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Phase 3A > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What fluids are given for maintenance in children?

A

0.9% saline + 5% glucose

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2
Q

How is amount of fluid per day determined in children?

A

100ml/kg/day for first 10kg
50ml/kg/day next 10kg
20ml/kg/day after that

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3
Q

What is the bolus fluid and volume in children?

A

0.9% saline 20ml/kg

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4
Q

What are the exceptions for the bolus volume in children and what is it in these cases?

A

Trauma
Diabetic Ketoacidosis
Neonates

10ml/kg 0.9% NaCl

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5
Q

How to assess asthma control?

A

How many courses of steroids?
Any hospital admissions?
Any ITU visits?

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6
Q

If bronchodilators and steroids are not controlling an asthma attack, what other treatments can be used?

A

Magnesium bolus
Aminophylline
IV salbutamol

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7
Q

What must be done while giving a magnesium bolus?

A

Cardiac monitoring

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8
Q

Before changing medications is asthma, what should be assessed?

A

Compliance with medication
Inhaler techniques
Environment - pets, smoking

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9
Q

What further investigations can be done after a UTI?

A

DMSA - radioisotope study

MCUG - micturating cystourethrogram

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10
Q

What is sepsis?

A

Dysregulated host response that leads to end organ dysfunction

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11
Q

What pathogen typically causes croup?

A

Parainfluenza virus

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12
Q

What is used to treat croup?

A

O2 if needed
Oral steroids - dexamethasone/prednisolone
Nebulised adrenaline if needed

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13
Q

List some complications of prematurity

A

Retinopathy
Chronic lung disease
Necrotising enterocolitis
Intraventricular haemorrhage

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14
Q

How can retinopathy of prematurity be prevented/treated?

A

Controlled oxygen therapy

Laser therapy

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15
Q

What is a complication of intraventricular haemorrhage in neonates?

A

Cerebral palsy

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16
Q

What is given at 8 weeks in the childhood vaccination schedule?

A

6-in-one
Pneumococcal
Men B
Rotavirus

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17
Q

What is covered in the 6-in-one vaccine?

A

Diphtheria, tentanus, pertussis, polio, Hib, Hep B

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18
Q

What strains of HPV is covered in the vaccine?

A

16 and 18 - cervical cancer

6 and 11 - genital warts

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19
Q

When is the first dose of MMR given?

A

1 year

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20
Q

What pathogen can cause an aplastic crisis in sickle cell?

A

Parvovirus B19

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21
Q

What is the inheritance pattern of Fanconi’s anaemia?

What type of anaemia does it cause?

A

Autosomal recessive

Aplastic anaemia

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22
Q

What are the signs of newborn respiratory distress syndrome? (5)

A 
Tachypnoea 
Intercostal recessions
Expiratory grunting
Cyanosis
Tachycardia
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23
Q

What is the management of newborn respiratory distress syndrome? (3)

A

Synthetic surfactant
Oxygen
Mechanical ventilation

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24
Q

What is the management of bronchiolitis? (3)

A

Paracetamol
Oxygen
Maintain fluid balance

NOT salbutamol

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25
Q

When does a child need admitting for acute otitis media? (2)

A

<3 months old

3 - 6 months old with a temperature >36

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26
Q

What medical treatment can be used to treat mild haemophilia A? (1)

A

Desmopressin

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27
Q

What immune cells are present in asthma? (3)

A

Eosinophils
Mast cells
T cells

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28
Q

What must be seen on spirometry and bronchodilator test for a diagnosis of asthma?

A

FEV1/FVC <70%

Bronchodilator test improvement FEV1 >12%

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29
Q

What is the first step in the paediatric asthma ladder? (2)

A

Low dose ICS (beclometasone)

SABA (Salbutamol)

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30
Q

What type of jaundice does hypothyroidism cause in neonates?

A

Unconjugated

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31
Q

What is the complication of raised bilirubin in neonates?

Where does this complication occur?

