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Specialities > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are some clinical signs of respiratory distress?

A

Grunting
- exhaling against a partially closed glottis

Stridor

Nasal flaring

Trachael tug

Intercostal recession

Paradoxical breathing
- seesaw movement

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2
Q

When should prematurity be corrected on a growth chart till?

A

2 years

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3
Q

How much weight can a baby loose after born which is normal and what are the normal weight increases expected?

A

10% loss of birthweight in first 10 days is acceptable.

Weight should double by 4 months and tripled by 1 year.

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4
Q

When is puberty said to have begun in males?

A

When testes reach 4ml

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5
Q

What is the term for puberty starting early? and how should it be investigated?

A

Precocious puberty

  • females <8 years
  • Males <9 years

Central causes: normal puberty happening too early:

  • intracranial tumour
  • familial

Peripheral causes:

  • Adrenal tumour
  • McCune-Albright syndrome

Investigations:

  • Brain MRI (for pituitary tumours causing GnRH realise)
  • USS of ovaries and testes (ovarian/ testicular tumours causing hormones)
  • wrist x-ray to assess if it is affecting the bone maturity
  • endocrine - hormones and GnRH
  • Urine steroid profile (for adrenal tumours)
  • TFTs (hypothyroidism can induce early puberty)
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6
Q

Highlight key motor skill milestones and red flags:

A

6 week: head control

6m: sit up right with support

9 -10m: crawling sit up right unsupported

12m: cruise walk
18m: walking

2 y: running

Red flags:

  • 6m no head control
  • 12 month no sitting unsupported
  • 18 month not walking
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7
Q

Highlight key fine motor skills and visual skills milestones and red flags:

A

3m: holds objects in palm
6m: transfer objects
9m: immature pincer grip
12m: mature pincer grip
18m: stack bricks

2 years: draw line

3 years: draw circle

Red flags:
- 5m does not hold object in hand

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8
Q

Highlight some key speech and language skill milestones and red flags:

A

3m: turns to sound

3-6: makes sounds

9m: Double syllable (mama, dada)
12m: Responds to name

12-15 months - 2-6 words

2 year: links words

4 years: - speaking

Red flags:
3m: no response to sound
9m: no babble
<2-6 words 18 months

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9
Q

List some key social skill milestones and red flags:

A

6w: smile
3m: laugh
9m: waves/ stranger danger
12m: Plays peak a boo
18m: spoon feeds
3year: dresses and toilet trained

Red flags:

  • 12 month: no gestures
  • 18 months: no play
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10
Q

Where might you find information about the childs immunisations, birth weight ete (something that should be asked for during every consultation):

A

Red book

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11
Q

What is a key thing in the history that suggests the pregnancy was normal?

A

If the baby stayed with mum after delivery

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12
Q

What is the important pulse to feel for in children?

A

Femoral pulse

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13
Q

What is an effective way of working out the constitutional height of a child i.e working out how tall they will be?

A

Mid-parental height:

Males:
[Fathers height + mothers] + 13 / 2

Females:
[Father’s height + Mothers] - 13 / 2

*normal range is +/- 10 cm

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14
Q

In children what is considered obese?

A

> 95th centile

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15
Q

What is the definition of a short stature?

A

2 standard deviation below or 2nd centile for someone their age and sex

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16
Q

Which hormones promotes the fusion of the epiphyseal in children?

A

Estrogen

Aromatase of testosterone and production of oestrogen in both sexes promotes the fusion of the epiphyseal plates.

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17
Q

Growth spurts are controlled by different hormones at different stages of life - what are they:

A

Infantile stage 0-2 years:

  • Growth Hormone
  • Insulin

Childhood phase 2 - pubertal years:

  • Growth Hormone
  • Thyroxine

Puberty:

  • Sex hormones
  • Growth hormone
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18
Q

List some investigations to be done into delayed puberty:

A

Bloods:

  • FBC
  • LH and FSH
  • Serum prolactin
  • IGF-1 levels
  • Celiac screen

Imaging:

  • MRI of brain
  • Wrist x-ray
  • Pelvis Ultrasound scan
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19
Q

What is the definition of delayed puberty:

A

Females:

  • 13 years old
  • Failure of Tanner stage 2

Males:

  • 14 years old
  • Testes <4ml
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20
Q

What are some causes for short stature?

