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finals > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

causes of meningitis in children neonates to 3 months?

A

GBS
E. coli
listeria monocytogenes

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2
Q

causes of meningitis in children aged 1 month to 6 years?

A 
Neisseria meningitis (meningococcus)
strep pneumoniae (pneumococcus)
H.influenzae
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3
Q

causes of meningitis in children aged >6 months?

A

neisseria meningitis

strep penumoniae

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4
Q

what is the sepsis 6 for children?

A 
O2
IV access and bloods- lactate, CRP, BG, ABG
IV or IO antibiotics
fluid resuscitation
get senior help
inotropes e.g. DA
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5
Q

what is meningococcal septicaemia?

A

gram negative diplococci

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6
Q

abx for meningococcal septicaemia in child <3 months and child >3 months?

A

<3 months- cefotaxime and amoxicillin to cover for listeria

>3 months- cefotaxime

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7
Q

what also needs to be given if h. influenzae is the cause of meningococcal septicaemia?

A

dexamethasone

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8
Q

prophylaxis of meningitis?

A

PHE notification
ciprofloxacin
rifampicin

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9
Q

what does rifampicin contraindicate with?

A

jaundice, liver failure, abnormal LFTs, alcoholism, polyphyria, diabetes, interacts with COCP

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10
Q

what should be given in the community of any febrile child with a purpuric rash?

A

IM benzylpenicillin and taken to hospital

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11
Q

what is scarlet fever?

A

Group A haemolytic streptococci
children aged 2-6 years
spread via respiratory route

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12
Q

features of scarlet fever?

A 
fever (24-48 hours)
malaise, headache, N&amp;V
sore throat
strawberry tongue
rash- fine punctate erythema which generally appears on torso and spares the palms and soles
spares around the mouth
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13
Q

diagnosis of scarlet fever?

A

throat swab

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14
Q

tx of scarlet fever?

A

start Abx before results- oral penicillin V for 10 days
children can return to school 24 hours after commencing Abx
NOTIFIABLE DISEASE

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15
Q

4 main differentials of an unwell neonate?

A

sepsis
congenital heart disease
NAI/ trauma
metabolic

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16
Q

what is impetigo?

A

localised highly contagious staph or strep skin infection

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17
Q

features of impetigo?

A

vesicular/pustular or bullous lesions on hands, face and neck
rupture causes fluid leak which causes honey-coloured crusted lesions

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18
Q

tx of impetigo?

A

mild- topical abx e.g. mupirocin

severe- flucloxacillin

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19
Q

childhood viral infections?

A 
HSV
chicken pox
EBV 
Roseola
Slapped cheek syndrome
hand, foot and mouth disease
Kawasaki
MMR
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20
Q

severe symptoms of HSV?

A 
eye disease (blepharitis or conjunctivitis)
CNS infections (aseptic meningitis and encephalitis)
gingivostomatitis
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21
Q

rash progression in chicken pox?

A

macular -> papules -> vesicles -> pustular -> crusts

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22
Q

complications of chicken pox?

A
  • Secondary bacterial infection- group A strep-> can lead to toxic shock syndrome and necrotising fasciitits
  • encephalitis- ataxia with cerebellar signs
  • purpura fulminans
  • pneumonia
  • disseminated haemorrhagic chicken pox
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23
Q

how long is school exclusion in chicken pox?

A

until lesions are dry and have crusted over (normally 5 days after rash starts)

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24
Q

tx of chocken pos?

A

calamine lotion
oral acyclovir
VZIG if immunocompromised or newborn

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25
Q

what is roseola infection?

A

HHV 6 (6th disease)
high fever followed by maculopapular rash, diarrhoea, cough
febrile convulsions in 10-15%

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26
Q

what causes slapped cheek syndrome?

A

parvovirus B19 -> infects erythroblastoid red cell precursors in the bone marrow
transmitted via resp secretions, vertical transmission, blood products

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27
Q

features of slapped cheek syndrome?

A

asymptomatic
erythema infectiosum- fever, malaise, headache followed by a ‘slapped cheek’ characteristic rash
aplastic crisis
foetal hydrops and death if severe anaemia

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28
Q

cause and treatment of hand, foot and mouth disease?

A

coxsackie A16 virus

admit for observation and give 48 hours parental abx e.g. ceftriaxone

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29
Q

what is Kawasaki disease?

