Paediatrics Flashcards
1
Q
What are the features of Patau syndrome (trisomy 13)?
A
- Microcephaly and small eyes
- Cleft lip/palate
- Polydactyly
- Scalp lesions
2
Q
What are the features of Edward’s syndrome (trisomy 18)?
A
- Micrognathia
- Low set ears
- Rocker bottom feet
- Overlapping fingers
3
Q
What are the features of Fragile X syndrome?
A
Trinucleotide repeat disorder causing:
- Learning difficulties
- Macrocephaly
- Long face
- Large ears
- Macro-orchidism
- Mitral valve proplapse
Diagnosis with chorionic villus sampling or amniocentesis
4
Q
What are the features of Noonan syndrome?
A
- Webbed neck
- Pectus excavatum
- Short stature
- Pulmonary stenosis
5
Q
What are the features of Pierre-Robin syndrome?
A
- Micrognathia
- Posterior displacement of tongue
- Cleft palate
NB - similar to Treachers Collins but TC is autosomal dominant
6
Q
What are the features of Prader-Willi syndrome?
A
- Hypotonia
- Hypogonadism
- Obesity
7
Q
What are the features of William’s syndrome?
A
- Short stature
- Learning difficulties
- Friendly, extroverted personality
- Transient neonatal hypercalcaemia
- Supravalvular aortic stenosis
8
Q
What are the features of Cri du chat syndrome?
A
- Chromosome 5p deletion
- Characteristic cry due to larynx and neurological problems
- Feeding difficulties, failure to thrive
- Learning difficulties
- Microcephaly and micrognathism
- Hypertelorism (far apart eyes)
9
Q
What are the features and complications of Down’s syndrome?
A
Features:
- Face: epicanthal folds, Brushfield spots, protruding tongue, small low set ears
- Flat occiput
- Single palmar crease
- Hypotonia
- Duodenal atresia
- Hirschsprung’s disease
Complications:
- CARDIAC!!!! - AV septal canal defects, VSD, tetralogy of Fallot, isolated patent ductus arteriosus
- Subfertility
- Learning difficulties
- Respeated respiratory infections
- ALL
- Hypothyroidism
- Alzheimer’s disease
- Atlantoaxial instability
- Otitis media and glue ear
10
Q
What is the epidemiology of Down’s syndrome?
A
1/1000 at 30 years, then divide the denominator by 3 for every extra 5 years of age
11
Q
What are the features of McCune-Albright syndrome?
A
- NOT inherited; due to a random, somatic mutation in the GNAS gene
- Precocious puberty
- Cafe-au-lait spots
- Polyostotic fibrous dysplasia
- Short stature
12
Q
What are the features of Turner’s syndrome?
A
- Due to presence of only one sex chromosone (X) or deletion of short arm of one of the X chromosomes (45, X)
- Short stature, webbed neck, shield chest
- Bicuspid aortic valve and coarctation of the aorta
- Primary amenorrhoea
- Elevated gonadotrophin levels
- Horshoe kidney
- Increased risk of autoimmune disease
13
Q
What is the Apgar score?
A
- A score used to assessed the health of a newborn baby at 1 and 5 minutes of age (if low repeat at 10 minutes)
- Looks at pulse, respiratory effort, colour, tone and reflex irritability
- 0-3 (very low), 4-6 (moderate low), 7-10 (good)
14
Q
What is the purpose of the Heel Prick (Guthrie) test?
A
Performed at 5-9 days of life, screening for:
- Congenital hypothyroidism
- Cystic fibrosis
- Sickle cell disease
- Phenylketonuira
- MCADD
- Maple syrup urine disease
- Isovaleric acidaemia
- Glutaric aciduria type 1
- Homocystinuria
15
Q
What is caput succedaneum and how is it managed?
A
- Oedema of the scalp at the vertex after birth
- Crosses suture lines
- No treatment needed, resolves in days
16
Q
What is cephalohaeatoma and how is it managed?
A
- Swelling on head of a newborn that develops several hours after birth due to bleeding between periosteum and skull
- Commonly in parietal region, does not cross suture line
- Jaundice may develop as a coplication
- No treatment needed, may take months to resolve
17
Q
What is an Epstein’s pearl and how is it managed?