A

Normal genetically short

Constitutional delay

Intrauterine growth restriction

Dysmorphic syndromes
- Down’s, - Turner’s

Skeletal dysplasia

Chronic system disease
- IBD, - CKD, Cystic fibrosis

Endocrine disorders

Social circumstances
- very poor social situations

Medication
- Steroids

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21
Q

What should the neck position be in infants and children undergoing resuscitation?

A

Neutral position in infants, with very slight extension

Children: sniffing position with chin lift

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22
Q

What organism is responsible for croup and how should it be managed?

A

Parainfluenza

Management:

  • Oxygen
  • Nebulised adrenaline 5ml 1:1000
  • Corticosteroids - dexamethasone (oral if mild)
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23
Q

How is Bronchiolitis diagnosed? and what is the causative agent?

A

Nasopharyngeal Aspirate for RSV testing

RSV

24
Q

what are some of the symptoms and How is whooping cough diagnosed, treated and what are some complications:

A

Symptoms:

  • Bouts of coughing fits - especially during the night
  • inspiratory whoop
  • subconjunctiva haemorrhage
  • spells of apnoea
  • may vomit at end coughing
  • absolute lymphocytosis may be seen

Diagnosed:

  • Nasal swab culture
  • PCR

Treatment:

  • notify public health
  • Macrolides within <21 says
  • Family prophylaxis

*prophylactic antibiotics for family members

Complications:

  • pneumothorax
  • bronchiectasis
  • seizures
  • can last for 100 days
25
Q

Which condition is associated with micrognathia, posterior tongue displacement and cleft palate?

A

Pierre- Robin syndrome

26
Q

Which condition is associated with short stature, webbed neck, over friendly and supraclavicular aortic stenosis? and what kind of face are the described as having?

A

William’s Syndrome

Elf like face

27
Q

What condition is associated with micrognathia, low set ears, short stature, overlapping digits and rocker bottom feet?

A

Edward’s Syndrome

28
Q

What are some of the clinical findings of a child with Patau syndrome:

A 
Microcephaly - with skin lesions on head 
Microopathamia 
Polydactyly 
Cleft lip 
Rocker bottom feet

Cyclopia - severe
Elephant trunk nose

29
Q

What are some complications of Down’s syndrome which may affect the child immediately or affect development?

A

Congenital heart disease
- AVSD

Cataracts

Hypotonia

  • affect ability to feed
  • delay in milestones

Intestinal atresia

Thyroid dysfunction

Hearing loss

Developmental impairment

  • in the milestones
  • leading to learning disabilites
30
Q

What health checks are recommended for children with Down’s syndrome?

A

Thyroid tests

Eye checks

Hearing checks

Growth monitoring
- have their own chart

Heart checks

Breathing checks

Blood checks

31
Q

Following a bronchoscopy sample, why might there by lipid laden macrophages?

A

Due to aspiration of milk

32
Q

What symptoms would make one think it is NOT asthma:

A

Cough only when its cold/ following viral infection

Moist cough/ productive

Signs of finger clubbing (likely something else is going on)

33
Q

What is the FEV1 post bronchodilator change that is diagnostic in children?

A

> 12% change

34
Q

What are the typical symptoms of bronchiolitis?

A

Dry Cough
Fever - mild
Coryzal symptoms
Poor feeding

Findings:

  • Dyspnoea
  • Wheeze
  • Bilateral findings
  • Heading bobbing
  • Subcostal recession

Diagnosis:
- Nasal-pharyngeal aspirate for virology

Management:
- oxygen
- fluids (try NG first)
+/- nebulised saline/ salbutamol

*continual monitoring

35
Q

What samples are needed for suspected TB in a child?

A

3x early morning sputum samples
or
Gastric aspiration

*gastric aspiration is in young children because they will have swallowed respiratory secretions from the night before.

36
Q

What is the chromosome affect in cystic fibrosis and and what is the carrier rate?

