Paediatrics Flashcards
1
Q
Name 5 signs/symptoms of anaphylaxis.
A
SOB wheeze/stridor hives/urticaria/wheal GI symptoms lightheadedness/LOC angioedema swelling of lips/tongue/throat
2
Q
what enzyme must you test 3 times to ensure it is anaphylaxis?
A
mast cell tryptase
3
Q
Name 3 drugs used in anaphylaxis.
A
adrenaline IM
chlorphenamine (antihistamine)
hydrocortisone
salbutamol
4
Q
Name 5 causes of altered consciousness.
A
FB head injury toxins electrolyte disturbance seizures infection tumour
5
Q
Name 3 features of raised ICP
A
LOC vomiting abnormal resp pattern HTN and bradycardia (cushings reflex) bulging fontanelle unequal/unreactive pupils papilloedema
6
Q
name 3 CI of an LP.
A
raised ICP bleeding tendency focal neurology reduced consciousness (i.e. low GCS) shock
7
Q
What is the last drug of choice in status epilepticus after midazolam and lorazepam have been given?
A
IV pheytoin
8
Q
Name 3 causes of status epilepticus.
A
epilepsy
fever
head trauma
CNS infection
9
Q
Name 6 features of meningitis.
A
brudzinskis (neck flexion causing flexion of lower limb) kernigs (supine with hip flexed-cannot extend knee) fever headache vomiting photophobia neck stiffness pain petechial rash
10
Q
What ix would you do if you suspect meningitis?
A
LP
FBC, U&E, co-ag screen, LFT, clotting, glucose, CRP, PCR
nasal wabs
11
Q
Name 3 meds used in mx of meningitis.
A
IV ceftriaxone
dexamethasone
IV cefotaxime+amoxicillin
12
Q
Name 3 long term comps of meningitis.
A
hearing loss
epilepsy
cognitive defecit
13
Q
Name the triad of symptoms seen in encephalitis.
A
headache
altered mental state
fever
seizures
14
Q
What is the rx of choice in encephalitis?
A
IV aciclovir
15
Q
In paeds sepsis, if normal physiological parameters not restored after 2 500ml boluses, what should you give?
A
adrenaline
16
Q
Name 8 causes of collapse.
A
hypoglycaemia breath holding vasovagal/situational syncope arrhythmia carotid sinus hypersensitivity drugs hypovolaemia heart condition (HOCM, stenosis) seizure head injury
17
Q
How do kids present with congenital heart defects? 3 words
A
failure to thrive
18
Q
Name 3 RF if congenital heart disease in child.
A
smoking alcohol Downs (genetic) FH toxins infection
19
Q
How do you treat HF in child?
A
correct defect causing it
diuretics
20
Q
Where do you hear a VSD murmur and what kind of murmur is it?
A
lower left sternal edge
pansystolic murmur
21
Q
What is the mx of coarctation of aorta? When is it most dangerous in child?
A
balloon catheter dilation
worse when occurs proximal to ductus arteriosus
22
Q
Describe the murmur of patent DA.
A
continuous machinery murmur
23
Q
What med is used to promote closure of patent DA?
A
indomethacin
24
Q
In tetralogy of fallot, which defect determines the degree of cyanosis?
A
pulm stenosis
25
How do infants with tetralogy of fallot present?
```
cyanosis and clubbing
HF and failure to thrive
exertional dyspnoea
boot shaped heart on CXR
ejection systolic murmur due to pulm stenosis
```
26
Name 2 mx options in tetralogy of fallot.
surgery
| prostaglandins (ensures patency of DA so blood can become oxygenated by lungs)
27
Which heart defect is not compatible with life and what 3 things need to be present to reduce effects of this condition?
transposition of great arteries
| need ASD, VSD or PDA
28
Which heart condition requires palliative or heart transplant as the treatment due to sx such as cyanosis and collapse soon after being born?
hypoplastic left heart
29
What heart condition is most likely to occur with lithium exposure in utero?
ebsteins anomaly (low tricuspid=big RA, small RV)
30
How do you treat eisenmengers syndrome?
heart lung transplant
31
What complication of a heart defect may cause haemoptysis and embolus formation?