A
- Congenital cyst found on the hard palate
- No treatment needed
- Will resolve in weeks
18
Q
What is haemorrhagic disease of the newborn?
A
- Bleeding in neonates secondary to vitamin K deficiency
- All newborns given IM or oral vit K to prevent
19
Q
What causes jaundice in the first 24h after birth?
A
ALWAYS PATHOLOGICAL
- Rhesus haemolytic disease
- ABO haemolytic disease
- Hereditary spherocytosis
- Glucose-6-phosphodehydrogenase
20
Q
What causes jaundice in 2-14 days?
A
- Common and usually physiological
- Due to increased RBC and less developed liver function
- More common in breastfed babies
21
Q
What causes jaundice after 14 days (or 21 days if premature)?
A
Must perform jaundice screen involving bilirubin, Coombs test, TFTs, FBC and blood film, urine, U&Es, LFTs
Causes:
- Biliary atresia > raised conjugated bilirubin, requires urgent surgical intervention
- Hypothyroidism
- Galactosaemia- inability to breakdown galactose
- Urinary tract infection
- Breast milk jaundice
- Prematuring
- Congenital infections eg. CMV, toxo
22
Q
How does coeliac disease present and how is it diagnosed and managed?
A
Features:
- Associtated with HLA-DQ2 and HLA-DQ8
- Presents around 3y with failure to thrive, diarrhoea, distension, anaemia
Diagnosis:
- Jejunal biopsy shows subtotal villous atrophy
- Anti-endomysial and anti-gliadin antibodies to screen
Management:
- Gluten avoidance
23
Q
How does Cow’s milk protein intolerance/allergy present and how is it diagnosed/managed?
A
Features:
- Presents in first 3 months of life in formula fed infants
- IgE and non-IgE mediated
- Regrugitation, vomiting, diarrhoea, atopy, colic sx, wheeze, angioedema
Diagnosis:
- Clinical with elimination diet
- Consider skin prick/patch
- Consider total IgE and specific IgE (RAST) for cow’s milk protein
Management:
1. Formulate fed - eHF or AAF milk
2. Breast fed - mum to eliminate cows milk
24
Q
How does GORD present and how is it managed?
A
Features:
- Most common cause of vomiting in infancy
- Presnts as milky vomits and crying after feeding, before 8 weeks
- RF include preterm delivery and neuro disorders
Diagnosis:
- Clinical
Management:
- 30 degree head up during feeds
- Infants to sleep on their back
- Smaller and more frequent feeds
- Thickened formula and alignate therapy
- Specialists can initate medical therapy and fundoplication as last resort
25
What is pyloric stenosis and how is it diagnosed/managed?
Features:
- Presents in 2-4 weeks of life with projectile vomiting
- Due to hypertrophy of pyloric muscles
- Palpable mass may be present
- Low chlorine, low K acidosis due to vomiting
Diagnosis:
- Ultrasound
Management:
- Ramstedt pyloromyotomy
26
What are the red flag features for constipation in childhood?
- Reported from birth/first few weeks of life
- Passage of meconium >48h
- Ribbon stools
- Faltering growth
- Weakness in legs
If no red flags can diagnose idiopathic constipation
27
How is constipation managed in children ?
If faecal impaction present:
1. Movicol paediatric plain (polyethylene glycol 3350 and electrolytes)
2. Add stimulant if no disimpaction after 2 weeks
Maintenance therapy:
1. Movicol paediatric plain
2. Add stimulant if no response or substite if not tolerated
3. Add lactulose/docusate if still hard
Do not use dietary intervention alone as first line treatment
28
How is constipation managed in infants?
Not yet weaned (<6m):
Bottle fed - give extra water in between feeds, gentle abdominal massage
Breast fed - consider organic causes
Weaned:
Offer extra fluids
Consider lactulose
29
What is Hirschsprung's disease and how is it diagnosed and managed?
Features:
- Caused by aganglionic segment of bowel due to plexus development failure
- Result is uncoordinated peristalsis and functional obstruction
- Assoc with Down's syndrome
Diagnosis:
- Rectal biopsy is GOLD STANDARD
Management:
1. Rectal washouts and bowel irreigation
2. Will need definitive surgery to affected segment of colon
30
What are the main causes of diarrhoea in children?