A

Chromosome 7
- F508

1/20 are carriers

37
Q

How is cystic fibrosis now diagnosed?

A

Guthrie blood spot test:
Immunoreactive trypsinogen
- can be diagnosed within 3 weeks

*trypsinogen is released into the blood because of blocked pancreatic ducts.

This is followed on with a sweat test

  • Pilocarpine Iontophoresis (makes one sweat)
  • > 60mmol/l of Chloride
  • 100mg of sweat

*following from this there is usually specific genetic testing such as F508 deletion testing

38
Q

What are some signs that a child may have cystic fibrosis which hasn’t been picked up? i.e. they have come from a country where screening is not done:

A

Meconium ileus

Nasal polyps

Distal small bowel obstruction
- occurs in 10%

Failure to thrive

Delayed puberty

Recurrent chest infections

Signs of Cor pulmonale

39
Q

What is the management of cystic fibrosis?

A

Chest physiotherapy x2

Good nutrition

  • NG tube
  • Gastrostomy

Pancreatic enzymes supplements + vitamins

Prophylactic antibiotics
+
IV antibiotics for infection

40
Q

What signs may you see of someone with Primary ciliary dyskinesia?

A

Dextrocardia
or even
- situs inversus (all organs on wrong side)

41
Q

What factors are taken into account that determine your lung function?

A

Height
Sex
Age
Ethnicity

42
Q

List some causes of obstructive lung disease in children:

A

Asthma

Bronchiolitis

Cystic fibrosis

Primary ciliary dyskineasia

43
Q

What are some causes of restrictive lung disease in children?

A

Scoliosis

Neuromuscular disease
- Duchenne muscular

Pulmonary fibrosis

  • *if a restrictive pattern is seen further investigations should be done which include:
  • transfer factor
  • High resolution CT
44
Q

What are some bronchial challenge testing that are done to diagnose asthma?

A

6 minute exercise challenge

Histamine provocation

Mannitol challenge test

45
Q

What is the condition called which results in inflammation of the foreskin in children and how is it treated?

A

Balanitis

Oral fluids to rehydrate
Genital retraction back of foreskin
+/-
Antibiotics

*complications can be cellulitis

46
Q

What is the condition called where there is increasing scarring of the foreskin and how is it treated and why?

A

Balanitis Xerotica Obliterans

Treatment:
- circumcision

*treated because it can cause meatal stenosis

47
Q

What is the most common cause of acute scrotum in a young child?

A

Torsion of the epididymal appendage

48
Q

List some other causes of acute scrotum in children:

A

Henock Schonlein Puprura
- can induce swelling of testes

Idiopathic scrotal oedema

  • not painful just discomfort
  • 7-8 years in summer
  • settles within 24 hours
49
Q

What is the formula for working out the predicted functional bladder capacity?

A

(age x 30) + 30

50
Q

What is the most common organism to cause meningitis in neonates?

A

Strep Agalactiae

  • group B strep.
    in first 48 hours this is from the mother
51
Q

Name two clinical signs that may be seen in a child with meningism:

A

Brudzinski sign:
- bending the neck causes the legs to flex

Kernig sign:
- flexing the hip causes neck pain and forces the leg to flex

52
Q

How can the child’s projected adult height be worked out?

A

Calculated working out the mid-parental height.

Girls:
(Father’s height + Mother’s Height) - 13 / 2

Boys:
(Father’s height + Mother’s Height)+13/ 2

+/- 10cm is normal

53
Q

List some causes of short stature:

A

Familial

Delayed puberty

Growth hormone deficiency

  • primary
  • acquired (tumour, iatrogenic, trauma, radiation)

Hypothyroidism

Corticosteroid use

Chronic illness

Nutritional deficiency

54
Q

How can the size of the testes help point to the origins of the cause of precious puberty in males?

A

Bilateral large testes = central cause

Unilateral large teste = testicular tumour

Bilaterally small testes = adrenal cause, hyperplasia or tumour

55
Q

What is the most common cause of painless PR bleeding in a child between 1-2 years old?

A

Merkel’s diverticulum

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