A

systemic vasculitis, uncommon

children aged 6 months- 4 years

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30
Q

features of Kawasaki disease?

A

fever >5 days AND 4/5 of:

  • not-purulent conjunctivitis
  • red mucous membranes
  • cervical lymphadenopathy
  • rash
  • red and oedematous palms and soles or peeling of fingers and toes
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31
Q

complication of Kawasaki disease?

A

coronary aneurysms (look on ECHO)

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32
Q

tx of Kawasaki disease?

A

IVIG within 10 days to reduce risk of coronary artery aneurysms
aspirin- high dose to reduce thrombosis risk then low dose for anti-platelet

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33
Q

4 features of measles?

A

Cough
Coryza
Conjunctivitis
Kolip spots- white spots on buccal mucosa
rash starts behind ears then spreads to whole body

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34
Q

complications of measles?

A

encephalitis, febrile convulsions, subacute sclerosing panencephalitis, diarrhoea, keratoconjunctivitis

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35
Q

features of mumps?

A

fever, malaise, muscular pain

parotitis: unilateral then bilateral

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36
Q

complications of mumps?

A

viral meningitis and encephalitis, orchitis

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37
Q

what is rubella known as?

A

german measles

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38
Q

features of rubella?

A

pink maculopapular rash on the face before spreading to whole body
lymphadenopathy- sub-occipital and post-auricular
congenital infection

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39
Q

what is in the 6-in-1 vaccine and when is it?

A 
diphtheria
tetanus
whooping cough
polio
Hib
Hep B
given at 2,3 and 4 months
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40
Q

differentials of a child with fever and bone pain?

A

arthritis
leukaemia
ewing’s sarcoma
neuroblastoma

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41
Q

features of neuroblastoma?

A 
abdo mass, crosses the midline
spinal cord compression
weight loss and malaise
pallor
bruising
bone pain

arises from neural crest tissue in the adrenal medulla and sympathetic nervous system

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42
Q

what is a wilm’s tumour?

A

nephroblastoma

originates from embryonal renal tissue

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43
Q

features of wilm’s tumour?

A 
large abdo mass
pain
anorexia
anaemia
haematuria
child can be well
44
Q

what is a retinoblastoma?

A

malignant tumour of retinal cells
it commonly presents when a red pupillary reflex is replaces with a white one, or a squint
screening if positive FH
good prognosis

45
Q

red flags for a painful limb in a child?

A 
young age
high fever
night waking
painful scoliosis
focal neurological signs
weight loss
systemic malaise
46
Q

kocher’s criteria for septic arthritis?

A

fever >38.5
cannot weight bear
ESR >40 in 1st hour
WCC >12

47
Q

what is transient synovitis?

A

irritable hip

can be associated with viral illness

48
Q

features of transient synovitis?

A

acute limp
child often looks well, WCC normal
comfortable at rest
mx= rest and analgesia

49
Q

when is developmental dysplasia of the hip diagnosed?

A

usually diagnosed in infancy by screening tests
Ortolani- attempts to relocate a dislocated femoral head
Barlow- assess if the hip is dislocatable

signs= unequal leg length and asymmetrical skin creases in the thigh or buttock

50
Q

RFs for DDH?

A 
Extended breech babies
prematurity
twins
first born child
female
oligohydramnios
birth weight >5kg
51
Q

what do breech babies require to look for DDH?

A

breech babies at or after 36 weeks require USS at 6 weeks regardless of mode of delivery

52
Q

tx of DDH?

A

splits and harnesses or traction

hip realignment may be needed later in life

53
Q

what is perthes disease?

A

Avascular necrosis of the capital femoral epiphysis of the femoral head due to interruption of the blood supply followed by revascularisation and reosification over 18-36 months

54
Q

RFS for perthes disease?

A

low birth weight
short stature
low SE status
passive smoking

55
Q

Ix of perthes disease?

A

flattened femoral head on XR

roll test- rolling of the hip of the affected extremity invokes guarding or spasm, esp with internal rotation

56
Q

tx of perthes disease?

A

remove pressure from joint to allow normal development
PT
usually self-limiting

57
Q

epidemiology and features of slipped upper femoral arthritis?

A 
typically seen in obese adolescent males
positive FH
pain is often referred to the knee
bilateral in 20%
limitation to internal rotation is usually seen
58
Q

XR of SUFE?