eisenmenger syndrome
32
Which genetic condition is associated with:
a) VSD (3)
b) Aortic stenosis (1)
c) ASD (1)
d) Pulm stenosis (1)
e) CoA (1)
a) Patau (13), Edwards (18), Downs (21)
b) Williams
c) Downs
d) Noonans
e) Turners
33
Name 3 features of innocent murmurs
Systolic, soft, short, positional, no radiation
34
Which 3 conditions require R to L flow through DA?
hypoplastic left heart
aortic stenosis
CoA
35
Which 3 conditions require L to R flow through DA?
pulm stenosis
tricuspid atresia
pulm atresia
36
What is total anomolous pulm venous return?
pulm a drain into RA instead of LA!! bonkers
37
Name some signs and sx of respiratory distress.
```
Use of accesory muscles
tachypnoea
recession
nasal flaring
grunting
head bobbing
tripoding
cyanosis
```
38
Name 4 causes of wheeze.
asthma
bronchiolitis
FB
viral wheeze
39
Name 4 causes of stridor.
```
FB
croup
epiglottitis
peritonsillar abscess
laryngomalacia
vocal cord dysfunction
anaphylaxis
```
40
Name 2 conditions worse on lying down.
GORD
| Post nasal drip
41
Name 3 cough red flags.
haemoptysis
failure to thrive
weight loss
sudden
42
Name 2 symptoms seen in OSA. Name 3 causes. Name 3 treatments.
snoring, grumpy, dry cracked lips/mouth, sleep disturbance, ENT infection
Adenotonsillar hypertrophy, obesity, craniofacial abnormality
Weight loss, removal of adenoids, CPAP
43
Name 2 features seen in a newborn with CF.
meconium ileus
| failure to thrive
44
Why might you be able to feel a RIF mass in CF? Explain.
Stuck faeces at ileocaecal junction
| due to lack of pancreatic enzymes, thick mucous and reduced chloride secretion
45
Why do children present with recurrent chest infections in CF?
thickened stagnant mucous, bacterial colonisation
46
What is the lung function pattern in CF?
obstructive
47
How does CF affect the pancreas?
can cause acute and chronic pancreatitis and diabetes due to lack of insulin
this is all due to mucus plugging causing local inflammation within the pancreas
48
What resp condition can occur from recurrent bact infection?
bronchiectasis
49
Name 3 non resp/GI comps of CF.
male infertility
finger clubbing
nasal polyps
allergic pulm aspergillosis
50
What enzyme is being looked for in CF testing in newborn? What is the sweat test looking for?
immunoreactive trypsinogen
| high levels of Cl-
51
Name 3 mx strategies for CF.
Resp: chest physio, mucolytics, inhalers, lung transplant
Pancreas: replace enzyme (creon), vits and inc calorie intake
52
Name 2 sx that require step up in mx of asthma.
use of inhaler >3x a week
| nocturnal symptoms
53
Name the 6 steps of paeds asthma mx.
```
SABA
SABA+ICS
ICS+LTRA
ICS+LABA
MART (ICS+LABA in one)
MART with inc ICS dose
Refer
```
54
Name 2 common bacterial and 2 common viral causes of pneumonia.
Bact-strep pneumonia, mycoplasma
| Viral-RSV, influenza
55
Name 3 features seen on examination of pneumonia.
```
sats low
high fever
dullness on percussion
inc RR
bronchial breathing
crackles
```
56
Name 3 mx of pneumonia.
alternate paracetemol and ibuprofen
good fluid intake
Abx- amoxicillin
57
Name 4 comps of pneumonia.
pleural effusion
empyema
abscess
sepsis
58
Name 4 sx of bronchiolitis. By which age do most children have it by?
```
coryzal sx
cough
wheeze/crackles
tachypnoea
recession
```
most have by 2 years old
59
What is bronchiolitis caused by?
RSV
60
How do you treat bronchiolitis:
a) at home
b) in hospital
c) high risk pts
a) fluids, meds to reduce temp, feeding
b) oxygen, fluids, NG tube, antivirals (ribavirin)
c) palivizumab
61
What is a viral wheeze? How do you treat?
wheeze caused by viral URTI
salb through spacer
62
Which virus causes most presentations of croup?
parainfluenza virus
63
Name 3 features of croup.
barking cough
fever
stridor
resp distress
64
Name 4 mx steps of croup.
paracetamol and ibuprofen
dexamethasone
o2 and adrenaline nebs if dex unsuccessful
65
Name 4 ddx of croup.
epiglottitis
FB
quinsy
anaphylaxis
66
Name 3 features of epiglottitis.