Acute:
1. Gastroenteritis - usually due to rotavirus
Chronic:
1. Cow's milk intolerance
2. Coeliac disease
3. Post gastroenteritis lactose intolerance
31
What is intussusception and how is it diagnosed/managed?
Features:
- Invagination of one portion of bowel into the lumen of adjacent bowel (usually ileo-caecal region)
- Presents as crampy abdominal pain, vomiting ,redcurrent jelly and sausage shaped mass in RUQ
Diagnosis:
- Target like mass on USS
Management:
- Recution by air insufflation
- If fails or peritonitic, surgery
32
What is Meckel's diverticulum and how is it diagnosed/managed?
Features:
- Congenital diverticulum of the small intestine
- Presents as abdominal pain, rectal bleeding and obstruction
Diagnosis:
- Meckels scan and mesenteric arteriography
Management:
- Remove if narrow neck or symptomatic, via wedge excision or small bowel resection and anastomosis
33
What is gastroschisis and exomphalos?
GASTROSCHISIS:
- Congenital defect in the anterior abdominal wall just lateral to the umbilica cord
- Newborns should go to theatre ASAP after delivery
EXOMPHALOS:
- Congenital defect in which the abdominal contents protrude through the anterior abdominal wall but are covered by the amniotic sac
- Associated with some syndromes
- C-section to reduce rupture risk
- Staged repair
34
What is necrotising enterocolitis?
- Leading cause of death among premature infants
- Presents with feeding intolerane, abdominal distension and bloody stools
- AXR shows dilated bowel loops, oedema, intramural gas, pneumoperitoneum, Wiglers signs, football sign
Management:
- Gastric decompression with NG tube
- Intravenous antibiotics
- Surgical if failure
35
What are the features and management of acute epiglottitis?
Features:
- Causes by Haem influenza type B
- Presents with high tempearture, stridor, drooling and tripod position
Diagnosis:
- By direct visualisation
- Can see thumb sign (swelling of epiglottis) on XR
Management:
- DO NOT EXAMINE THROAT
- Immediate ENT/anaesthetics referral +/- endotracheal intubation
- Oxygen and IV ceftriaxone/cefuroxime
36
How is asthma managed in children aged <5?
1. SABA
2. SABA + 8 week trial moderate dose ICS (then start low dose maintenance)
3. SABA + paediatric low dose ICS + LRTA
4. Stop LRTA and refer to specialist
37
How is asthma managed in children aged 5-16?
1. SABA
2. SABA + paediatric low dose ICS (<200 budesonide)
3. SABA + paediatric low dose ICS + LRTA
4. SABA + paedatric low dose ICS +LABA
5. SABA + maintenance and reliever therapy (MART)
6. SABA + moderate dose MART (200-400 budesonide)
7. SABA + high dose ICS (>400 budesonide)/add theophylline/specialist referral
38
What is MART?
A form of combined ICS and LABA treatment which is used for both maintenance therapy and symptom relief
39
How do you manage a moderate asthma attack?
1. Give 1 puff SABA every 30-60 seconds through a spacer up to 10 puffs
2. Repeat and refer to hospital if ongoing sx
3. 3-5d steroid therapy
Steroid dose:
2-5yo - 20mg OD
>5yo - 30-40mg OD
40
How do you manage a severe/lifethreatening asthma attack?
If poor response to SABA and steroids:
1. Iptratropium bromide and SABA nebs
2. Consider nebulised magnesium sulfate
3. Refer to HDU/ICU for IV salbutamol/Mg/aminophylline
- After discharge, GP must be informed within 24h and child must be reviewed within 2 days
- If severe attack, follow up under resp for 1 year minimum
- If near fatal, should be under specialist indefinitly
41
What are the features and management of bronchiolitis?
Features:
- Coryzal symptoms incl dry cough
- Usually due to RSV infection
Management:
- Hospital if RR>60, unable to feed, dehydrated
- 999 if apnoeic, severe respiratory distress, central cyanosis, oxygen <92%, RR>70
- SUPPORTIVE management
42
What are the features and management of croup?
