Paediatrics Flashcards
What are the typical blood gas findings for a baby with pyloric stenosis?
Hypochloraemic, hypokalaemic metabolic alkalosis with base excess
What does a “double bubble” appearance on abdominal x ray indicate?
Duodenal atresia
Target like papules on the skin are indicative of what?
Erythema multiforme
Arise due to a hypersensitivity reaction due to infection or medications
Large asymptomatic and self-limiting
What are some duct dependent lesions?
Coarctation of the aorta
Hypoplastic left heart syndrome
Critical aortic stenosis
What are some features of heart failure in a neonate/ infant?
Faltering growth Breathlessness, especially on feeding Hepatomegaly Recurrent chest infections Tachyonoea Tachycardia Poor feeding Enlarged heart
How would an infant with heart failure due to a large VSD be treated?
Diuretics
ACEi
Additional calorie input
Surgery at 3-6 months
What are the features of ADHD?
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)
What is important to monitor for a patient on methylphenidate?
Growth (as it is an appetite suppressant, hence can impair growth)
Also baseline ECG before starting due to potential cardiotoxicity
How would you manage a baby with gastro-oesophageal reflux?
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
What is the inheritance pattern of haemophilia?
X-linked recessive
What is the most common congenital cause of stridor in infants?
Laryngomalacia
Usually self resolves by 2 years old
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?
West syndrome (infantile spasms) Tx with vigabitrin and ACTH
What drug is first line in West syndrome?
Vigabitrin
What are some risk factors for congenital hip dysplasia?
Female, oligohydramnios, birth weight >5kg, breech, family history
What tests are done to examine a baby for congenital hip dysplasia?
Barlow test: to dislocate an articulated femoral head
Ortolani test: to relocate a dislocated femoral head
What imaging is used for Perthes disease?
X Ray
What is the management of Perthes disease?
Stabilise with cast/ brace
Observe if under 6
Oder children will probably need surgery
What is the inheritance pattern of Duchenne muscular dystrophy?
X linked recessive
How may a boy with Duchenne muscular dystrophy present?
Delayed walking
Waddling gait
Gower’s sign
Calf pseudohypertrophy (calves enlarged due to fibrous tissue)
How would you confirm a diagnosis of suspected Duchenne muscular dystrophy?
Raised creatine kinase
Genetic testing for dystrophin gene mutation
Muscle biopsy
What is kernicterus?
Irreversible bilirubin induced bran dysfunction
What investigation is used to diagnose vesico-reflux?
Micturating cystourethrogram
What is a micturating cystourethrogram and what is it used to diagnose?
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
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
Adults FSGS, systemic illness eg diabetes, HSP
What are the features of nephrotic syndrome?
Hypoalbuminaemia
Proteinuria
Oedema
Hypercholesterolaemia
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
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
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
What are Brushfield spots?
Small white spots on the iris that are characteristic of Down syndrome
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
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
What is the chromosome abnormality in Klinefelter syndrome?
47, XXY
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
At what age should a child be able to smile?
6 weeks
Refer at 10 weeks if not
What is the limit age for sitting unsupported?
9 months
What is the limit age for a child feeding the self with a spoon?
18 months
What is the triad of signs in ADHD?
Impulsivity
Hyperactivity
Inattention
Which if nephrotic or nephritic syndrome will show hypercholesterolaemia?
Nephrotic syndrome
Due to response of liver to hypoalbuminaemia, so cholesterol production also increases
What rate is an insulin infusion given at for a patient presenting with DKA?
0.1 units/kg/hour
Hand foot and mouth disease is caused by which organism?
Cocksackie virus
A sausage shaped abdominal mass and red current jelly stools are characteristic signs of which condition?
Intussuscpetion
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”)
Which condition is the most common cause of pulmonary hypoplasia?
Diaphragmatic hernia
Can also be caused by oligohydramnios
Barlow and Ortolani tests are used to aid the diagnosis of what?
