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Medical School Finals > Paediatrics > Flashcards

Paediatrics Flashcards

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USMLE® Step 1 flashcards
1
Q

Hand foot and Mouth

  1. Organism
  2. Presentation
  3. Ix
  4. Rx
A
  1. Coxsackie A16/Enterovirus 71 - contagious and often occurs at nursery in outbreaks.
  2. Mild upset, sore throat, mild fever, oral ulcers, vesicles on the palm and sole of feet.
  3. Clinical
  4. Symptomatic Rx only. Cam go to school
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2
Q

Intussusception

  1. Cause
  2. Presentation
  3. Ix
  4. Rx
A
  1. Telescoping of the bowel into another segment. Proximal to or at the level of the ileocecal valve.
  2. 6-9 months/ Colicky pain, red jelly stool, drawing legs up to abdomen, sausage shaped mass.
  3. USS, AXR, Clinical
  4. Air sufflation
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3
Q

Malrotation

  1. Cause
  2. Presentation
  3. Ix
  4. Rx
A
  1. Feature in exomphalos, congenital diaphragmatic hernia and intrinsic duodenal atresia.
  2. Volvulus may occur. Bile stained vomit.
  3. Upper GI contrast study and USS
  4. Laparotomy
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4
Q

Deafness in children;

1. Causes

A
  1. Conductive; Glue ear, Down’s syn

- SN; usher syn, pendred syn, rubella congenital infection, meningitis, head trauma.

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5
Q

Achondroplasia

  1. Cause
  2. Presentation
  3. Ix
  4. Rx
A
  1. AD disorder (2 parents = 25% likelihood) mutation in fibroblast growth factor receptor 3 gene.
  2. Short limbs, short fingers, large head, flattened nasal bridge, trident hands and lumbar lordosis
  3. Genetics, clinical
  4. Nil
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6
Q

Croup

  1. Cause
  2. Presentation
  3. Ix
  4. Rx
A
  1. Parainfluenza virus
  2. 6months - 3yo. Stridor, barking cough, fever, coryza, increased work of breathing.
  3. Paeds assessment, viral PCR, clinical.
  4. Oral dexa (0.15mg/kg) to all kids.
    Emergency - high flow O2 and nebulised adrenaline.
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7
Q

Ebsteins anomaly

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Lithium in utero
  2. Ventriclisation of the right atrium and tricuspid incompetence. Small RV. Associated with WPW
  3. Echo, ECG
  4. Nil
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8
Q

Meconium aspiration

  1. Define
  2. Risks and causes
A
  1. Aspiration of meconium causing RDS. Common in the neonatal period.
  2. More common in post-term deliveries, maternal HTN, pre-eclampsia, chorioamnionitis, smoking.
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9
Q

Febrile convulsions

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Seizure provoked by fever in healthy kids.
  2. Between 6mo and 5yo. Often in a viral infection, brief seizure, most often GTCS.
  3. Ix for epilepsy if not clear febrile convulsion
  4. Manage at home w/ water and paracetamol. Do not require admission unless seizure >5min. However any child w/ first seizure should be admitted. ~30% have another febrile convulsion.
    If recurrent, rectal or buccal midazolam
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10
Q

Innocent murmur - Describe ???

A

Soft, systolic, short, symptomless, sitting/standing.
Venous hum - due to turbulent blood flow from the great veins to the heart. Continuous blowing just below clavicle.
Still’s murmur - Low pitched lower L sternal edge.