Features:
- Stridor, barking cough and fever
- Peak incidence 6m to 3y
- Usually due to parainfluenza virus
Management:
- CXR if modeate or severe; will show steeple sign
- Admit if <6m, known upper airway abnormalities, uncertainty about diagnosis
- Single dose oral dexamethasone to all children
- May need high flow oxygen and neb adrenaline
43
What are the features and management of cystic fibrosis?
Features:
- Autosomal recessive disorder causing increasing viscosity of secretions
- Due to defect in CFTR gene which encodes a chloride channel
- Usually due to delta F508 on chromosome 7
- Presents with malabsoprtion and recurrent chest infections due to staph aureues/pseudomonas aeruginosa
Management:
- Mucolytics (dornase alfa)
- Mannitol and hypertonic NaCl are second line
- Flucloxacillin and neb colistimethate prophlaxis against staph and pseudo
- Specialist physiotherapy
- Consider long term azithromycin
- Pancreatin for malsbroption
44
What is transient tachypnoea of the newborn?
- Common cause of respiratory distress in newborn, particularly post C-section
- Due to delayed resorption of fluid in the lungs (think HF for babies)
- CXR shows hyperinflated lungs and fluid in horizontal fissure
- Management is supporitve
45
What is surfactant deficient lung disease?
- Respiratory distress secondary to insufficient surfactant production and structual immaturity in premature babies
- Other RF include diabetic mother, c-section, male sex
- CXR shws ground glass appearance
- Prevent with maternal corticosteroids during pregnancy
- Manage with oxygen, assisted ventilation and exogenous surfactant via ET tube
46
What are the features/diagnosis/management of whooping cough?
Features:
- Viral URTI sx followed by cough and inspiratory whoop for 2-8 weeks
- Due to gram-negative bacteria Bordetella pertussis
Diagnosis:
- Nasal swab/PCR and serology
Management:
- Admit if under 6 months
- Oral macrolide (-mycin) if cough onset within 21d
- Antibiotic prophylaxis to contacts
- Notifiable disease
- Schoole xclusion for 48h after commencing anitbiotics
47
What vaccinations are offered for whooping cough?
Pregnant women:
Vaccine between 16-32 weeks
Infants
Immunised at 2, 3, 4 months and 3-5 years
48
What is congenital diaphragmatic hernia?
- Herniation of abdominal viscera into the chest cavity due to incomplete formation of diaphragm
- Will have characteristic concave abdominal appearance
- Causes pulmonary hypoplasia and hypertension > respiratory distress
- HIGH FATALITY ! 50%
49
What is meconium aspiration syndrome?
- Respiratory distress in the newborn as a result of meconium in the trachea
- More common in post-term babies
- CXR showspatchy infiltrations and atelectasis
-
50
Which innocent murmurs are heard in children?
Ejection murmurs - due to turbulent blood flow at the outflow tract of the heart
Venous hums - due to turbulent blood flow in the great veins returning to the heart (continuous blowing noise below the clavicles)
Still's murmur - low pitched sound heart at the ower left sternal edge
51
How is aortic stenosis managed in children?
- Associated with William's syndrome, coarctation of the aorta, Turner's sydrome
- Aim to avoid or delay valve replacement if possible
- If gradient across valve >60mmHg > balloon valvotomy
52
How does congenital heart disease usually present?
- During antenatl period on fetal anomaly scan
- Murmur at newborn examination
- Cyanosis
- Heart failure (poor feeding, SOB, sweating, hepatomegaly)
53
What are the acyanotic causes of congenital heart disease?
1. Ventricular septal defects (most common)
2. Atrial septal defects
3. Patent ductus arteriosus
4. Coarctation (narrowing) of aorta
5. Aortic valve stenosis
Because there is more pressure on the left side, oxygenated blood will move from left to right (left to right shunt)
54
What are the cyanotic causes of congenital heart disease?