```
hot potato voice
high fever
drooling of saliva/cant swallow
extreme stridor
Appear v unwell
```
67
Name 2 mx options of epiglottitis
intubation/tracheostomy
| oral/IV abx
68
Name 2 congenital throat problems that may compromise breathing.
laryngomalacia
| subglottic stenosis
69
What is the most common cause of the common cold?
rhinovirus
70
Name 3 features of common cold.
post nasal drip
coughing
sneezing
blocked nose
71
How do you treat common cold?
honey and lemon
fluids
ibuprofen and paracetamol
72
Name a common viral cause of tonsillitis/pharyngitis.
EBV
73
Name 3 features of tonsillitis/pharyngitis.
```
sore throat
difficulty swallowing
lymphadenopathy
fever
headache
abdo pain
```
74
How do you treat tonsillitis/pharyngitis?
usually self limiting
| if bacterial: phenoxymethylpenicillin
75
Name 3 comps of tonsillitis/pharyngitis.
otitis media
rheumatic fever
quinsy
76
Name 2 bacterial causes of otitis media.
H influenza
| Strep pneumoniae
77
Name 3 features of otitis media.
hearing loss
fever
ear pain
78
Explain what you would see on otoscopy with otitis media.
red inflamed TM with loss of light reflex
79
If otitis media unresolving after 4 days, what abx should be given?
amoxicillin
80
Name 4 comps of otitis media.
TM perforation
mastoiditis
meningitis
facial nerve palsy
81
Name 3 features of acute sinusitis.
unresolving cold
facial pain/ache
nasal speech
mouth breathing
82
Name 2 common bacterial causes of acute sinusitis.
strep pneum
| H Influenza
83
If sinusitis unresolved after 5 days, what abx can you give?
amoxicillin
84
Name 2 comps of sinusitis.
orbital cellulitis
| meningitis
85
Name 4 features of centor/fever pain criteria.
fever
tonsillar exudate
lymphadenopathy
no cough
86
What condition can cause glue ear?
adenoid hypertrophy-blocks ET
87
Which condition caused by bordatella pertussis is a notifiable disease?
whooping cough (levels reduced due to vaccine)
88
Name 3 sx of whooping cough.
hacking cough
vomiting
choking/gasping/SOB
89
How do you detect whooping cough?
nasopharyngeal aspirate/swab
90
How do you treat?
supportive+abx azithromycin
91
Name 3 comps of whooping cough.
seizures
pneumonia
conjunctival haemorrhage
92
What are children at risk of if given aspirin?
reyes syndrome
93
Name:
a) 4 causes of vomiting in children
b) 3 causes of vomiting in infant/toddler
a) gastroenteritis, viral infection, constipation, appendicitis
b) intusucception, pyloric stenosis, malrotation/volvulus
beware of cranial signs, urinary or FB signs
94
What is the commonest cause of diarrhoea in children?
viral infection
95
What antibodies are you testing for in coeliac?
TTG-IgA THEN
| endomysial antibodies
96
What protein is tested for to detect IBD?
faecal calprotectin
97
A 2 y/o child with diarrhoea and NO other symptoms-Dx?
toddlers diarrhoea-support with high fat foods, reduced milk and sugar
98
Name 3 causes of constipation in first few weeks of life.
```
hirshprungs disease
anorectal malformation
spinal
thyroid
cows milk allergy
```
99
Name the order of laxative agents given in constipation.
1. Movicol (osmotic)
2. Senna (stimulant)
3. Lactulose (osmotic)
100
Name 3 causes of acute abdo pain:
a) medical cause
b) surgical cause
c) other
a) UTI, constipation, gastroenteritis
b) intusucception, volvulus, hirschprungs, hernia, appendicitis, torsion
c) DKA, IBD, mesenteric lymphadenitis
101
Name 4 causes of chronic abdo pain.
abdo migraine
post prandial pain syndrome
IBS
epigastric pain syndrome
102
What medication is used in IBS and what does it do?
mebevarine-prevents bloating and crampy pain as an antispasmodic
103
What do you see on USS of intussusception?
target sign
104
Name 3 features of intussusception.