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11
Q

Pertussis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Bordetella pertussis
  2. Incubation 10-14days.
    - 2-3 days preceding coryza then coughing bouts w/ vomiting and central cyanosis. Inspiratory whoop. Infants may have apnoeic spells.
    - Coughing causes subconjunctival haemorrhages and anoxia (seizures)
    - Lasts 10-14 weeks.
  3. Nasal swab + culture.
    - PCR & Serology
  4. Admit infants under 6mo
    - Notify PHE
    - Oral azithromycin
    - Contact prophylaxis
    - Vaccination @ 2,3,4mo and 3,5yo
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12
Q

Retinoblastoma

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. AD inherited, loss of function of the retinoblastoma tumour suppressor gene on chromo 13.
  2. Absence of red-reflex.
    - White pupil.
    - strabismus
    - vision problems
  3. Slit lap exam
    - head CT
  4. Enucleation
    - Radio
    - chemo
    - Photocoag
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13
Q

Pyloric stenosis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Hypertrophy or the circular muscles of the pylorus.
  2. Projectile vomiting, often after feeds.
    - Non-bilous
    - Constipation and dehydration may be present
    - Olive mass in upper abdomen
    - Visual peristalsis
    - Hypochloraemia, hypokalaemia acidosis due to vomiting.
  3. USS
  4. Ramstedt pyloromyotomy
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14
Q

APGAR

A 
2 points for each; 
A  = active movement 
P = >100bpm 
G = Grimace and other 
A = Pink all over 
R = Strong and crying 
1 point for each; 
A = Limb flexion 
P = <100bpm 
G = Grimace only 
A = cyanosed extremities. Pink body
R = Weak

0 points if absent

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15
Q

GORD in kids

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Risks = preterm delivery. Neuro disorders.
  2. Typically develops before 8 weeks.
    - Vomiting and regurg
    - Often Put weight on okay.
  3. Clinical
  4. Position more upright in feeds.
    - smaller feeds
    - Thickened feeds
    - Alginate (Gaviscon)
    - PPI or H2 if faltering growth, distress and refusing feeds etc occurs.
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16
Q

Hirschsrungs disease

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Aganglionic segment of bowel due to developmental failure of the parasym Auerbach and Meissner plexuses.
  2. Failure or delay in passing meconium.
    - Constipation
  3. Gold standard = rectal biopsy
    - Anorectal manometry
    - DRE followed by explosive diarrhoea
  4. Resect the bad part
17
Q

Cerebral palsy

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A

Disorder of movement and posture due to non-progressive brain lesion.

  1. Antenatal - cerebral malformation, congenital infection
    - Intrapartum - birth asphyxia and trauma
    - Post-partum - haemorrhage, trauma and meningitis.
  2. Abnormal tone
    - Delayed milestones
    - Abnormal gait
    - Learning difficulties
    - epilepsy
    Can be; spastic, dyskinetic, ataxic or mixed.
  3. Clinical
    - Brain imaging
  4. MDT approach
    - Manage Sx
    - Spasticity = surgery, splints, baclofen.
18
Q

Roseola Infantum

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Human herpes virus 6 (sixth disease)
    - Incubation period of 5-15days.
  2. High fever lasting a few days followed by a maculopapular rash starting on chest and spreading to limbs.
    - Febrile convulsions
    - Diarrhoea
    - Cough
    - Nagayama spots on the uvula and soft palate.
  3. Clinical
  4. Anti-pyretics.
19
Q

Acute Lymphoblastic Leukaemia

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Most common cancer in kids.
    - 2-5yo
  2. Features are those of bone marrow failure;
    Anaemia - lethargy and pallor
    Neutropenia - infection
    Thrombocytopenia - bleeding and bruising.
    - Others = bone pain, HSM, fever, testicle swelling.
  3. FBC - anaemia, thrombocytopenia, neutropenia.
    - Blood film showing blasts.
    - Clotting - DIC
    - Raised LDH
    - Immunophenotyping; Philadelphia chromo etc.
  4. Induction of remission (Vincristine +anthracycline + cyclophosphamide), consolidation, maintenance (6-mcp & MTX).
    - CNS prophylaxis.
    - General supportive care; replace RBC + GCSF + Antibiotics/fungals + Allopurinol.
    - Stem cell Tx
20
Q