Characteristed by right to left shunt, cyanosis starts around 80-85% oxygen
1. Tetralogy of Fallot
- Most common overall
- Four heart abnormalities
- Infants may develop hypercyanotic 'tet' spells in response to emotion or pyrexia
- Can treat test spells with b-blockers
- Need cardiac repair surgery
2. Transposition of the great arteries
- Most common at birth
- Pulmonary artery and aorta swap locations (blood on right never gets oxygenated and vice versa)
- Will lead to death UNLESS there is a patent ductus arterosis, foramen ovale or VSD
- Can give prostaglandin E to keep ductus arteriosus open until surgery
- Can lead to congestive heart failure
3. Tricuspid atresia
- Tricuspid does not form
55
What is the nitrogen washout test?
aka Hyperoxia test
- Used to differentiate cardiac from non-cardiac causes of cyanosis
- Give infant 100% oxygen for ten minutes and take ABG; if p02 <15kPa - congenital heart disease
56
What is acrocynaosis?
- Peripheral cyanosis around the mouth and extremities due to benign vasomotor changes
- Occurs immediately after birth in healthy infants
- May persist for 24-48h
57
How is patent ductus arteriosus diagnosed and managed?
Features:
- Left subcalvicular thrill
- Continuous machiney murmur
- Large collapsing pulse
Management:
- Indomethaxin or ibuprofen to close
58
What is Wilm's tumour and how is it managed?
Features:
- Common childhood malignancy
- Presents as abdominal mass and painless haematuria
Management:
- Nephrectomy +/- chemo/radio
- Good prognosis
59
What causes hypertension in children?
1. Renal parenchymal disease
2. Renal vascular disease
3. Coarctation of the aorta
4. Phaemochromocytoma
5. Congenital adrenal hyperplasia
6. Essential htn
60
Describe the features of nephrotic syndrome in childhood
- Triad of proteinuria, hypoalnuminaemia and oedema
- Usually due to minimal change glomerulonephritis
- Treat with steroids
- Careful of high lipids, hypercoagulability and predisposition to infection
61
What is vesicoureteric reflux and how is it investigated/managed?
Features:
- Abnormal backflow of urine from bladder into the ureter/kidney
- Found in 30% of children with UTI
- Due to displaced ureters
Investigation:
1st line - Micturating cystourethrogram
Consider DMSA scan to look for rena lscarring
Management:
- Prophylactic antibiotics
- Surgical repair
62
What are the indications for imaging the urinary tract?
USS:
1. Infants <6m with first UTI should have an USS within 6 weeks
2. Children >6m with first UTI do not require imaging unless atypical/failure to response to abx
DMSA scan can be done 4-6 months after initial infection
MCUG can be done for infants <6m with atypical or recurreny infection
63
What is noctural enuresis and how is it managed?
Diagnosis:
Involuntary discharge of urine in a child aged 5y or older in the absence of pathology. Can be primary or secondary (after 6 months dryness)
Most children achieve dryness by 3-4 years of age
Management:
- Treat underlying cause
- Toileting patterns and reward charts
- Enuresis alarm (1st line)
- Desmopressin for short term control
64
What is homocystinuria and how is it managed?
- Autosomal recessive disease
- Causes high levels of homocysteine concentrations
- Pts have fine, fair hair and MSK/neuro/ocular abnormalities
- Treat with vitamin B6 (pyridoxine)
65
What is phenylketonuria and how is it managed?
- Autosomal recessive disease, chromosome 12
- High levels of phenylanine
- Developmental delay, fair hair, seizures, musty odour
- Strict maternal diet during pregnancy
65
How is undescended testes managed?
Unilateral:
- Refer from 3m of age for orchidopexy
Bilateral:
- Review by senior paediatrician within 24h due to need for urgent endocrine/genetic investigation
Complications include infertility, torsion, testicular cancer and pyschological impact
66
What are labial adhesions and how are they managed?
Features:
- Fusion of labia minora in the midline
- Present with urine pooling in vagina
Management:
- Spontaneous resolution often occurs around puberty
- Can use oestrogen cream if recurrent UTI
- May need surgical intervention
67
What is precocious puberty?
Development of secondary sexual characteristics before 8 years in females and 9 in males
Classification:
1. Gonadotrophin dependent - due to premature activation of hypothalamic-pituitary-gonadal axis. Raised FSH/LH
2. Gonadotrophin independent - due to excess sex hormones. Low FSH/LH
Causes:
Males - most likely to be organic due to tumour, if small testes - adrenal cause
Females - usually idiopathic or familial
68
What are the features of Klinefelter's syndrome (aka primary hypogonadism)
- Karyotype 47 XXY
- High LH, low testosterone
- Lack of secondary sexual characteristics, small testes, taller than average, infertile
69
What are the features of Kallman's syndrome (hypogonadotrophic hypogonadism)?