Pallor, shock, peritonitic bowel obstruction
sausage shaped mass felt on palpation
bilious vomiting
105
Name 3 mx steps of intussusception.
1) support: IV fluids, analgesia, NG tube, abx
2) Rectal air insufflation
3) If air unsuccessful, then surgery
106
How does hirschprungs disease present?
bowel obstruction-no peristalsis, abdo distension. vomiting, bloody stools
First 24hrs of life-failure to pass meconium
107
Name 2 groups likely to be affected by hirschprungs.
familial
| downs pts
108
How do you ix for hirschprungs? How do you rx?
biopsy suspected bowel
| remove surgically
109
How do you treat GORD?
1. thickened feeds, sit infant upright, small frequent feeds, no food before sleeping
2. Gaviscon (alginate prep), omeprazole, ranitidine
3. Surgery-nissen fundoplication
110
what is dysentry?
infection of intestines leading to watery diarrhoea with blood and pus in faeces
111
What can you feel on palpation in pyloric stenosis?
olive shaped mass of pylorus upper right of umbilicus
112
Name 3 steps in managing pyloric stenosis.
1. rehydrate IV fluids, NG tube to remove stomach contents
| 2. ramstedts pyloromyotomy
113
Name 3 features of malrotation+volvulus.
shock
bile stained vomit
abdo distention and tenderness
114
Name sign seen on AXR in volvulus.
double bubble (one from duodenum and one from stomach)
115
Name 2 signs seen on contrast AXR in volvulus.
```
corkscrew duodenum
birds peak (narrowing seen from blockage)
```
116
What is the name of the definitive treatment used in volvulus if bowel is still viable? What is done if it is not?
a) Ladd's procedure (snip through ladds bands to release malrotation
b) remove bowel and put on permanent IV feeds
117
How does a neonate present who has a diaphragmatic hernia?
resp distress
118
Name 3 comps of diaphragmatic hernia.
chronic lung disease
GORD
brain injury due to hypoxia
119
A lack of fusion of what causes a scrotal hernia?
processus vaginalis
120
When does an inguinal hernia require urgent surgery?
if presents less than a year of age
121
Name 3 complications of appendicitis.
abscess
perforation
peritonitis
122
Name 2 signs on examination in a pt with appendicitis.
rebound tenderness
rosvings sign +ve
psoas sign (flexion
123
what does rebound tenderness indicate?
perotinitic involvement and often peritonitis
124
what 2 things may psoas sign +ve indicate?
appendicitis
| psoas abscess
125
Name 3 causes of appendicitis.
overgrowth of gut bacteria
blockage of lumen
stasis
126
Where is mcburneys point?
2/3 from umbilicus to ASIS
127
Name 3 symptoms of colic.
```
drawing up of knees
normal weight gain
inconsollable high pitched crying
3hrs crying
3days a week
3week
```
128
How much fluid /kg should be given to a child who is dehydrated?
20ml/kg
129
Name 3 indications for a CT head in head injury.
```
LOC for>5mins
amnesia>5mins
drowsiness/vomiting
NAI
Seizure
low GCS
Signs of basal skull
focal neuro deficit
```
130
which kind of haemorrhage affects middle meningeal a.?
extradural
131
Which brain haemorrhage usually occurs in trauma with acute onset? What kind of interval occurs?
```
extradural
lucid interval (regain consciousness before losing it again)
```
132
Name 3 comps of brain injury.
infection
seizure
raised ICP
133
How many headache attacks are needed before a child is diagnosed with migraines?
5
134
Name some sx of childhood migraine.
tiredness
abdo pain
vomiting
visual aura
135
Name 3 non pharma and 3 pharma treatments for migraine.
Non- trigger diary, sleep, diet
| Pharm- ibuprofen, sumatriptan, propranolol
136
Name 3 presentations after birth in a baby with cerebral palsy.