Congenital hip dysplasia
Confirmed with USS
Barlows dislocats, ortolanis relocates
What is the most common cause of gastroenteritis in children?
Rotavirus
What are the 4 primitive reflexes?
Grasp
Moro
Walking
Rooting
At approximately what age does a child start crawling?
9 months
What is the triad seen in haemolytic uraemic syndrome?
Acute renal failure
Thrombocytopenia
Haemolytic anaemia
What is haemolytic uraemic syndrome most classically caused by?
E Coli gastroenteritis producing Shiga toxins
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)
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
What is a febrile convulsion?
Seizures in children aged 6months to 6years caused by fever
That have had no history of an afebrile seizures
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
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
What is the investigation of choice to diagnose infantile spasms?
EEG which will show hysarrythmia
3Hz per second spike and wave activity on EEG is characteristic of what?
Absence seizures
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
What is the first line medication for absence seizures?
Valproate
Be aware of carbamazepine as this can worsen absence seizures!
Which drug is first line for focal seizures?
Carbamazepine
2nd line is lamotrigine
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
What non medical treatments can be recommended for epilepsy management?
Ketogenic diet
Epilepsy support group
Inform DVLA if they can drive
Vagal nerve stimulation
Which type of seizure is ethosuximide used for?
Absence seizures
What drugs are used in status epilepticus?
Community: buccal midazolam or rectal diazepam
Hospital: IV lorazepam then IV phenytoin infusion if seizure state persists
Liver damage and hair loss are side effects of which anti epileptic drug?
Sodium valproate
What are some side effects of carbamazepine?
Rash
P450 inducer
Agranulocytosis
Aplastic anaemia
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
Depigmented skin patches and roughened patches of skin are both features of with neurocutaneous disorder?
Tuberous sclerosis
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
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
At what age does the anterior fontanelle close?
18 months
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)
What are some common bacterial causes of meningitis in children and adults?
Neisseria meningitidis, h influenzae, strep pneumoniae
Neonates: GBS, Listeria, E Coli
What’re some examples of live attenuated vaccines?
MMR
Rotavirus
BCG
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)
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)
How would you treat a neonate with persistent pulmonary hypertension of the newborn?
Nitric oxide (potent vasodilator) Mechanical ventilation ECMO is severe
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
What is the most common cause of ambiguous genitalia in newborns?
Congenital adrenal hyperplasia
Define failure to thrive
Poor weight gain in a child with a drop down 2 centile spaces
Aka weight faltering
What gene s associated with coeliac disease?
HLA-DQ2
Which food groups will have to be avoided when following a gluten free diet?
Wheat
Rye
Barley
Oats (most commercial oats have contaminated gluten)
What are some complications of coeliac disease?
Osteoporosis Non-Hodgkin’s lymphoma Malignancy in oesophagus and bowel Anaemia Thyroid Hyposplenism Infertility Hyposplenism
Which test is most specific for coeliac disease?
Endomysial antibody titre
What rash is associated with coeliac disease?
Dermatitis herpetiformis
Intensely pruritic blistering lesions on extensor surfaces, can be treated with Dapsone
Dermatitis herpetiformis is associated with which condition?
Coeliac disease
What are some risk factors for coeliac disease?
T1DM FHx IgA deficient Autoimmune thyroid disease T21, 45XO IBD HLA-DQ2 gene
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
Kocher criteria is used in the diagnosis of what?
Septic arthritis
What are some differentials for a limping child?
SUFE, Perthes, congenital hip dysplasia, transient synovitis, septic arthritis, osteosarcoma, trauma (e.g. #)
How would you manage a child with suspected septic arthritis?
Joint aspiration before abx
IV flucloxacillin 4/52
Analgesia
May require arthroscopic lavage
What are the categories of development in children?
Gross motor
Fine motor
Speech and language
Emotional, social and behavioural
What is colic?
Repeated episodes of crying in an otherwise healthy and well-fed child under the age of 3 months
