen in haemolytic uraemic syndrome?
Acute renal failure Thrombocytopenia Haemolytic anaemia
49
What is haemolytic uraemic syndrome most classically caused by?
E Coli gastroenteritis producing Shiga toxins
50
What are the different types of cerebral palsy?
Spastic (most common, due to UMN of motor cortex damage) Dystonic (due to basal ganglia damage) Ataxic (due to cerebellar damage)
51
How does spastic cerebral palsy present?
Can be either hemiplegic (but worse for arms than legs), diplegic, or paraplegic Diplegic has characteristic scissor gait All present with spasticity, hyper-reflexia, increased tone, Babinski reflex positive
52
What is a febrile convulsion?
Seizures in children aged 6months to 6years caused by fever | That have had no history of an afebrile seizures
53
What is the difference between a simple and complex febrile convulsion?
Simple: lasts less than 15 minutes, generalised tonic clonic seizure, no more than one in the same episode of illness Complex: lasts >15 minutes, focal seizures, recurs in the same episode of illness
54
What advice would you give to parents of a child presenting with febrile convulsions?
``` That they are very common Likely to recur in future No risk of brain damage No significant increased epilepsy risk Antipyretics are not shown to help ```
55
What is the investigation of choice to diagnose infantile spasms?
EEG which will show hysarrythmia
56
3Hz per second spike and wave activity on EEG is characteristic of what?
Absence seizures
57
How will a child with absense seizures present?
Usually begin aged 4 to 6 “Daydreaming” with simple automatisms e.g. lip smacking, fumbling fingers No post ictal phase Normal neurological exam
58
What is the first line medication for absence seizures?
Valproate | Be aware of carbamazepine as this can worsen absence seizures!
59
Which drug is first line for focal seizures?
Carbamazepine | 2nd line is lamotrigine
60
Which drugs are used for different types of epilepsy management?
Tonic clonic: 1st line valproate 2nd lamotrigine 3rd carbamazepine Absence: valproate Myoclonic: valproate Focal: 1st line is carbamazepine 2nd is lamotrigine Avoid carbamazepine in absence/ myclonic as they can worsen it
61
What non medical treatments can be recommended for epilepsy management?
Ketogenic diet Epilepsy support group Inform DVLA if they can drive Vagal nerve stimulation
62
Which type of seizure is ethosuximide used for?
Absence seizures
63
What drugs are used in status epilepticus?
Community: buccal midazolam or rectal diazepam Hospital: IV lorazepam then IV phenytoin infusion if seizure state persists
64
Liver damage and hair loss are side effects of which anti epileptic drug?
Sodium valproate
65
What are some side effects of carbamazepine?
Rash P450 inducer Agranulocytosis Aplastic anaemia
66
What are some criteria of neurofibromatosis type 1?
``` Neurofibromatas 6 or more cafe at lait spots Axillray freckling Lisch nodules of the iris 1st degree relative with NF-1 ```
67
Depigmented skin patches and roughened patches of skin are both features of with neurocutaneous disorder?
Tuberous sclerosis
68
What antibiotic (and what length of tx) would you give for a child with a sore throat that scores a 3 on the centor criteria?
Penicillin V 10 days (erythromycin if penicillin allergic) | Avoid amoxicillin as this will cause a widespread rash if it is EBV
69
What are some prevention tips you can tell parents of to minimise the likelihood if UTIs in their child?
``` Good hydration Fully complete voiding Encourage regular voiding every few hours Avoid constipation Avoid scented bubble baths Wipe front to back Cotton underwear, not tight/ nylon ```
70
At what age does the anterior fontanelle close?
18 months
71
What signs can be elicited when examining a patient with suspected bacterial meningitis?
Brudzinski sign: flexion of neck with child supine causes flexion of knees and hips Kernigs sign: pain when attempting to extended a knee that is flexed (hip also flexed and child is supine)
72
What are some common bacterial causes of meningitis in children and adults?
Neisseria meningitidis, h influenzae, strep pneumoniae | Neonates: GBS, Listeria, E Coli
73
What’re some examples of live attenuated vaccines?
MMR Rotavirus BCG
74
Which vaccines are only offered to at risk babies?
``` Hepatitis B (those born to hepatitis B infected mums) BCG (if born in area of high incidence or parent/ grandparent born in high incidence country) Whooping cough (offered to pregnant women from 20 weeks) ```
75
What are features to distinguish between viral induced wheeze and bronchiolitis?
Viral induced wheeze follows URTI, usually caused by rhinovirus, no crepitations heard on auscultation, usually in 2-5 year olds. Tx supportive but can also offer beta-2 agonists and ipatropium bromide (Bronchiolitis in under 2’s and has fine crepititations, usually RSV)
76
How would you treat a neonate with persistent pulmonary hypertension of the newborn?
``` Nitric oxide (potent vasodilator) Mechanical ventilation ECMO is severe ```
77
What are some red flag signs and symptoms for a child presenting with headache?
Symptoms: if persistent and less than 6y/o, if duration <6months, worse at nighttime or in morning, worse when coughing or lay down, early morning nausea and vomiting, seizures, behavioural changes, development regression Signs: raised fontanelle, papilloedema, growth abnormalities, skin lesions suggestive neurocutaneous syndromes, neurological signs e.g. weakness, ataxia, squint
78
What is the most common cause of ambiguous genitalia in newborns?
Congenital adrenal hyperplasia
79
Define failure to thrive
Poor weight gain in a child with a drop down 2 centile spaces Aka weight faltering
80
What gene s associated with coeliac disease?
HLA-DQ2
81
Which food groups will have to be avoided when following a gluten free diet?
Wheat Rye Barley Oats (most commercial oats have contaminated gluten)
82
What are some complications of coeliac disease?
``` Osteoporosis Non-Hodgkin’s lymphoma Malignancy in oesophagus and bowel Anaemia Thyroid Hyposplenism Infertility Hyposplenism ```
83
Which test is most specific for coeliac disease?
Endomysial antibody titre
84
What rash is associated with coeliac disease?
Dermatitis herpetiformis | Intensely pruritic blistering lesions on extensor surfaces, can be treated with Dapsone
85
Dermatitis herpetiformis is associated with which condition?
Coeliac disease
86
What are some risk factors for coeliac disease?
``` T1DM FHx IgA deficient Autoimmune thyroid disease T21, 45XO IBD HLA-DQ2 gene ```
87
What is the management of SUFE?
Always surgical, urgent referral to orthopaedics (Internal fixation usually with single screw) Best rest and non weight bearing until surgery
88
Kocher criteria is used in the diagnosis of what?
Septic arthritis
89
What are some differentials for a limping child?
SUFE, Perthes, congenital hip dysplasia, transient synovitis, septic arthritis, osteosarcoma, trauma (e.g. #)
90
How would you manage a child with suspected septic arthritis?
Joint aspiration before abx IV flucloxacillin 4/52 Analgesia May require arthroscopic lavage
91
What are the categories of development in children?
Gross motor Fine motor Speech and language Emotional, social and behavioural
92
What is colic?
Repeated episodes of crying in an otherwise healthy and well-fed child under the age of 3 months

EOY4 (15 decks)

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