A

Kernicterus

The basal ganglia

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32
Q

What are the symptoms of kernicterus? (4)

A

Lethargy, irritability, poor suck, abnormal muscle tone and posture, high-pitched cry, apnoea, and eventually seizures and coma

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33
Q

At what point should physiological jaundice resolve? In both term infants and preterm infants (2)

A

14 days

21 days

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34
Q

What management should be used before medical management for GORD in infants? (3)

A

Thickening agents
Sit at 30 degrees after feeds
Small feeds more often

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35
Q

What three drug classes can be used for GORD in infants? Give an example of each (6)

A

Alginate - Gavison
PPIs - omeprazole
H2 receptor antagonists - ranitidine

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36
Q

What are the risk factors for pyloric stenosis? (4)

A 
Firstborn
Male
Smoking in pregnancy
Family history 
Early antibiotic use
Bottle feeding
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37
Q

What are the signs of pyloric stenosis? (3)

A

Projectile vomiting (initially increases in frequency and force before projectile)
Gastric peristalsis after feeds
Olive shaped mass on examination

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38
Q

What is seen on ABG in pyloric stenosis? (3)

A

Hypochloraemic, hypokalaemic, metabolic acidosis

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39
Q

What is the surgical management of pyloric stenosis? (1)

A

Pyloromyotomy

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40
Q

Where does intussusception most commonly occur? (1)

A

Ileum into caecum

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41
Q

What are the signs of intussusception? (3)

A

Red currant jelly stools
Sausage shaped mass
Intermittent colicky pain

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42
Q

What is the management of intussusception? (1)

A

Rectal air insufflation

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43
Q

What is Meckel’s diverticulum? (1)

A

A remnant of the vitello-intestinal duct

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44
Q

What is the pathological process in malrotation? (3)

A

1) There is impaired rotation of the midgut as it returns into the abdominal cavity during development
2) Early in life Ladd bands obstruct the bowel or a volvulus occurs
3) This leads to ischaemia

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45
Q

How does malrotation present? (2)

A

Bilious vomiting and abdominal pain

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46
Q

What investigation should be done in suspected malrotation?

A

Abdominal xray with contrast

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47
Q

What is the pathophysiology of Hirschsprung’s?

A

Failure of the nerve cells to develop from the rectum upwards in the GI tracts

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48
Q

What are risk factors for Hirschsprung’s? (3)

A

Male
Down’s syndrome
Family history

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49
Q

What investigation should be done in suspected Hirschsprung’s? (1)

A

Rectal biopsy

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50
Q

What is the management of Hirschsprung’s? (1)

A

Swenson procedure

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51
Q

What is the inheritance pattern of congenital adrenal hyperplasia? (1)

A

Autosomal recessive

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52
Q

What electrolyte disturbances are seen in CAH and why? (3)

A

Hyponatraemia
Hyperkalaemia
Due to lack of aldosterone

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53
Q

What enzyme is deficient in classic CAH? (1)

A

21-hydroxylase

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54
Q

What is the medical management for CAH? (1)

A

Lifelong glucocorticoid replacement therapy (hydrocortisone)

55
Q

What specific serology should be done in Nephrotic syndrome? (1)

A

Varicella serology

56
Q

What should be done in cases of nephrotic syndrome resistant to steroids? (1)

A

Renal biopsy

57
Q

What is the most common cause of nephritic syndrome? (1)

A

Post streptococcal glomerulonephritis

58
Q

What is the management for nephritic syndrome? (2)

A

Antihypertensives

Anti-inflammatories

59
Q

What is the triad of symptoms in HSP? (3)

A

Purpura
Joint pain
Abdominal pain

60
Q

What is Kernig’s sign?

A

A sign of meningism where hip flexion and knee extension cause pain

61
Q

What is Brudzinski sign?

A

A sign of meningism where lift the head off a surface causes involuntary lifting of the legs

62
Q

What is seen in the CSF in bacterial meningitis? (4)

A

High protein, low glucose, turbid appearance and raised white cell count

63
Q

What is seen in the CSF of viral meningitis? (3)

A

Clear appearance, raised WCC, monocytes

64
Q

What are the three key features of diabetic ketoacidosis? (3)

A

Hyperglycaemia
Hyperketonaemia
Metabolic acidosis

65
Q

What respiratory sign is seen in diabetic ketoacidosis? (1)

A

Kussmaul’s breathing

66
Q

What is the management of DKA? (3)

A

ABCDE
Insulin via fixed rate IV infusion
Fluids - 0.9% NaCl, plus K+

67
Q

What can be used to maintain a patent heart duct in congenital heart defects? (1)

A

Prostaglandin E

68
Q

What does Tetralogy of Fallot consist of? (4)

A

1) Large VSD
2) Overriding aorta
3) Pulmonary stenosis (causing RV outflow obstruction)
4) Right ventricular hypertrophy

69
Q

What are the five cyanotic congenital heart abnormalities? (5)

A 
Tetralogy of Fallot
Truncus arteriosus
Tricuspid atresia
Transposition of the great vessels
Total anomalous pulmonary-venous connection
70
Q