Kawasaki disease

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. UK.
    - Vasculitis w/ suspected viral trigger.
  2. High grade fever >5days. resistant to anti-pyretics.
    - Conjunctival injection
    - Bright red, cracked lips
    - Strawberry tongue
    - Cervical lymphadenopathy
    - Swollen and red hands and feet.
    - Desquamation of the soles and palms.
    - COMPLICATION = CORONARY ARTERY ANEURYSM.
  3. Clinical
  4. High dose aspirin (beware Reye’s syn)
    - IVIG
    - Serial Echo for aneurysms.
21
Q

Nocturnal enuresis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Constipation, DM, UTI, abuse
    - Unwanted urination at night in a kid 5yo or older in the absence of congenital or acquired defects or the neuro or uro tract.
  2. Pissing at night
  3. Look for cause; DM, infection, constipation etc.
  4. Rx triggers.
    - Lifestyle; toileting before bed, fluid limitation
    - Reward system; star chart
    - Enuresis alarm (1st line <7yo)
    - Desmopressin (1st line >7yo)
22
Q

Slipped capital femoral epiphysis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. UK
    - Related to trauma or more chronic course.
  2. Obese boys 10-15yo
    - Slippage of the capital femoral epiphysis.
    - Risk of Avascular necrosis.
    - Displaces postero-inferiorly
    - Hip, groin, medial thigh or knee pain
    - Loss of internal rotation of the leg in flexion.
  3. AP and lateral (frog leg) view.
  4. Emergency due to avascular necrosis risk
    - Internal fixation across the growth plate.
23
Q

Paediatric BLS

A

Kids compression to breath ratio = 15:2

24
Q

Puberty - first signs

A

Males = Increase in testicular size around 12yo

Females = Breast buds 11.5yo
- Menarche at 13 (11-15)

25
Q

Severe asthma attack in children

A
  • SpO2 <92%
  • PEF 33-50% best or predicted
  • Too SOB to talk or feed
  • HR >125 (>5yo) or >140 (1-5yo)
  • RR >30breath (>5yo) or >40 (1-5yo)
  • Use of accessory muscles
26
Q

Life threatening asthma attack in kids

A
  • SpO2 <92%
  • PEF <33% of best or predicted.
  • Silent chest
  • Poor resp effort
  • Agitation
  • Altered consciousness
  • Cyanosis
27
Q

Bronchiolitis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Respiratory syncytial virus
    - Acute bronchiolar inflammation.
    - More serious in those who are premature, congenital heart disease, CF.
  2. Most common in 3-6mo.
    - Coryza prodrome
    - Dry cough
    - SOB
    - wheeze + fine inspiratory crackles
    - Feeding problems
    - -> 999 if; apnoea, severe resp distress (grunting, chest recession, RR >70, cyanosis)
  3. Clinical
    - Immunofluorescence of nasopharyngeal secretions; RSV.
  4. Supportive
    - Humidified oxygen if sats <92%
    - NG feeding
    - Suction of secretions.
28
Q

Edward’s syndrome

A
  • Micrognathia
  • Low ears
  • Rocker bottom feet
  • Overlapped fingers
29
Q

Patau syndrome (tri 13)

A
  • microcephaly
  • Small eyes
  • Cleft palate
  • Polydactyly
30
Q

Fragile X

A
  • Learning difficulties
  • Macrocephaly
  • Long face
  • Large ears
  • Huge balls
31
Q

Noonan syndrome

A
  • Webbed neck
  • Pectus excavatum
  • Short
  • Pulmonary stenosis
32
Q

Prader-willi syndrome

A
  • Hypotonia
  • Hypogonadism
  • Obesity
33
Q

Congenital hernia management

A
  • Diaphragmatic - repair
  • Inguinal - Repair
  • umbilical - manage conservatively, resolves.
34
Q

Brachial Plexus Injury

A

Erbs palsy

  • Damage to C5/6 roots
  • Winged scapula
  • Breech baby

Klumpke’s Paralysis

  • Damage to T1
  • Loss of intrinsic hand muscles
  • Traction

Medical School Finals (24 decks)

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