- X-linked recessive
- Low LH and testosterone
- Delayed puberty and ANOSMIA
70
What are the features of androgen insensitivity syndrome?
- X-linked recessive causing genotypically male children (46XY) to have a female phenotype
- End-organ resistance to testosterone - will be converted to oestradiol
- High LH, high/normal testosterone
- Primary amenorrhoea, groin swelling (undescended testes)
- Raise child as female + bilateral orchidectomy + oestrogen therapy
71
What is hypospadias?
- Abnormality of penus involving ventral urethral meatus, hooded prepuce and curvature
- Usually picked up on newborn check but may present later as abnormal urine stream
- Refer to specialist service for surgery around 12 months
- Ensure not circumcised prior to this as may need foreskin for the surgery
72
How is vulvovaginitis managed in children?
- In general, examination/swabs should not be performed
- Usually bacterail or fungal
- If bloody discharge consider foreign body
- Manage with soothing creams, topical abx/antifungals and oestrogen cream if refractory
73
What is benign rolandic epilepsy?
- Form of childhood epilepsy which occurs between 4-12 years of age
- Typically partial seizures at night +/- secondary generalisation
- EEG shows centrotemporal spikes
- Seizures usually stop by adolescence
74
How is meningitis managed in children?
Investigations:
- Perform LP unless signs of raised ICP or meningococcal septicaemia
- If unable to perform LP, do blood cultures and PCR
Management:
1. Abx
- IV amoxicillin and cefotaxime if <3m
- IV cefotaxime if >3m
2. Steroids if bacterial concerns on LP (only if over 3 months old)
3. IV fluids
4. Cerebral monitoring
5. Public health notification
6. Contact prophylaxis with ciprofloxacin
75
Which organisms usually cause meningitis in children?
Neonatal to 3 months:
- Group B strep
- E coli
- Listeria
1 month to 6 years:
Neisseria meningitidis (meningitidis)
Streptococcus pneumoniae (pneumococcus)
H influenzae
> 6 years:
> Neisseria meningitidis
> Streptococcus pneumoniae
76
What is the most common ocular malignancy in childhood and how is it managed?
Retinoblastoma
- AD, chromosome 13
- Absence of red reflex
- Manage with enucleation, radiation therapy, chemo, photocoagulation
77
What are the features od ADHD and how is it managed?
Diagnosis:
Persistent features relating to inattention and/or hyperactivity/impulsivity
Management:
1. Ten week watch and wait before referral to secondary care
2. Methyphenidate 1st line (over 5yo)- brand name ritalin/concercta
3. Lisdexamfetamine/dexamfetamine 2nd line (over 5yo) - brnad name vyvanse
Must perform baseline ECG prior to treatment and monitor height and weight every 6 months
78
What are the features and management of DDH?
Features:
- Hip issues in infant
- RF include female sex and breech presentation
Investigations:
- Screened at birth with Barlow and Ortolani tests
- Routine USS if fam hx hip problems, breech presenation or multiple pregnancy
- 1st line ix is XR if >4.5 months
Management:
- Often self-resolves
- Pavlik harness if <5 months old
- Surgery if older
79
What are the features and management of Perthe's disease?
Features:
- AVN of the femoral head
- Seen in children aged 4-8 years old
- Presents as progressive hip pain, limp and stiffness
Investigations:
- XR shows widening joint space and flattening of femoral head
- Consider technetium bone scan or MRI if persistent sx despite normal XR
Management:
- Conservative mgmt with cast and braces
- Operate if over 6 years old
80
What are the features and management of slipped capital femoral epiphysis (aka SUFE) ?
Feautres:
- Typically obese boys
- Displacement of femoral head postero-inferiorly
- May be acute or chronic
- Loss of internal rotation of leg in flexion
Investigation:
- AP and lateral (frog leg) XRs
Management:
- Internal fixation
81
What are the features and management of juvenile idiopathic arthritis?