Where does all blood from the pulmonary and circulatory system return to in TAPVC? (1)

A

Right atrium

71
Q

What murmur is heard with a VSD? (1)

Where is it heard best? (1)

A

Pansystolic murmur

Left lower sternal border

72
Q

At what point is a patent ductus arteriosus considered persistent? (1)

A

1 month after due date

73
Q

What is the treatment for a persistent PDA? (1)

A

NSAID - Indomethacin

74
Q

What is Eisenmenger syndrome? (3)

A

A complication of a longstanding VSD
There is increasing pulmonary hypertension
Eventually this leads to a bidirectional or reversed shunt (From Left to Right to Right to Left)

75
Q

What syndrome is pulmonary stenosis associated with? (1)

A

Noonan’s

76
Q

What syndrome is associated with mitral valve prolapse? (1)

A

Fragile X

77
Q

Name 6 features of Down’s Syndrome (6)

A 
Flat nasal bridge
Epicanthic folds
Small mouth
Large tongue
Brushfield spots
Single palmar crease
Hypotonia
Short fingers
Upwards slanting eyes
78
Q

What prenatal signs on scan indicate Turner’s syndrome? (2)

A

Cystic hygroma

Fetal oedema of neck, hands or feet

79
Q

Other than Down’s syndrome, name two other trisomies and the chromosome the affect (4)

A

Edward’s syndrome - c18

Patau’s syndrome - c13

80
Q

What are feature’s of Edward’s syndrome? (4)

A 
Low birth weight
Micrognathia
Short sternum
Rocker-bottom feet
Flexed, overlapping fingers
81
Q

What are features of Neurofibromatosis type 1? (5)

A 
Lisch nodules in iris
Skin fold freckles
Neurofibromas
Learning difficulties
Cafe au lait spots
82
Q

What condition are ash leaf spots associated with? (1)

What other features may be present in this condition? (4)

A

Tuberous sclerosis

Developmental delay, focal epilepsy, roughed (Shagreen) skin over lumbar spine, cafe au lait spots, infantile spasms

83
Q

What are the features of Klinefelter’s? (3)

What is the genotype? (1)

A

Infertility, hypogonadism, tall stature, gynaecomastia

XXY

84
Q

What are risk factors for hip dysplasia? (4)

A 
Breech presentation
Family history
Oligohydramnios
First born
Female
85
Q

What tests are done in suspected hip dysplasia? (2)

A

Ortolani’s test - reduces joint

Barlow’s test - dislocates joint

86
Q

What test is diagnostic in suspected hip dysplasia? (1)

A

Ultrasound

87
Q

What conservative management is used for hip dysplasia? (1)

A

Pavlik harness for a minimum of 6 weeks

88
Q

What is a key differential to exclude in transient synovitis? (1)

A

Septic arthritis

89
Q

What extra-articular manifestation is associated with juvenile idiopathic arthritis? (1)

A

Chronic anterior uveitis

90
Q

What are the major criteria for diagnosis of Still’s disease? (4)

A

Arthritis
Intermittent daily fever >2 weeks
Salmon coloured rash
Leukocytosis

91
Q

What drugs can be used to treat juvenile idiopathic arthritis? (4)

A

NSAIDs
Intra-articular steroids
Methotrexate
Biologics - TNF alpha blockers

92
Q

Where does septic arthritis typically occur? What is the most common causative agent? (2)

A

The metaphysis

Staph aureus

93
Q

What investigations are done in suspected septic arthritis? (4)

A

Joint aspiration and culture
Blood cultures
Inflammatory markers
X ray

94
Q

What late x ray changes are seen in septic arthritis? (2)

A

Loss of density

Diffuse rarefaction of the metaphysial area

95
Q

What is the management for septic arthritis? (1)

A

IV flucloxacillin

96
Q

What is Perthes disease? (1)

A

Avascular necrosis of the femoral head of unknown origin

97
Q

What are risk factors for Perthes disease? (4)

A 
Male
Thrombophilias
Low socioeconomic status
Low birth weight
Second hand smoke
98
Q

What gait do children with Perthes disease have? (1)

A

Trendelenburg gait

99
Q

What is seen on hip x ray in Perthes disease? (2)

A

Increased joint space

Crescent sign

100
Q

What is Drehmann sign? (2)

A

Passive flexion of the hip seen in slipped femoral epiphysis

101
Q

What imaging is needed to diagnose slipped femoral epiphysis? (2)