```
low APGAR score
floppy
delayed milestones
hand preference before age of 1
toe walking
feeding difficulty
```
137
Name 3 rx for cerebral palsy.
braces
surgery-cut nerves, straighten bones
OT, PT
botox injections
138
If unsure whether pt has allergy, what test can be done?
skin prick
139
Name a commonly used antihistamine in allergy.
cetirizine
140
How do you treat cows milk protein allergy?
have hydrolysed formula then cows milk free diet
141
Name the abx used in bact conjunctivitis.
chloramphenicol eye drops
142
What colour are the plaques in impetigo?
honey colour
143
Name 1 comp of impetigo.
cellulitis
144
What bacteria is impetigo caused by (name 2)? WHat abx is used to treat? Name 3 other mx strategies.
S. aureus and strep pyogenes
Fusidic acid topical
Keep clean with soap and water, dont share towels, avoid school until lesions crusted over or on abx
145
What virus is chicken pox caused by?
varicella zoster
146
Name 3 features of chicken pox.
spread by respiratory route
Fever for up 2 4 days
then maculopapular>vesicular rash (starts on head and trunk)
147
Name 3 comps of chicken pox.
pneumonia
cellulitis
encephalitis
148
What do you give to:
a) neonate/immunocompromised who has been exposed to chicken pox
b) has chicken pox
a) VZIM (varicella zoster immunoglobulin)
| b) aciclovir
149
What virus causes koplik spots to form and what are they?
measles
| white spots on gums in mouth
150
Is measles a notifiable or non notifiable disease?
notifiable
151
Which viral rash do you get conjunctivitis in?
measles
152
Where do you get lymphadenopathy in rubella?
sub occipital
| post auricular
153
What do you call the rash seen in erythema infectiosum/fifth disease? What virus is it caused by?
slapped cheek
| parvovirus B19
154
What virus causes roseola infantum? What common feature occurs with this disease?
human herpes virus 6
| febrile convulsions
155
How do you describe the rash seen in scarlet fever? How do you describe the tongue? What areas of body are spared by rash?
sandpaper rash
strawberry tongue
palms face and soles of feet
156
What abx is given in scarlet fever?
penicillin
157
What disease does the virus coxsackie A16 cause?
hand foot and mouth disease
158
Name 4 features of orbital cellulitis that distinguishes it from preseptal/periorbital cellulitis.
proptosis
opthalmoplegia
blurred vision and dec acuity
diplopia
159
Name the abx for:
a) periorbital
b) orbital
cellulitis
a) oral co amoxiclav
| b) IV cefotaxime/flucloxicillin
160
What ix is done in orbital cellulitis?
CT of face
161
Which disease presents with:
- extremely high fever that doesn't go away
- conjunctival redness
- strawberry tongue
- trunk rash with red soles and palms
- cervical lymphadenopathy
kawasaki disease
162
What ix can be done in those <2y/o to detect for vesicoureteric reflex.
micturating cystourethrogram
163
Name 3 mx strategies of vesicoureteric reflux.
self resolving so give prophylactic abx
Surgery:
-make a valve
-reposition ureters
164
By which age do most children achieve dryness and stop bed wetting?
3-4years old
165
Name 4 mx steps in enuresis.
1. Correct fluid intake, toilet regularly, reward for using toilet before bed
2. Enuresis alarm
3. Desmopressin
4. Refer to specialist
166
```
What must you do at:
a) 3months
b) 6months
c) 1year
with undescended testes
```
a) referral
b) seen by surgeon
c) surgery performed
167
What is the name of the surgery that moves a testicle to the correct location, in the scrotum?
orchidopexy
168
Name 3 ix done in haematuria.
```
urine dip
cystoscopy
FBC-eGFR, clotting and PCR
Abdo exam for masses
BP
USS
```
169
Name 3 features of HSP. How do you rx?
```
follows infection or vaccine:
p/w
-fever
-joint pain
-rash
-renal involvement
```
self limiting so supportive
170
why are you at risk of thromboembolism in nephrotic syndrome?
lipid and AT3 usually bound to albumin so if albumin lost to urine, then more free levels of antithrombin 3 in blood
171
When do children get ITP?
usually post viral/vaccines and is acute and self resolving
172
if symptomatic (e.g. purpura) in ITP, with low platelet count, what 2 meds can be given?
corticosteroids-pred
IVIG (stops destruction of platelets)
If unsuccessful, splenectomy/platelet infusion
173
What condition presents with small stature,small head and fontal bossing?
fanconi syndrome
174
Name 4 RF for DDH.