A

femoral head is displaced and falling infero-laterally (melting ice cream cone)

59
Q

tx of SUFE?

A

best rest and non-weight bearing

percutaneous pinning of the hip may need pinning

60
Q

what is JIA?

A

autoimmune disease that involves a single joint or ankle in children or adolescents

61
Q

examination for JIA?

A

abdo
MSK
lymph nodes
rash exam

62
Q

features of JIA

A

persistent joint swelling
high fever
salmon-coloured pink rash
eye inflammation

63
Q

Ix of JIA?

A 
bloods- FBC, U&amp;E, LFT, albumin, ESR/CRP
blood cultures
USS/XR
ECHO
CT/MRI
64
Q

mx of JIA?

A

NSAIDS (acute)
corticosteroids for symptomatic relief and systemic disease
analgesia
methotrexate- if multiple joint involvement
sulfasalazine and leflunomide
etanercept (TNF alpha inhibitor)
Tocilizumab

65
Q

complications of JIA?

A 
chronic anterior uveitis
flexion contractures of the joints
growth failure
OP
amyloidosis
anaemia of chronic disase
66
Q

mx of GORD in infants?

A

add thickening agents to feeds e.g. Nestargel
positioning of head after feeds
H2 receptor antagonists e.g. ranitidine
PPI e.g. omeprazole
surgery if complicated- Nissen fundoplication

67
Q

what is pyloric stenosis?

A

hypertrophy of the pyloric muscle causing gastric outlet obstruction
more common in boys aged 2-7

68
Q

features of pyloric stenosis?

A

projectile vomiting post feeds, not bile stained

hypochloraemic hyponatraemic metabolic alkalosis

69
Q

diagnosis of pyloric stenosis?

A

gastric peristalsis may be seen as a wave after feed
pyloric mass felt in RUQ
USS- hypertrophy of pylorus muscle

70
Q

mx of pyloric stenosis?

A

IV fluids

pyloromyometry- division of the hypertrophied muscle

71
Q

what could a redcurrant jelly stool comprising blood-stained mucus and sausage shaped mass in RUQ infer?

A

intussusception

child may draw up legs and become pale during episodes with severe pain

72
Q

Ix of intussusception?

A

XR- distended small bowel and absence of gas in distal colon and rectum
abdo USS- can show a target sign and response to treatment

73
Q

mx of intussusception?

A

reduction by air insufflation under radiological control

surgery if failure of this or signs of peritonitis

74
Q

what is the main cause of massive painless GI bleed in children aged 1-2 years?

A

Meckel diverticulum

this is a remnant of the vitello-intestinal duct which contains ectopic gastric mucosa or pancreatic tissue

75
Q

features of Meckel diverticulum?

A

most are asymptomatic but they may present with severe rectal bleeding, which is classically neither bright red nor true melaena
can also mimic appendicitis

76
Q

mx of Meckel diverticulum?

A

surgical resection

77
Q

what is bile stained vomit in 1st week of life until proven otherwise?

A

malrotation- when the mesentery is fixed at the duodenal flexure or ileocaecal region

78
Q

features of malrotation?

A

obstruction with bilious vomiting

vascular compromise

79
Q

Ix of malrotation?

A

upper GI contrast study- diagnostic

USS abdo

80
Q

tx of malrotation?

A

surgical correction (ladd’s procedure)- corrects volvulusc

81
Q

clinical signs of dehydration?

A 
appears unwell
dry mucous membranes
lethargic
decreased urine output
sunken eyes
tachycardia
tachypnoea
sunken fontanelle
reduced skin turgor
82
Q

main causes of GE in children?

A

norovirus, rotavirus, adenovirus

campylobacter jejuni

83
Q

what fluid is given in a fluid bolus for children?

A

0.9% saline -> fluid bolus. 20mls/kg normally except 10mls/kg in a diabetic or severe trauma (due to risk of cerebral oedema)

84
Q

what maintenance fluid is given in children?

A

0.9% saline with 5% dextrose

OR 10% dextrose in a neonate (<48 hours old)

85
Q

what blood products are given to a child in shock?

A

FFP (clotting factors) and cryo (concentrated factors and fibrinogen)

86
Q

how to calculate fluid replacement in a child?