A

Frog leg lateral view x ray of the hip

102
Q

In children over 5 what is the firstline treatment for frequent enuresis? (1)

A

Enuresis alarm (plus positive reward system)

103
Q

If Enuresis alarm does not work what medical treatment can be used for enuresis? (1)

A

Desmopressin

104
Q

What type of cerebral palsy is associated with kernicterus? (1)

A

Dyskinetic

105
Q

What causes inguinal hernias in children? (1)

A

Patent processus vaginalis

106
Q

What are the three types of undescended testis? (3)

A

Retractile
Palpable
Impalpable

107
Q

What investigations are done for an impalpable undescended testis? (3)

A

USS
HCG - elevated suggested ectopic testis producing testosterone
Laparoscopy

108
Q

What is the surgical management for undescended testes and why is it performed? (3)

A

Orchiopexy

Due to increased risk of malignancy and reduced fertility

109
Q

What does ‘blue dot sign’ indicate? (1)

A

Torsion of the testicular appendage

110
Q

What calculation is used to estimate the weight of a child? (1)

A

(age + 4) x 2

111
Q

What does the APGAR score consist of? (5)

A 
Activity (muscle tone)
Pulse
Grimace (reflex irritability)
Appearance (skin colour)
Respiration
112
Q

What murmur is common in preterm infants? What does it sound like?

A

Patent ductus ateriosus

Continuous machinery murmur

113
Q

What is the management for necrotising enterocolitis? (6)

A

Nil by mouth
Gastric decompression via NG
IV fluids/TPN
Amoxicillin + gentamicin + metronidazole

114
Q

How is apnoea of prematurity managed? (3)

A

CPAP
Caffeine
Theophylline

115
Q

What is seen on chest x ray in meconium aspiration? (3)

A

Overinflated lungs
Consolidation
Collapse

116
Q

How is persistent pulmonary hypertension managed? (2)

A

Nitric oxide and sildenafil

117
Q

What does the Guthrie test screen for? (10)

A 
Phenylketonuria
Hypothyroidism
MCAD deficiency
Isovaleric acidaemia
Homocystinuria
Haemoglobinopathies
Cystic fibrosis
Maple syrup urine disease
Glutaric aciduria type 1
118
Q

What does the Guthrie test detect in Cystic Fibrosis? (1)

A

Serum immunoreactive trysinogen

119
Q

What does the Guthrie test detect in Cystic Fibrosis? (1)

A

Serum immunoreactive trypsinogen

120
Q

What three areas are affected in autism? (3)

A

Communication difficulties
Social interaction
Rigidity of thought

121
Q

What GP screening interview is used for autism? (1)

A

M-CHAT

122
Q

What are the three core symptoms of ADHD? (3)

What must be fulfilled along with these symptoms for a diagnosis? (2)

A

Inattention
Impulsivity
Hyperactivity

Must be persistent for at least 6 months and have an impact on daily function in multiple environments

123
Q

What type of therapy is best used in ADHD? (1)

A

Family therapy

124
Q

What must be monitored for ADHD patients on methylphenidate? (1)

A

Growth

125
Q

What is a poor prognostic marker for neuroblastoma? (1)

A

N-myc overexpression

126
Q

What investigation is done in suspected Duchenne muscular dystrophy? (1)

A

Creatinine phosphokinase

127
Q

What are congenital side effects of sodium valproate in pregnancy? (3)

A

Spina bifida
Cleft palate
Small fingers and toes

128
Q

What is the mechanism of achondroplasia? (1)

A

Activation of the FGFR3 gene

129
Q

What is the difference between omphalocele and gastroschisis? (2)

A

Omphalocele is covered in a sac is and is a defect in embroyological development where the intestine fails to re-enter to body
Gastroschisis does not have a sac covering and is caused by an umbilical cord defect

130
Q

What is the most common cause of bacterial meningitis in neonates? (1)
Name two other causes in neonates? (2)

A

E.Coli

Group B Strep, Listeria monocytogenes

131
Q

What treatment is given in primary care in suspected meningitis? (1)

A

IM benzylpenicillin

132
Q

What is the most common cause of bacterial meningitis? (2)

A

Group B Neisseria meningitidis

133
Q

Why are three CSF samples taken in meningitis? (3)

A

Microbiology
Virology
Chemistry

134
Q

What is the management for meningitis? (3)

A 
IV Ceftriaxone ( + Amoxicillin in infants)
Rifampicin for close contacts

Phase 3A (6 decks)

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