```
female
breech
high birth weight
FH
first born
```
175
Name 2 tests used to detect DDH and explain each.
Barlow-attempt to dislocate hip (adduct and push posterior)
| ortalani-relocate hip (abduct and pull anterior)
176
What ix is done if DDH is suspected
USS
| x ray if over 4.5months
177
If >6weeks but <5months with DDH, what mx can be done?
pavlik harness
| if older, may need surgery
178
Name 2 xray changes in perthes disease.
flattened femoral head
| widening of joint space
179
What mx options are there for perthes?
casts
braces
surgery
180
What main ix can detect osteomyelitis? What is the main ix for septic arthritis?
bone culture/biopsy
aspiration of synovial fluid
181
What is the mx of osteomyelitis?
surgical debridement
| 5weeks flucloxacillin
182
What is the mx of septic arthritis?
surgical drainage+IV fluclox
183
When do children most commonly get transient synovitis?
post viral infection
184
What is the mx of trans synovitis?
nothing, self limiting after few weeks
185
Which direction does a SUFE go?
post and inferior
186
Name 4 causes of rickets.
lack of absorption (coeliac, IBD)
renal prob
liver prob
lack of dietary intake
187
Name 2 mx meds for rickets.
calciferol
| calcium supplements
188
Name 3 manifestations of downs.
```
cardiac defects
hypothyroidism
dislocations
duodenal atresia
learning difficulty/developmental delay
resp infection
```
189
What chromosome abnormality occurs in turners?
lack of x chromosome so 45X instead of 46XX
190
Name 3 manifestations of turners.
ovarian failure
horseshoe kidney
CoA
AI disease (thyroid, coeliac, IBD)
191
Name 3 comps of having duchennes muscular dystrophy.
resp difficulty-cannot breathe well, cannot couhg leading to infection
cardiac-congestive failure and arrhythmia
GI-pseudoobstruction
tend to end up in wheelchair-shortened life expectancy
192
What can carbmizole use during pregnancy lead to?
transient hypothyroidism
193
Name 5 complications of prematurity.
```
intraventricualr haemorrhage
retinopathy of prematurity
jaundice
iron deficiency anaemia
infection
NEC
resp-pneumothorax, RDS
PDA
hypothermia
hypoglycaemia/calcemia
```
194
What is RDS due to a lack of?
surfactant
195
Name 3 mx steps of RDS.
Oxygen and ventilate with ET tube
Give surfactant through tube
Give mother dexamethasone 48hrs before delivery
196
Name 3 features of nec.
abdo distention
bilious vomiting
feeding difficulty
bloody stools
197
Name 3 ddx of NEC.
intussusception
malrotation/volvulus
haemolytic disease
meconium ileus (usually due to CF)
198
Name 3 mx steps of NEC.
NG tube
IV fluids and TPN
Abx (gent+metro)
199
Name 3 comps of NEC.
sepsis
perforation
DIC
short bowel syndrome
200
What causes retinopathy of premuturity?
reoxygenation after hypoxia-proliferation of vessels
201
Name a comp of retinopathy of prematurity.
blindness
| retinal detachment
202
Name mx option of retinopathy of prematurity.
laser photocoagulation
203
Name 2 causes of jaundice when it occurs:
a) <2 days
b) 2-14days
c) >14 days
a) haemolytic (G6PD, rhesus HDN, spherocytosis), infection
b) physiological-breast milk jaundice, immature liver causing slow breakdown of RBC
c) cong hypothyroidism, biliary atresia, galactosaemia,
204
Name 2 rx of jaundice.
phototherapy
| or transfusion if severe
205
Name serious comp of jaundice-give specific name.
kernicterus-bilirubin crosses BBB causing coma, seizure, neurological signs
206
Name 4 RF of GBS.
maternal pyrexia
prev baby had it
PROM
prematurity
207
What serious infection in mother can cause neonatal seizures, critical illness and meningoencephalitis? What is the treatment?
```
herpes simplex (genital herpes)
IV aciclovir
```
208
What is the first thing you do in paediatric BLS?
5 rescue breaths