A

1) estimate weight= (age +4) x 2
if <1 year- (age (months) +9) / 2

2) calculate bolus e.g. 20mls/kg

3) calculate maintenance requirements for 24 hours
1st 10kg= 100mls/kg
2nd 10kg= 50mls/kg
subsequent kg= 20mls/kg

4)calculate deficit- if dehydrated
% dehydration x weight = deficit (need)

5) fluid need = maintenance + deficit - bolus = amount per day

87
Q

what should be given if a child is hypoglycaemic?

A

10% dextrose 2mls/kg STAT

88
Q

what are maintenance fluids for a neonate?

A 
days    term     preterm (mls/kg)
1            60           80
2           80           100
3           100          120
4           120          140
5           150          150
89
Q

how to replace electrolytes in a child?

A

Na K+ energy (mmol/kg/day)
1st 10kg 2-4 1.5-2.5 110
2nd 10kg 1-2 0.5-1.5 75
sub kg 0.5-1 0.2-0.7 30

90
Q

how does cow’s milk protein intolerance present?

A 
in first 3 months of life in formula fed infants
regurgitation and vomiting
diarrhlea
urticaria, atopic eczema
'colic' symptoms- irritability, crying
wheeze, chronic cough
91
Q

diagnosis of CMPI?

A

skin prick/patch testing
can be IgE mediated (immediate) or non- IgE mediated (delayed)
test total IgE and specific IgE (RAST) for cow’s milk protein

92
Q

mx of CMPI?

A

refer to a paediatrician if failing to thrive
if formula fed- extensive hydrolysed formula (eHF) 1st line, amino acid-based formula (AAF) in infants with severe CMPA if no response to eHF

if breast-fed- continue breastfeeding, eliminate cow’s milk protein from maternal diet. Use eHF milk when breast-feeding stops

usually resolves by 1-2 years

93
Q

what is necrotising enterocolitis?

A

more common in premature babies fed with cow’s milk

part of the bowel becomes necrotic, cause is unknown

94
Q

features of necrotising enterocolitis?

A 
bilious vomiting
feeding intolerance
abdominal distension
bloody stools 
can progress to abdo discoloration, perforation and peritonitis
95
Q

ix of necrotising enterocolitis?

A 
abdo XR- dilated bowel loops, bowel wall oedema, pnematosis intestinalis, portal venous gas, pneumoperitoneum, 
Rigler sign (air inside and outside the bowel wall), football sign (air outlining the faleiform ligament)
96
Q

mx of necrotising enterocolitis?

A

ABCDE
stop oral feeds
broad spectrum antibiotics
laparotomy if bowel perforation

97
Q

causes of diarrhoea in a child?

A 
toddler's diarrhoea
coeliac disease
cow's milk protein intolerance
gastroenteritis
overflow from constipation
lactose intolerance
IBD
following bowel resection -> malabsorption
98
Q

mx of constipation in a child?

A
  1. macrogol laxative e.g. polyethylene glycol and electrolytes- Movicol paediatric plan-2 weeks
  2. osmotic laxative e.g. lactulose
  3. stimulant laxative e.g. senna or picosulphate
  4. consider enema or manual evacuation under GA
99
Q

what does failure to pass meconium <24 hours after birth indicate?

A

hirschsprung’s disease

100
Q

red flags for failure to thrive/growth failure in a child?

A

hypothyroidism

coeliac disease

101
Q

what is hirschsprung’s disease?

A

large bowel obstruction

the absence of parasympathetic ganglion cells

102
Q

associations with hirschsprung’s disease

A

male

down’s syndrome

103
Q

features of hirschsprung’s disease

A

neonatal period- failure to pas meconium

older children- constipation, abdominal distension, bile-stained vomiting

104
Q

diagnosis of hirschsprung’s disease

A

PR- can cause a release of flatus and faeces that can relieve symptoms and diagnose
Suction rectal biopsy- absence of ganglionic cells and Ach positive nerve trunks

105
Q

mx of hirschsprung’s disease

A

whole bowel irrigation for symptomatic relief
enemas
surgical and usually involves an initial colostomy followed by anastomosing normally inverted bowel to the anus

106
Q

name an anti thelemintic used for worms?

A

mebendazole

107
Q

when to refer a child with bronchiolitis?

A

a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume, taking account of risk factors and using clinical judgement)
clinical dehydration.

finals (14 decks)

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