Features:
- Painless limp
- Family hx of autoimmunity
- Morning stiffness
Investigations:
- Bloods - raised ESR, ANA
- Screen for anterior uveitis
Management:
- NSAIDs + DMARD (methotrexate)
82
What are the common knee problems in children?
1. Chondromalacia patellae:
- Softened cartilage
- Anterior knee pain in a girl whilst walking up the stairs
2. Osgood-Schlatter disease:
- Pain, tenderness and swelling over tibial tubercle
- Typically sporty teenager
3. Osteochondritis dissecans:
- Intermittent swelling and locking
- Pain after exercise
4. Patellar subluxation:
- Knee gives way
5. Patellar tendonitis:
- Chronic anterior knee pain that worsens after running
- Typically sporty teenage boy
83
What is the Kocher criteria for diagnosis of septic arthritis?
- Fever >38.5C
- Non-weight bearing
- Raised ESR >40
- Raised WCC >12
1 point each - if 3 points 93% probability SA
84
What are the features and management of transient synovitis?
Features:
- Acute hip pain following a viral infection
- Typically in children aged 3-8 years old
- May have a low grade fever
Management:
- Self limiting
- Often mimics septic arthritis so may need urgent specialist assessment to rule this out
85
How is a) eczema and b) seborrhoeic dermatitis managed in children?
a)
1. Avoid irritants
2. Simple emollients (10:1 ratio to steroids)
3. Topical steroids
4. Wet wrapping
5. Oral ciclosporin if severe
b)
1. Conservative + topical emollient
2. Topical imidazole if persistent
86
What are the features and management of hand, foot and mouth disease?
Features:
- Caused by intestinal viruses of the Picornaviridae family (coxsackie A16 and enterovirus 71)
- Causes sore throat, oral ulcer and vesicles on palms and soles of feet
Management:
- Conservative
- School exclusion not required
87
What are the features and management of immune thrombocytopenia (ITP)?
Features:
- Type II hypersensitvity reaction involving antibodies against the glycoprotein complex
- May follow infection or vaccination
- Presents as bruising/purpuric rash and epistaxis/gingival bleeding
Management:
- Supportive
- Avoid contact sports
- If plts very low or significant bleeding can give corticosteroids, IVIG or platelet transfusions
88
What are the features and management of Kawasaki disease?
Features:
- Type of vasculitis which can lead to coronary artery aneurysms
- Presents as high grade resistant fever, bright red lips, stawberry tongue, reddened palms and soles
Management:
- High dose aspirin (this is the only indication as it is usally contraindicated in children due to risk of Reyes syndrome)
- IVIG
- Echo
89
What is Reye's syndrome?
- A rare disorder causing swelling in the brain and liver
- Occurs following viral infection
- Can be precipitated by aspirin use
- NO CURE; focus is on preventing brain damage
90
What are the features and management of measles?
Features:
- RNA paramyxovirus spread by aerosol transdmission
- Characteristic koplik spots and maculopapular rash
- Prodrome of fever, irritability and conjunctivitis
Investigations:
- IgM antibodies
Management:
- Supportive
- Admit if pregnant/immunocompromised
- Notifiable disease
- Most common complications are otitis media and pneumonia
- Contacts should have MMR within 72h
91
What are the contraindications to MMR vaccination?
- Severe immunosuppression
- Allergy to neomycin
- Live vaccine in last 4 weeks
- Plan for pregnancy within 1 month
- IVIG within past 3 months
92
What are the features and management of roseola infantum?
Features:
- AKA sixth disease (HHV6)
- Causes high fever, maculopapular rash and nagayama spots (oral)
Management:
- Conservative
Complications:
- Aseptic meningitis
- Hepatitis
93
What are the different causes of nappy rash?
Irritant dermatitis:
- Most common cause
- Due to irritant effect of ammonia and faeces
- Creases are spared
Candida dermatitis:
- Erythematous rash involving the flexures
- Characteristic satellite lesions
- Manage with topical imidazole, cease barrier cream until settled
Seborrhoeic dermatitis:
- Erythematous rash with flakes
- Coexistent cradle cap
Psoriasis:
- Erythematous scaly rash
Atopic eczema:
Other areas of skin likely to be affected
Manage with barrier cream and mild steroid cream in severe cases
94
What are the features and management of scarlet fever?
Features:
- Reaction to erythrogenic toxicn produced by Group A strep (strep pyogenes)
- Respiratory transmission
- Presents with fever, malaise, sore throat, strawberry tongue, coarse pinhead rash on torso (SPARES PALMS AND SOLES)
Management:
- Oral pen V for 10 days
- Azithromycin if pen allergic
- Return to school 24h after starting abx
- Notifiable disease
Complications:
- Otitis media
- Rheumatic fever
- Acute glomerulonephritis
95
What are the features and management of chicken pox?
Features:
- Varicella zoster virus
- Presents with fever and papular/vesicular rash
Management:
- Calamine lotion
- School exclusion until lesions have crusted over
96
How should immunisations be given in premature babies?
According to chronological age ie. same as everyone else
If born before 28w, they should receive their first set of imms in hospital due to risk of apnoea
97
Which vaccination should be deferred in children with unstable neurological condition?
DTP- this is because the pertussis component can cause neurologic damage
98
What are the defintions of:
a) maternal mortality rate?
b) stillbirth rate?
c) neonatal death rate?
a) deaths in pregnancy, labour and 6 weeks after
b) babies born dead after 24 weeks
c) babies dying between 0-28 days
99
Which hearing test is done in newborn and infants?
Otoacoustic emission test
Do auditory brainstem response test if abnormal
100
Which hearing test is done at school entry?
Pure tone audiometry
101
What are the major risk factors for sudden infant death syndrome?
- Putting baby to sleep prone
- Parental smoking
- Prematurity
- Bed sharing
- Hyperthermia
102
How are threadworms managed?
- Diagnose by applying sellotape to perianal area and sending to lab
- Most patients are treated empirically with antihelminitic agent for all household members
- Mebendazole 1st line STAT
103
What are the IM doses for benpen for meningitis?
<1yrs - 300mg
1-10 years - 600mg
>10 years - 1200mg
104
What is an umbilical granuloma and how is it managed?
- Cherry red lesion surrounding umbilicus which may bleed or discharge
- Manage with application of salt or cauterise with silver nitrate
105
What is omphalitis and how is it managed?
- Bacterial infection of the umbilicus
- Usually staph aureus
- Treat with topical and systemic abx
106
What are the causes of snoring in children?
- Obesity
- Nasal problems
- Recurrent tonsillitis
- Down's syndrome
- Hypothyroidism
107
How is caffeine used in newborn babies?
As a respiratory stimulant to wean a neonate off a ventilator
108
How does shaken baby syndrome present?
Triad of:
1. Retinal haemorrhages
2. Subdural haematoma
3. Encephalopathy
109
What is a green stick fracture?
- Incomplete fracture, usually at the shaft of a long bone
- Caused by a bending-type mechanism of injury
110
What is a buckle fracture?
- AKA torus fracture
- Incomplete cortical disruption resulting in periosteal haematoma only
- Caused by compression force
111
What is a Salter Harris fracture?
- A type of fracture involving the epiphyseal plate (growth plate)
5 types:
S: straight across the epiphyseal plate (type 1)
A: above the plate (type 2)
L: lower than the plate (type 3)
T: transversing the plate (type 4)
ER: erasing the plate (type 5)
112
What conditions can cause pathological fractures in children?
Osteogenesis imperfecta:
- Defective osteoid formation due to inability to produce intercellular osteoid collagen and dentine
- XR shows translucent, wormian bones and multiple fractures
Osteopetrosis:
- Bones becomre harder and denser
- Autosomal recessive
- Marble bone on XR (cant differentiate between cortex and medulla)
113
How long should a child isolate from school with mumps?
5 days from onset of swollen glands
114
What is erythema toxicum neonatorum?
- Harless red vesiculopapular rash which appears on the skin of newborn
- Self-limiting with most lesions disappearing by 2 weeks of onset
115
What are the features of congenital hypothyroidism?
- Low thyroid due to an anatomic defect in the gland, an inborn error of thyroid metabolism or iodine deficiency
- Neonate is a 'good baby' (rarely cry, sleep lots)
- Lethargy, coarse facial features, hypotonic
- Umbilica hernia may be present
